ACT UP: AIDS should have been bigger TDCJ Sunset focus

As prison healthcare costs continue to spiral out of control, it's becoming clear that keeping inmates healthy isn't just a cause for liberal do-gooders. Since many inmates today are serving decades-long sentences and taxpayers must fork over for their care, it also makes good economic sense.

Earlier I reported on what was in the Sunset Commission report for the Texas Department of Criminal Justice. Here's more from the Austin Chronicle ("Naked City," Oct. 20) on a big issue that wasn't discussed - skyrocketing medical costs related to AIDS treatment and policy recommendations to prevent HIV transmission among prisoners:

The Austin chapter of the nonpartisan AIDS Coalition to Unleash Power, or ACT UP (www.actupaustin.org), which aims to end the spread of the disease, blasted the state's Sunset Commission on Oct. 17, for its failure to address substantive HIV/AIDS prevention and education in its report on the Texas Department of Criminal Justice. The report mentions the disease just once in its 174 pages, even though TDCJ inmates have rates of HIV infection five times higher than the general public, making the disease the No. 1 killer of Texas inmates.

It's long been known that prisons are incubators for HIV, Hep C, and a variety of sexually transmitted diseases. But I've never seen that statistic - that AIDS is the #1 killer of Texas inmates. (Honestly I'd have thought #1 would be other inmates, perhaps followed by staph infections - now that I think of it, I've never seen a ranked list of causes of death inside Texas prisons. Anybody?) In any event, HIV is a big medical cost driver for TDCJ. According to this fact sheet from ACT-UP:

Each new case of HIV disease will cost more than $300,000 to treat over the person’s lifetime, with annual per capita expenditures ranging from $14,000 to $35,000 depending on stage of the disease. Furthermore, these expenditures have been gradually rising as pharmaceutical prices and new drug options increase. For new infections among offenders, even after release, nearly all this expense will be borne by Texas taxpayers. Even though only about 1.7% of Texas state prison inmates are known to be HIV infected, more than 40% of the pharmaceutical budget of the correctional managed health care contracts is spent on HIV-related medications.

Forty percent of the TDCJ pharmacy bill is a lot of scratch! Anybody looking to reduce inmate medical costs would almost by definition need to start there to have much impact.

The solutions for preventing spread of HIV in prison are pretty obvious: Sex and needles are the reason the disease spreads, so condom distribution and clean, in-house tattoo parlors would dramatically reduce its prevalence. It may be against the rules, but the bottom line is that prisoners have sex and get tattoos and guards can't stop them - indeed, they don't even try.

So if the rules are a completely unenforced facade and their violation is causing diseases to spread, that leaves two options: Hire enough guards to enforce the rules, or change the rules to allow condom distribution and a safe venue for tattooing inside prisons. Texas can't find enough guards to staff prisons now - we're nearly 3,000 guards short, and one in four guards quit each year. So that leaves changing the rules.

Canada recently began distributing condoms and installing in-prison tattoo parlors to prevent the spread of disease, and I thought that was one of the smartest moves I've seen on the prison health front in quite a while.

I'm not sure if Texas politicians are ready for that yet, but ACT-UP is right - if they're not, it's at least in part because officials at TDCJ and the Sunset Commission haven't focused on the problem as much as they should.

See more from ACT-UP.