Any reasonable standard of care for HIV positive prisoners would mandate a nutrient-rich diet, including nine daily servings of fruits and vegetables,” says Harvard’s Judy Shabert, a physician and dietitian. Indeed, numerous studies show slower disease progression in PWAs with higher nutrient levels.

But for real-world prisoners? Not in this lifetime. Steve Nesselroth, director of the Osborne Association’s AIDS in Prison Project in New York City, says, “Even with a doc’s note, the only thing most prisoners get is a double portion of the low-quality food being served.” And extras sometimes available—Ensure, Sustacal or Instant Breakfast—are loaded with immune-suppressing, thrush-promoting sugar. (See “Sweetness and Blight,” POZ, December 1997.) “If taxpayers knew how much money could be saved by preventing high-cost illness with good nutrition,” Nesselroth says, “there’d be mandates for good diets and supplements.”

Since there aren’t, what can prisoners do? Prison commissaries offer limited options, primarily packaged junk food made from nutrient-poor white flour and sugar and often high in diarrhea-promoting fat. Where food packages are allowed, it’s usually infrequently and with strict weight limits. (Ideally, you should ask for nuts, dried fruit, chopped dried veggies—available in health food stores—to make soup, plus multivitamin tablets.)

But many prisoners improve their nutrition via the underground economy, reports Mike Haggerty, director of the Correctional HIV Consortium (a national information center). An inmate might have a “hustle” doing a service such as laundry, cell cleaning or jailhouse lawyering, that can be bartered for fruits, vegetables and meat obtained by kitchen workers. Nutritious meals can then be prepared using the Crock-pots or water-boiling “stingers” if available.

Haggerty concludes, “Using hustled foods may be many prisoners’ best hope for getting the nutrients they need to fight HIV.”