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AIDS deaths decline in prison

State officials seeing fewer cases, better care

A decade after the much-publicized deaths of several inmates with AIDS prompted criticism of the state's health care services for prisoners, the death toll in Massachusetts prisons has dropped by half, mostly due to fewer inmates with AIDS and better treatment for HIV, according to specialists.

The number of prison deaths in Massachusetts declined from 36 to 18 since 1995 while deaths known to be related to AIDS dropped from 14 to two in the same period, according to the Department of Correction and the Bureau of Justice Statistics, an arm of the US Department of Justice.

"Just like in the community, people are living longer with HIV," said Dr. Arthur Brewer, medical director of the University of Massachusetts Correctional Health, which provides health care for the state's prisons.

But the victory against AIDS in prison comes as state budget cuts are making it more difficult for low-income residents outside prison walls to receive the drugs they need from assistance programs.

"I think there is no question that the prison system has dramatically changed the way they looked at HIV," said Dr. Barbara Herbert, who served on a blue ribbon panel in 1992 investigating allegations of inadequate care for inmates with AIDS at MCI-Framingham. "The medical care that people get in prison at this moment in time in some cases supersedes the level of care they get out of prison."

While Massachusetts has historically provided AIDS drugs to needy residents who could not afford them, recent budget cuts that sliced a third of the state HIV/AIDS Bureau's funding will probably force the agency to make difficult choices about who should be eligible for the drugs, said Rebecca Haag, executive director of the AIDS Action Committee of Massachusetts.

"The statistics do demonstrate that by having early access to care and treatment and drugs, you can have an impact on the death rate," Haag said. "With the one-third reduction in resources, that will force the government to make choices amongst the populations in need. . . .These drugs are life and death to these people."

And DOC is spending the money to buy them. AIDS drugs, which cost the state about $10,000 per inmate annually, have made up about 20 to 25 percent of the department's medical budget for the last several years.

"We're getting the best possible price," said Justin Latini, DOC spokesman. "The price has obviously gone up because of the quality of the drug."

Government agencies buy the drugs in bulk to cut costs, he said.

Between 1999 and 2003, the amount DOC spent on medicines overall increased from $6 million to more than $11 million, $3 million of which paid for a drug cocktail that combats AIDS for about 300 of the state's 9,150 inmates.

AIDS drugs are not the only reason deaths have declined in prisons. The number of suicides also has dropped, from three in 1995 to one in 2002. Homicides also appear to have declined. In 1996, there were at least two murder investigations. But no inmate had been killed in the years that followed, until the recent slaying of defrocked priest John J. Geoghan.

Yet, AIDS and the advent of new, powerful drugs are by far the largest factors explaining the drop in deaths, Brewer said. Prison deaths skyrocketed in the early 1990s and began to fall in 1995 as protease inhibitors became available to the public.

The Massachusetts statistics mirror trends in prisons nationwide. In 1995, a third of all deaths in state prisons nationwide were due to AIDS-related illnesses, but that dropped to just 6 percent in 2000, according to the Bureau of Justice Statistics. Because the rate of HIV-infection among prison inmates is more than four times higher than the general public's, the drugs had a more dramatic effect on the death toll in prisons.

Massachusetts, where heroin abuse gave rise to the third-highest rate of HIV-infected inmates in the nation, has seen its percentage of known infected inmates drop from more than 5 percent of all inmates to about 3 percent.

The state also became known as a leader in assuring access to AIDS drugs for all residents.

"Massachusetts has a very good reputation in providing comprehensive care, treatment, and support services to people living with AIDS, with a combination of both state and federal resources," said Julie Scofield, who heads the National Alliance of State and Territorial AIDS Directors in Washington, D.C.

Some states have waiting lists for the drug and have capped enrollment in AIDS drug assistance programs.

"But Massachusetts has been devastated by budget cuts in the last year, so it is dropping fast down that list," said Scofield.

AIDS has long been a source of controversy for DOC. In 1987, inmates at MCI-Norfolk rioted, citing lack of AIDS testing as a major grievance. That same month, two inmates filed a lawsuit against Governor Michael Dukakis, alleging the state failed to protect them from AIDS because it had not instituted mandatory screening.

In 1992, the AIDS-related death of inmate Robin Peeler sparked two investigations, a flurry of debate in the State House, and changes in how DOC treated AIDS, advocates said. In recent years, public health officials and the DOC have worked to implement early AIDS intervention programs in prisons and jails, said Jean McGuire, director of the state's HIV/AIDS Bureau.

Although Massachusetts remains one of a few states where an inmate's request is the only way for an AIDS test to be administered, the state has focused on persuading inmates to volunteer for tests with inmate-led AIDS-awareness classes and the Transitional Intervention Project, which counsels inmates and helps them sign up for drug benefits when they leave prison.

AIDS in prison
AIDS-related deaths in state prisons, per 100,000 inmates:
NOTE: * Through July 30; projects to 22 for the year. AIDS death data not available for 2001-2003.

Inmates with HIV
Inmate medicine budget
Between 20 and 25 percent of the Department of Corrections medicine budget is for AIDS drugs.
NOTE: AIDS drug budget not available for 2000-2002.

SOURCES: Bureau of Justice Statistics; Massachusetts Department of Corrections

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