There is a factory in Texas that manufactures vast amounts of multiple drug resistant (MDR) strains of HIV in a population at extraordinary risk of transmitting these strains to others. The members of this group -- and those they infect -- are the recipients of medical care that, to anyone with basic HIV knowledge, is practically murderous.
This "factory" is the Texas Department of Corrections, and it's hard to imagine how MDR HIV could be any more efficiently created and spread. A recent nationwide POZ survey of prisoners with HIV got several hundred responses. In a mountain of mostly bleak and desperate letters, those from Texas stood out, both in volume (40 percent) and in the painful detail of what the writers endure.
Texas Corrections established a special facility -- the Stiles Unit, in Beaumont -- for inmates with HIV because it was near a state clinic staffed by physicians with HIV treatment expertise. Sounds rational, doesn't it?
But the prescription decisions made by the HIV specialists are subject to review by different doctors back at the Stiles Unit -- usually with only minimal HIV training -- who often "substitute" drugs, changing the prescribed treatment to something less costly for the prison pharmacy or more convenient for prison guards to hand out. The result is profoundly substandard treatment.
All this is bad enough. But the story the letters tell gets worse. The patient-inmates are forbidden to get more than one dose of any medication at a time; they aren't allowed to keep their drugs "on person," which makes it nearly impossible to adhere to complicated dosing regimens.
Several times a day, to be certain they get their meds at the right time, the patient-inmates must try to get to a pill dispensary that almost always requires a long wait -- often an hour or more. When the dispensary's closing time comes, the window slams shut, no matter how many inmates are still lined up for their medication. Sound like a recipe for disaster? You bet. Because of inflexibility in work details or the laziness (or cruelty) of guards, many inmates can't even go to the pill dispensary when they are supposed to. Dangerous "dose missing" is routine. To top it off, those in charge at the MDR HIV factory don't care if the patient-inmates, on the one hand, don't get food to take with drugs that require it or, on the other, if they are forced to eat at the same time they must take medication that requires an empty stomach. The list goes on: Condoms are not available. The viral transmission rate is surely huge. Emergency medical conditions are often ignored, allowing inmates to die needlessly. So-called compassionate release is a joke.
If this tragedy provokes an "Oh, it's only prisoners" reaction, consider this: Of the prisoners who survive this Texas jail hellhole, more than 80 percent will be released back into the communities they came from. Many will be responsible about their sexual behavior and will work hard to become productive citizens, fighting the burdens of addiction, homelessness and stigma.
Others won't. Others will introduce new strains of MDR HIV, courtesy of the State of Texas, into the viral flow of the free world, making HIV treatment exponentially more difficult for all. That virus will be carried in the bodies of people who have been cruelly instructed that the greater world could care less whether they live or die. It should be no surprise when they respond in kind.
Because of the tangled nature of drugs, poverty, HIV and the justice system, prisons are at the center of the epidemic's vortex. Prison heads could take advantage of this unique situation to focus treatment and education on those at greatest risk of getting ill or infecting others. Or they can, as in Texas, become factories of misery and MDR virus. In the process, they further endanger the public and disrespect the humanity some of us still hope for from our officials.