ties have a financial interest in limiting choice (much as HMO's do in the free world, but with even greater restrictions). The ability to make the most basic decisions about HIV antibody testing, HIV status disclosure, prevention education, or medical treatment is often denied to prisoners. In 1976, the Supreme Court found that prisoners are the only class of citizen guaranteed "the right to adequate medical care" (Estelle v. Gamble). The courts define adequate care as meeting community standards. However, the Estelle decision did not allow for inspection and enforcement of those standards. Litigation has become the routine means of improving medical care and general prison conditions. All changes for the standards in prisons have been through the courts. Without successful litigation, medical care is defined entirely by the prison and rarely reflects community standards.
             The range of prison health care is as widely varied. It is impossible to generalize about conditions across one state, much less across the entire country. A select few prisons provide care equal to or even better than that available on the outside. However, the great majority do not even approach that level and quality of care. Some provide conditions seen only in developing countries. A recent report by the Correctional Association of New York looked at services provided by twenty-two correctional facilities in the New York State system. The report found "uneven clinical management, a vagueness among staff physicians about critical HIV/AIDS issues, wide variations in HIV testing, support services and education, and an absence of prevention measures."
             However, despite the fact that prisons do provide medical services to those with HIV and AIDS (as well as other conditions), the disease continues to spread throughout the prison population. Why should this be? In part it is because many prison and police officials – and a large number of the r...