    [House Hearing, 110 Congress]
    [From the U.S. Government Publishing Office]

     STOP AIDS IN PRISON ACT OF 2007, AND THE DRUG ENDANGERED CHILDREN ACT
                                    OF 2007

    =======================================================================

                                    HEARING

                                   BEFORE THE

                       SUBCOMMITTEE ON CRIME, TERRORISM,
                             AND HOMELAND SECURITY

                                     OF THE

                           COMMITTEE ON THE JUDICIARY
                            HOUSE OF REPRESENTATIVES

                           ONE HUNDRED TENTH CONGRESS

                                 FIRST SESSION

                                       ON

                            H.R. 1943 and H.R. 1199

                                   __________

                                  MAY 22, 2007

                                   __________

                               Serial No. 110-118

                                   __________

             Printed for the use of the Committee on the Judiciary

          Available via the World Wide Web: http://judiciary.house.gov

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                           COMMITTEE ON THE JUDICIARY

                     JOHN CONYERS, Jr., Michigan, Chairman
    HOWARD L. BERMAN, California         LAMAR SMITH, Texas
    RICK BOUCHER, Virginia               F. JAMES SENSENBRENNER, Jr.,
    JERROLD NADLER, New York                 Wisconsin
    ROBERT C. ``BOBBY'' SCOTT, Virginia  HOWARD COBLE, North Carolina
    MELVIN L. WATT, North Carolina       ELTON GALLEGLY, California
    ZOE LOFGREN, California              BOB GOODLATTE, Virginia
    SHEILA JACKSON LEE, Texas            STEVE CHABOT, Ohio
    MAXINE WATERS, California            DANIEL E. LUNGREN, California
    MARTIN T. MEEHAN, Massachusetts      CHRIS CANNON, Utah
    WILLIAM D. DELAHUNT, Massachusetts   RIC KELLER, Florida
    ROBERT WEXLER, Florida               DARRELL ISSA, California
    LINDA T. SANCHEZ, California         MIKE PENCE, Indiana
    STEVE COHEN, Tennessee               J. RANDY FORBES, Virginia
    HANK JOHNSON, Georgia                STEVE KING, Iowa
    LUIS V. GUTIERREZ, Illinois          TOM FEENEY, Florida
    BRAD SHERMAN, California             TRENT FRANKS, Arizona
    TAMMY BALDWIN, Wisconsin             LOUIE GOHMERT, Texas
    ANTHONY D. WEINER, New York          JIM JORDAN, Ohio
    ADAM B. SCHIFF, California
    ARTUR DAVIS, Alabama
    DEBBIE WASSERMAN SCHULTZ, Florida
    KEITH ELLISON, Minnesota

                Perry Apelbaum, Staff Director and Chief Counsel
                     Joseph Gibson, Minority Chief Counsel
                                     ------

            Subcommittee on Crime, Terrorism, and Homeland Security

                      ROBERT C. SCOTT, Virginia, Chairman

    MAXINE WATERS, California            J. RANDY FORBES, Virginia
    WILLIAM D. DELAHUNT, Massachusetts   LOUIE GOHMERT, Texas
    JERROLD NADLER, New York             F. JAMES SENSENBRENNER, Jr.,
    HANK JOHNSON, Georgia                Wisconsin
    ANTHONY D. WEINER, New York          HOWARD COBLE, North Carolina
    SHEILA JACKSON LEE, Texas            STEVE CHABOT, Ohio
    MARTIN T. MEEHAN, Massachusetts      DANIEL E. LUNGREN, California
    ARTUR DAVIS, Alabama
    TAMMY BALDWIN, Wisconsin

                          Bobby Vassar, Chief Counsel

                        Michael Volkov, Minority Counsel
                                C O N T E N T S

                                  ----------

                                  MAY 22, 2007

                                                                       Page

                                   THE BILLS

    H.R. 1199, the ``Drug Endangered Children Act of 2007''..........    74
    H.R. 1943, the ``Stop AIDS in Prison Act of 2007''...............    76

                               OPENING STATEMENTS

    The Honorable Robert C. ``Bobby'' Scott, a Representative in
      Congress from the State of Virginia, and Chairman, Subcommittee
      on Crime, Terrorism, and Homeland Security.....................     1
    The Honorable J. Randy Forbes, a Representative in Congress from
      the State of Virginia, and Ranking Member, Subcommittee on
      Crime, Terrorism, and Homeland Security........................     3
    The Honorable Lamar Smith, a Representative in Congress from the
      State of Texas, and Ranking Member, Committee on the Judiciary.     4
    The Honorable Maxine Waters, a Representative in Congress from
      the State of California, and Member, Subcommittee on Crime,
      Terrorism, and Homeland Security...............................     5

                                   WITNESSES

    The Honorable Dennis Cardoza, a Representative in Congress from
      the State of California........................................
      Oral Testimony.................................................     7
      Prepared Statement.............................................     9
    Mr. Willie Mitchell, Chairman of the Board, San Antonio Fighting
      Back, San Antonio, TX..........................................
      Oral Testimony.................................................    12
      Prepared Statement.............................................    14
    Mr. Devon Brown, Director, Department of Corrections for the
      District of Columbia, Washington, DC...........................
      Oral Testimony.................................................    41
      Prepared Statement.............................................    43
    Mr. Vincent Jones, Executive Director, Center for Health Justice,
      West Hollywood, CA.............................................
      Oral Testimony.................................................    44
      Prepared Statement.............................................    46
    Mr. Philip Fornaci, Director, D.C. Prisoners' Project, Washington
      Lawyers' Committee for Civil Rights and Urban Affairs,
      Washington, DC.................................................
      Oral Testimony.................................................    51
      Prepared Statement.............................................    53
    Rear Admiral Newton E. Kendig, M.D., Assistant Director, Health
      Services Division, Federal Bureau of Prisons, U.S. Department
      of Justice, Washington, DC.....................................
      Oral Testimony.................................................    55
      Prepared Statement.............................................    58

                                    APPENDIX

    Material Submitted for the Hearing Record........................    73

     STOP AIDS IN PRISON ACT OF 2007, AND THE DRUG ENDANGERED CHILDREN ACT
                                    OF 2007

                                  ----------

                             TUESDAY, MAY 22, 2007

                  House of Representatives,
                  Subcommittee on Crime, Terrorism,
                                  and Homeland Security
                                    Committee on the Judiciary,
                                                        Washington, DC.

        The Subcommittee met, pursuant to notice, at 12:39 p.m., in
    Room 2226, Rayburn House Office Building, the Honorable Robert
    C. ``Bobby'' Scott (Chairman of the Subcommittee) presiding.
        Present: Representatives Scott, Waters, Johnson, Forbes,
    and Coble.
        Staff present: Bobby Vassar, Subcommittee Chief Counsel;
    Rachel King, Majority Counsel; Veronica Eligan, Professional
    Staff Member; and Michael Volkov, Minority Counsel.
        Mr. Scott. The Subcommittee will come to order.
        I am pleased to welcome you today to the hearing before the
    Subcommittee on Crime, Terrorism, and Homeland Security on H.R.
    1199, the ``Drug Endangered Children Act of 2007,'' and H.R.
    1943, the ``Stop AIDS in Prison Act of 2007.''
        We will first take up H.R. 1199, the ``Drug Endangered
    Children Act of 2007.'' Congressman Cardoza is the primary
    sponsor of the bill, which would extend funding for the Drug
    Endangered Children Grant Program through fiscal year 2008 and
    2009.
        This grant program was first authorized in title 7 of the
    USA Patriot Improvement and Reauthorization Act of 2005, which
    authorizes up to $20 million a year for grants to address this
    problem.
        One of the most troubling aspects of drug use is its impact
    on children. According to the Drug Enforcement Agency, over
    15,000 children were found at methamphetamine labs from 2000 to
    2004. The problem is not limited to methamphetamine use. A
    Health and Human Services study found that over 1.6 million
    children live in homes where a variety of illicit drugs are
    used.
        These drug-infested conditions stretch child welfare
    agencies beyond their capacity because of increased violence
    and neglect.
        On February 6 of this year, the Subcommittee held a hearing
    on H.R. 545, the ``Native American Methamphetamine Enforcement
    and Treatment Act of 2007,'' which was passed out of this
    Subcommittee and out of the full Judiciary Committee.
        A central provision of H.R. 545 extends eligibility for
    Drug Endangered Children grants to Native American tribes.
    However, unless this bill passes the authorization for Drug
    Endangered Children grants will expire this year, negating the
    efforts to help Native American children.
        After we take that bill up, we will take up H.R. 1943, the
    ``Stop AIDS in Prison Act.'' The gentlelady from California,
    Ms. Waters, introduced H.R. 1943, a bill similar to H.R. 1638,
    which she introduced in September of 2006.
        The bill would create comprehensive HIV/AIDS programs in
    Federal prisons that would educate, diagnose and treat
    prisoners who are infected with HIV/AIDS and prevent those who
    are not infected from becoming infected. Yet the HIV/AIDS
    epidemic is spreading at an alarming rate, especially in
    minority communities.
        According to the Centers for Disease Control and
    Prevention, the CDC 2005 statistic states racial and ethnic
    minorities comprise 69 percent of all new HIV/AIDS cases.
    Furthermore, 41 percent of all prisoners in Federal prisons at
    the end of 2004 were African-American.
        These statistics show a clear need to educate prisoners
    about HIV/AIDS prevention, to detect existing cases and to
    treat those infected. Education, detection and treatment will
    not only protect prisoners, it will protect the prison
    personnel. Additionally, the treatment and education that the
    prisoners receive while incarcerated should help decrease the
    spread of the disease to the community upon their release.
        H.R. 1943 seeks to provide an effective HIV/AIDS program in
    Federal prisons for educating, detecting and treating HIV and
    AIDS. Under the bill, all inmates would have access to
    scientifically accurate education and prevention programs which
    may be provided by community-based organizations, local health
    departments or inmate peer educators. The information would be
    expressed in a culturally sensitive way, including the
    availability of a variety of languages and an audio format for
    those with low literacy skills.
        Detection, the second portion of the program's approach,
    would begin upon a person's entry to the prison system. All
    people entering the system would be detected unless declined by
    the prisoner and would continue throughout the prisoner's
    incarceration, including annual testing available to all
    prisoners upon request and mandatory testing to prisoners who
    have been involuntarily exposed to the virus or to prisoners
    who become pregnant while incarcerated.
        Finally, the treatment portion of the program would ensure
    that infected persons receive timely comprehensive medical
    treatment consistent with the current Department of Health and
    Human Services guidelines and standard medical practice.
    Treatment options, confidentiality, counseling and access to
    medications would all be available to prisoners and medical
    personnel would help develop and implement procedures to
    safeguard confidentiality.
        Before re-entry into the community, HIV-infected prisoners
    would receive referrals to appropriate health care providers,
    additional education about protecting their family members and
    others in their community and a 30-day supply of medications to
    hold them over until they can connect with services in the
    community.
        It is now my pleasure to recognize the esteemed Ranking
    Member of the Subcommittee, my friend and colleague from
    Virginia, the Honorable Randy Forbes, for his comments.
        Mr. Forbes. Thank you, Chairman Scott. And I appreciate, as
    always, your holding this legislative hearing on H.R. 1943, the
    Stop AIDS in Prison Act of 2007, and H.R. 1199, the Drug
    Endangered Children Act.
        I want to acknowledge the dedicated work of representative
    Maxine Waters, who has been a tireless advocate on the issue of
    HIV and AIDS in prison. I am proud to be an original cosponsor
    of H.R. 1943, the Stop AIDS in Prison Act.
        I also want to acknowledge the commitment of Ranking Member
    Smith, who is a cosponsor of the same bill in the last Congress
    and a cosponsor of this year's version.
        It is certainly great to see our friend Congressman Cardoza
    here today to testify and also a true superstar, Mr. Mitchell,
    who is here with us today. And we look forward to the very
    distinguish panel to testify.
        In 2006, the Department of Justice reported that
    approximately 1.9 percent of State prison inmates and 1.1
    percent of Federal inmates were known to be infected with HIV.
    The rate of confirmed AIDS cases is three times higher among
    prison inmates than the United States general population.
        These statistics, however, may understate the problem,
    because the Bureau of Prisons is responsible for housing all
    Federal inmates, and almost all States do not test all inmates
    for HIV.
        The need for testing at the Federal and State level is
    readily apparent. There are approximately 170,000 inmates in
    Federal prison. BOP tests inmates who requested tests, fall
    within a high-risk group, have clinical indications of HIV
    related or are involved in an incident when HIV transmission
    may have occurred. Forty-eight States test inmates if they have
    HIV-related symptoms or if the inmates request the test. Only
    18 States test all incoming inmates. Only three States test
    inmates upon release.
        H.R. 1943 requires routine HIV testing for all Federal
    prison inmates upon entry and prior to release from Federal
    Bureau of Prison facilities. Under the proposal for existing
    inmates, the Bureau of Prisons has 6 months from enactment to
    offer HIV/AIDS testing from inmates. The bill also requires
    HIV/AIDS awareness education for all inmates and comprehensive
    treatment for those inmates who test positive.
        While H.R. 1943 addresses the problem in the Federal
    system, I hope that we can also examine the need for testing,
    education and prevention in State prisons. If we truly care
    about successful rehabilitation and re-entry of prisoners, we
    must address this problem at the State level as well.
        I also want to indicate my support for H.R. 1199, the Drug
    Endangered Children Act, which is also a subject of today's
    hearing. The bill extends the authorization for the current
    grant program to address the problem of drug endangered
    children.
        It is a sad consequence of our Nation's drug problem that
    drug traffickers have such a devastating impact on innocent
    children who happen to reside in a house used to facilitate the
    production and distribution of illegal drugs.
        We owe it to our Nation's children to do all that we can to
    protect them and provide them the services needed to allow them
    to grow and develop in a health, loving home.
        I look forward to hearing from today's witnesses.
        Mr. Chairman, I yield back.
        Mr. Scott. Thank you. Thank the gentleman.
        We have with us the Ranking Member of the full Committee,
    and I will ask him if he has any comments.
        Mr. Smith. Thank you, Mr. Chair. I do have a statement I
    would like to make.
        On the way to that statement, let me say to you, though,
    that this is the first time I have attended a meeting of the
    Crime Subcommittee this year and have gotten to be here while
    you are serving as Chairman. Not too many years ago, I was
    Chairman of this Subcommittee and you were the Ranking Member,
    so we have worked together for a long time on this and similar
    issues.
        But it is good to be here today. Let me thank you for
    holding a hearing today on these two important legislative
    items.
        And I also want to thank my colleague, Congresswoman
    Waters, for her leadership and her collaboration on H.R. 1943,
    the Stop AIDS in Prison Act of 2007. I introduced a similar
    bill in the last Congress, and I am pleased to be a cosponsor
    again with Representative Waters in this Congress.
        The problem of HIV and AIDS in Federal and State prisons is
    difficult to measure because inmates are not routinely tested.
    There are 170,000 prisoners in the Federal system. In a 2006
    report, the Justice Department estimated that almost 2 percent
    of State prison inmates and over 1 percent of Federal inmates
    were known to be infected with HIV.
        As a percentage, this puts the occurrence of HIV and AIDS
    among inmates in Federal prison three times higher than within
    the general population of the United States.
        The cost of an HIV screening is between $6 and $15 per
    test. So requiring that Federal inmates be tested when they
    enter prison and when they leave prison is just good, common,
    practical sense.
        H.R. 1943 requires HIV testing for all Federal prison
    inmates upon entry and prior to release and for all existing
    inmates within 6 months of enactment. Identifying inmates who
    are infected allows prison officials to take the precautionary
    measures necessary to protect the health and safety of prison
    employees and other inmates. This also ensure that medical
    treatment can be administered to inmates suffering from the
    disease.
        Finally, both the inmates themselves and the community they
    rejoin upon release will obviously benefit from the inmate
    knowing his status.
        I look forward to our hearing today.
        Mr. Chairman, before I stop I want to tell a quick story,
    and I mean this as a compliment to Maxine Waters, the
    congresswoman from California.
        Mr. Scott. You have to explain that it is a compliment? It
    may not sound like a compliment, but here we go. [Laughter.]
        Mr. Smith. I will certainly yield to her when I am
    finished, but I think that she will corroborate the story.
        And that is, in the last Congress and frankly in the last
    revision that occurred in Texas, I picked up the east side of
    San Antonio, which is a predominantly Black community. And I
    started listening to what I was hearing and trying to respond
    to the suggestions that I was getting and the needs that I was
    witnessing and hearing about as well.
        And so I looked around and saw that a bill such as the one
    that we are considering today had been considered, and I
    explored it some more. And I went to someone who is a personal
    friend as well as a colleague, Maxine Waters, and we decided to
    introduce this bill ourselves in the last Congress. We were the
    two primary cosponsors.
        Little did I know that things were going to change so
    dramatically in the election, but it is an indication of I
    think Ms. Waters' sincerity and hopefully my cooperation that
    regardless of who is in the majority, we thought the issue was
    so important and needed to be addressed, that we would continue
    to do so and approach the subject in a bipartisan way, which in
    fact has occurred.
        So I want to thank her, both for her help in the last
    Congress and for her instrumental help in this Congress as
    well, trying to achieve what we want to achieve.
        And, Mr. Chairman, I will yield the balance of my time,
    such as it is, to the congresswoman from California.
        Mr. Scott. With a comment like that, we will give the
    gentlelady from California equal time. [Laughter.]
        Ms. Waters. Mr. Chairman, just let me take a moment to
    thank you for holding this hearing today and our Ranking
    Member, Mr. Randy Forbes.
        And, of course, I want you to know that not only is Mr.
    Lamar Smith one of the original cosponsors of my legislation--
    along with John Conyers, yourself, Mr. Forbes, Ms. Lee and
    Donna Christensen--every time I see him in the hall, he asks
    me, ``When is our bill coming up?'' And so, today you have
    answered the question that has been asked of me time and time
    again. He has been anxious to get on with this legislation, and
    I appreciate his interest and his passion about this subject.
        And I just look forward to hearing from our witnesses
    today.
        And while I have the microphone, let me just say that in
    addition to my bill, the Drug Endangered Children Act of 2007
    is extremely important.
        We have a Member who is here today who is going to talk
    about his passion related to this issue, the children that are
    endangered by methamphetamine, and I think that he has a
    compelling story to tell about what he knows about the subject.
    And so, I am anxious also to hear from him today, and I just
    thank him for the time that he has been putting in.
        Thank you, Congressman Cardoza, for taking time to provide
    leadership on this issue.
        And I yield back the balance of my time.
        Mr. Scott. Thank you.
        And, without objection, if the others will submit their
    statements for the record, we have a distinguished panel with
    us today to consider important issues that are currently before
    us.
        The first will be Representative Dennis Cardoza, who will
    testify on H.R. 1199.
        Representative Cardoza is in his third term representing
    the 18th Congressional District of California. He is the
    Chairman of the Agriculture Committee Subcommittee on
    Horticulture and Organic Agriculture. In 2007 he joined the
    Rules Committee, and he also serves on the Democratic Steering
    and Policy Committee.
        Before coming to Washington, he served a term on the
    Atwater City Council and was later appointed to the Merced City
    Council, where his duties provided invaluable experience in
    dealing with a wide range of important local and county issues.
        The remainder of the witnesses will be testifying on H.R.
    1943.
        Our first witness on the bill will be Mr. Devon Brown, who
    is the director for the District of Columbia Department of
    Corrections. He has more than three decades of experience in
    the congressional field. He recently returned to D.C.
    government from the state of New Jersey, where he was the
    commissioner of corrections from April 2002 to January 2006.
    Before his tenure as commissioner for the New Jersey
    Corrections, he served as deputy trustee of the Office of
    Corrections for the District of Columbia. During that time, he
    also served as interim director for the Department of
    Corrections for 6 months.
        The next panel member will be Mr. Vincent Jones. Mr. Jones
    has been the executive director of the Center for Health
    Justice since December of 2006. In his role, he oversees
    programmatic development, manages development activities and
    oversees the agencies capacity to fulfill its mission to
    empower more people affected by HIV and incarceration. He has
    more than 15 years' experience in strategic planning,
    fundraising, organizational positioning, programmatic
    development and management teams.
        Our third panel member is Philip Fornaci. He, in August
    2003, became the director of the D.C. Prisoners Legal Services
    Project. In 2006 that project was merged with the Washington
    Lawyers Committee for Civil Rights and Urban Affairs, where he
    took over as director of the new organization. He litigates on
    behalf of prisoners in both D.C. jails and Federal institutions
    while also managing the project's public affairs efforts, with
    a particular interest in civil rights of ex-offenders and the
    treatment of people with disabilities within the criminal
    justice system.
        Our fourth panel member is Rear Admiral Newton Kendig, M.D.
    He is the assistant director of Health Services Division, U.S.
    Bureau of Prisons, since August of 2006. He is a fifth-
    generation graduate of Jefferson Medical College in
    Philadelphia. He completed his residency in internal medicine
    at the University of Rochester and subspecialty training in
    infectious diseases at Johns Hopkins in 1991, where he later
    joined the faculty. He subsequently served as medical director
    of the Maryland Department of Corrections and Public Safety for
    5 years.
        Our final panel member is going to be introduced by the
    gentleman from Texas.
        Mr. Smith. Mr. Chairman, thank you for another opportunity
    today to go out of order. It is appreciated.
        I am honored to introduce Willie Mitchell, chairman of San
    Antonio Fighting Back, who is from our hometown of San Antonio,
    Texas.
        Mr. Mitchell has had a distinguished career in business,
    community service and politics. He currently serves as chair of
    San Antonio Fighting Back, Inc., sits on the United Way of San
    Antonio and Barrett County Board of Trustees and on the San
    Antonio Water Board, as well as many other committees and
    boards, including the Community Anti-Drug Coalition and the
    America Greenhouse Coalition.
        Mr. Mitchell ran for the San Antonio City Council in 1979.
    He has served as an active member of the Texas Council on Crime
    and Delinquency and has appeared on the ``Today'' show,
    representing the Center for Educational Development, teaming
    the athletic peer group. He has also appeared on ``Texas
    Epidemic'' in San Antonio, Texas, and is a recipient of the San
    Antonio Distinguished Citizen Award.
        Mr. Mitchell attended Tennessee A&I State University in
    Nashville, Tennessee, and upon graduation was drafted by the
    Kansas City Chiefs, National Football League, in 1964. Mr.
    Mitchell played in the first Super Bowl in 1966 and was a
    member of the Kansas City Chiefs team that won the 1969 Super
    Bowl.
        Mr. Chairman, I just want to say about Willie Mitchell,
    beyond what I just said and beyond the organizations that he is
    a member of, he is literally a hero to many of us in San
    Antonio. He is known throughout the community for his good
    works, for his good words, for his talks that inspire so many
    young people across the board. And it is just nice that he was
    able to make the time and come up from San Antonio today to be
    able to testify before our Committee.
        As I say, there aren't many genuine heroes we have these
    days, particularly those who are living among us, but Willie
    Mitchell is one of those in San Antonio.
        Thank you, Mr. Chairman.
        Mr. Scott. Thank you. Thank you, Mr. Smith.
        Each of the witnesses' written testimony will be made part
    of the record in its entirety, and I would like each of the
    witnesses to summarize his or her testimony in 5 minutes or
    less.
        I think the timer is working. If it is working, the green
    light will come on. When 1 minute is left, the yellow light
    will come on. And when the red light comes on, that indicates
    that your time has pretty much expired.
        We are going to begin with Congressman Cardoza at this
    time.
        And we can take your testimony and then if there are any
    questions, and then the rest of the hearing will be on the
    other bill.
        Mr. Cardoza?

    TESTIMONY OF THE HONORABLE DENNIS CARDOZA, A REPRESENTATIVE IN
                 CONGRESS FROM THE STATE OF CALIFORNIA

        Mr. Cardoza. Thank you, Mr. Chairman. Thank you for
    inviting me here today.
        You and your Committee have accomplished a great deal for
    the American people in the short time since you have taken over
    as Chair, and I admire your commitment to making our Nation's
    communities safer.
        Thank you for your interest in my bill. I appreciate all
    the comments of Mr. Forbes and Mr. Smith and Ms. Waters.
        I come here today to testify about an issue that is very
    close to my heart: drug endangered children.
        Drug trafficking and addiction have had a harrowing effect
    on children across this country, contributing to domestic
    violence, abuse, and neglect. According to a recent Health and
    Human Services study, over 1.6 million children live in a home
    where at least one parent abuses illicit drugs, including
    cocaine, methamphetamine, heroin, and prescription drugs.
        I am especially concerned about the impact drug abuse is
    having on the foster care system. Seven years ago, my wife
    Kathy and I adopted two foster children, Joey and Elena. It is
    a little difficult for me at this time to refer to them as
    foster children, because after 7 years of being in our home and
    being part of our family, they are our children, not foster
    children. But in any case, they were at one time foster
    children.
        It was truly an eye-opening experience for both Kathy and
    I, and I was inspired to become an advocate for improving the
    lives of foster kids. It breaks my heart that in communities
    across this country drugs like methamphetamine are harming
    innocent children and over-burdening the foster care system.
        Methamphetamine is particularly dangerous for children
    because parents set up meth labs in their homes. These labs are
    highly toxic and susceptible to fires and explosions.
    Tragically, according to the Drug Enforcement Administration,
    children are found in over 20 percent of all meth labs seized.
        It is well-documented that children exposed to drug abuse
    are more emotionally traumatized than other foster children and
    often have serious drug-related health problems. For these
    reasons, drug endangered children present unique challenges to
    the system. In fact, according to a National Association of
    Counties study, 69 percent of county social service agencies
    are working to develop special training procedures and
    protocols to help children with methamphetamine-addicted
    parents.
        I recently introduced the Drug Endangered Children Act of
    2007 to address the challenges nationwide. The legislation
    would reauthorize the Department of Justice to make $20 million
    grants for drug endangered children for fiscal years 2008 and
    2009. The Drug Endangered Children program was originally
    authored as part of the Patriot Act reauthorization, but money
    was never appropriated.
        Last June during the consideration of the Science, State,
    Justice and Commerce appropriations bill, I offered an
    amendment to provide $5 million for the program for fiscal year
    2007. The amendment passed with bipartisan support, but the
    funding was not included in the continuing resolution adopted
    this year when the underlying bill from last year didn't pass
    through the Committee process.
        The Drug Endangered Children's grants are designed to
    improve coordination among law enforcement, prosecutors and
    child protection services to help transition drug endangered
    children into a residential environment and as-safe-as-possible
    custody as soon as possible.
        The Byrne JAG and COPS programs have proven that grants to
    local law enforcement, other government agencies are extremely
    effective in taking public policy and tackling public safety
    problems. The Drug Endangered Children program would operate in
    a similar manner to these highly successful Justice Department
    programs by funding coordination across jurisdictions to
    address the needs of drug endangered children. In addition,
    these grants would leverage the Federal Government's investment
    by offering an incentive for local governments to invest their
    own money to confront this growing epidemic.
        I want to again thank you, Mr. Chairman, for the
    opportunity to present my testimony today. I strongly believe
    that the Drug Endangered Children Act would improve the lives
    of the more than 1.6 million children across the country
    impacted by parental drug abuse. I urge the Subcommittee to
    support this legislation.
        And as you mentioned earlier, Mr. Chairman, you have
    already supported legislation that would build on this in the
    Native American Meth Act, and without this underlying
    legislation, the legislation you passed earlier this year
    wouldn't have any impact.
        [The prepared statement of Mr. Cardoza follows:]
    Prepared Statement of the Honorable Dennis Cardoza, a Representative in
                     Congress from the State of California
        Thank you, Mr. Chairman for inviting me here today. You and your
    committee have accomplished a great deal for the American people in the
    short time since you have taken over as Chairman of the Subcommittee on
    Crime, Terrorism, and Homeland Security, and I admire your commitment
    to making our nation's communities safer.
        I am here today to testify about an issue that is close to my
    heart: drug endangered children. Drug trafficking and abuse have had a
    harrowing effect on children across our country, contributing to
    domestic violence, abuse, and neglect. According to a recent Health and
    Human Services study, over 1.6 million children live in a home where at
    least one parent abuses illicit drugs, including cocaine,
    methamphetamine, heroin, and prescription drugs.\1\
    ---------------------------------------------------------------------------
        \1\ Department of Health and Human Services, Office of Applied
    Studies. ``The National Survey on Drug Use and Health.'' 2004.
    ---------------------------------------------------------------------------
        In my district in the Central Valley of California, I have seen the
    devastating impact of methamphetamine on children's lives. While
    visiting schools in my area, I have been told by teachers and
    administrators that a significant proportion of students have a parent
    or relative who abuses meth. I am positive that similar stories can be
    told in other parts of the country where drug abuse is rampant.
        I am especially concerned about the impact drug abuse is having on
    the foster care system. Seven years ago, my wife Kathy and I adopted
    two foster children--Joey and Elena. It was truly an eye-opening
    experience for both of us, and I was inspired to become an advocate for
    improving the lives of foster kids. This year I introduced legislation
    to provide Medicaid coverage for foster kids with mental health
    problems who age out of the foster care program. Also, I am planning on
    introducing legislation to guarantee that every foster child has a
    Court Appointed Special Advocate (CASA)--a vital step to improving
    outcomes for children in foster care. Without a doubt, one of the most
    serious challenges facing the foster care system is parental drug
    abuse. In communities like mine across the country, drugs like
    methamphetamine are affecting innocent children and overburdening the
    foster care system.
        Meth is extremely dangerous for children not only because meth
    addicts are more likely to abuse and abandon their children, but also
    because meth-addicted parents often set up meth labs in their homes.
    These labs are highly toxic and susceptible to fires and explosions and
    therefore place innocent children in physical danger. In my district,
    children have been found at labs with burns from spilled ingredients
    from the methamphetamine production process. In addition, there is a
    high risk of lasting health damage from toxic fume inhalation.
    Tragically, according to the Drug Enforcement Administration (DEA),
    children are found at 20 percent of all meth lab seizures.\2\
    ---------------------------------------------------------------------------
        \2\ Swetlow, Karen. ``Children of Clandestine Methamphetamine Labs:
    Helping Meth's Youngest Victims.'' 2003: p. 3.
    ---------------------------------------------------------------------------
        *ERR13*Drug endangered children present unique challenges for law
    enforcement agencies, prosecutors, child protective services, social
    service agencies, health care providers, and other government entities.
    These children are often traumatized and abused, and they require
    special attention and care to transition into a safe and healthy
    residential environment. According to a survey released by the National
    Association of Counties, 69 percent of responding officials from county
    social service agencies indicate that their counties have had to
    provide specialized training for their welfare system workers and have
    had to develop special protocols for workers to address the special
    needs of children displaced by parental meth abuse.\3\
    ---------------------------------------------------------------------------
        \3\ National Association of Counties. ``The Meth Epidemic in
    America: The Impact of Meth on Children.'' July 5, 2005: p. 10.
    Available at http://www.naco.org/Template.cfm?Section=Meth--Action--
    Clearinghouse&template=/ContentManagement/
    ContentDisplay.cfm&ContentID=17216.
    ---------------------------------------------------------------------------
        I recently introduced the Drug Endangered Children Act of 2007
    (H.R. 1199) to address the challenges facing children abandoned,
    neglected, or abused by parents addicted to illicit drugs. The
    legislation would authorize the Department of Justice to make $20
    million in grants for drug endangered children for Fiscal Years 2008
    and 2009. The grants are designed to improve coordination among law
    enforcement, prosecutors, children protection services, social service
    agencies, and health care providers to help transition drug endangered
    children into safe residential environments.
        Grants to local law enforcement and other local government agencies
    are extremely effective in tackling public safety problems in
    communities across the country. The Community Oriented Policing
    Services (COPS) program has been critical in reducing crime across the
    country. The Edward Byrne Memorial Justice Assistant Grant program is
    another example of a program that empowers state and local governments
    to fight crime and respond to emerging public safety threats.
        The Drug Endangered Children (DEC) program would operate in a
    similar manner to these highly successful Justice Department programs.
    By funding coordination across jurisdictions and among several
    different types of government agencies, the DEC program would foster
    cooperative efforts to address the needs of children affected by drug
    abuse. These grants would leverage the federal government's investment
    by offering an incentive for local government to invest their own money
    in confronting this important problem.
        This legislation renews the authorization for the Drug Endangered
    Children program originally included as part of the USA PATRIOT
    Improvement and Reauthorization Act of 2005 (P.L. 109-177). Last June
    during the consideration of the Departments of Commerce and Justice,
    Science, and Related Agencies Act of 2006 (H.R. 5672), I offered an
    amendment to provide $5 million for the program in Fiscal Year 2007.
    The amendment passed by voice vote, but the funding was not included in
    the Continuing Resolution adopted earlier this year.
        The Drug Endangered Children Act of 2007 represents a continuation
    of the work of the Subcommittee on Crime, Terrorism, and Homeland
    Security this year. On February 6, 2007, the Subcommittee reported out
    the Native American Methamphetamine Enforcement and Treatment Act of
    2007. A central provision of this legislation is to extend Drug
    Endangered Children grants to tribes and territories. This provision is
    irrelevant without the reauthorization of the DEC program itself. H.R.
    1199 builds on the prior work of the Subcommittee to help Native
    American communities devastated by the methamphetamine epidemic.
        Thank you, Mr. Chairman, for the opportunity to present my
    testimony to the Subcommittee on Crime, Terrorism, and Homeland
    Security. I strongly believe that the Drug Endangered Children Act of
    2007 would improve the lives of the more than 1.6 million children
    across the country impacted by parental drug abuse. I urge the
    Subcommittee to support this legislation.

        Mr. Scott. Thank you very much.
        Are there any questions for Mr. Cardoza?
        Mr. Forbes?
        Ms. Waters?
        Ms. Waters. Mr. Chairman and Members, I certainly support
    this legislation, and I thank Congressman Cardoza again for his
    leadership on this issue.
        We have all heard many stories about the unfortunate
    situations where children find themselves in homes sometimes
    with both parents using meth or----
        Mr. Scott. If the gentlelady would yield for just a minute?
        We want to recognize the presence of the gentleman from
    North Carolina, Mr. Coble, and the gentleman from Georgia, Mr.
    Johnson, who are also present with us today.
        You can continue. Sorry.
        Ms. Waters. That is all right.
        We have heard these horror stories about children who are
    abandoned or children who are placed at great risk because they
    are unfortunate enough to end up in these situations. And even
    though it is not well-known among the Members of even Congress
    and perhaps the public, I know that Congressman Cardoza has a
    special experience with this situation of children who were at
    risk because of their parents having been on methamphetamine.
        And I would just like to ask you if the children that you
    have knowledge of are safely being cared for now?
        Mr. Cardoza. Well, it varies, Ms. Waters. And thank you for
    your recognition.
        When we got our children from the foster care system, they
    had been abandoned by their mother, who was a methamphetamine
    addict. They were in foster care, being somewhat abused for a
    second time, and a CASA volunteer saved our kids, a
    kindergarten teacher that recognized that my son was under
    severe stress and could see it in the classroom.
        We were lucky and our children were lucky. We were lucky to
    get them. They are wonderful kids. They will be great adults if
    we don't--I often joke, if we let them live that long, they
    will be great adults. Like any kids, they are persnickety and
    get into mischief. But we love them deeply, and they are in a
    great situation now.
        But the impact from the years that they were in a bad
    situation still affects their lives, even though they are 13
    and 10 now. That impact continues. Even though they have got a
    nurturing mother and a father that take care of them and love
    them, there are impacts that reside inside them that affect
    them to this day.
        I am personally aware of two children that were taken out
    of a meth lab about a mile from my home. When they removed
    these children, they were covered in red phosphorus and their
    teddy bears literally had to be considered hazardous materials
    and were taken away in Hazmat bags by men in white suits,
    because they were so contaminated and dangerous. The children
    were literally little toxins. They were taken to the hospital
    to be decontaminated.
        And when you see those kinds of experiences, you know the
    effect of methamphetamine on parents causes parents to simply
    abandon the kids. And especially if they have been taken the
    drugs during pregnancy, while the drug can have an effect on
    the child physically, the emotional lack of attachment that the
    parent has, because they oftentimes abandon newborns and
    things, is something that early child development practitioners
    will tell you has a lifelong effect on this young people that
    were abandoned.
        That is why the counties are having such trouble dealing
    with some of the after-effects of this, and I really appreciate
    your question. I am very passionate about this subject, and I
    know the money will be well-spent if we can direct it this way.
        Ms. Waters. Thank you very much.
        Mr. Scott. Thank you.
        Mr. Smith?
        Mr. Johnson?
        Mr. Johnson. I wish to commend you, Representative Cardoza,
    for this measure to extend this act, which would provide $20
    million per year for children who have been adversely impacted
    by their drug environments. If we don't pay now, we will
    certainly pay later. And $20 million compared to $97 billion is
    a small amount when it goes toward helping children. So you are
    to be commended.
        I have only talked with you a couple of times since I have
    been in Congress, and my idea of you is of someone who is very
    stern and focused and that kind of thing. But to hear you and
    your wife have taken in foster children who were challenged
    gives me a different perspective on your character. So I look
    forward to getting to know you better and thank you so much for
    your service to your country in that regard.
        Mr. Cardoza. Thank you, Mr. Johnson.
        Mr. Scott. Does the gentleman want equal time? [Laughter.]
        Mr. Cardoza. I will do some soul searching about my
    sternness.
        The reality is there are a great deal of young people that
    are put--you know, 1.6 million people are affected in some way;
    500,000 children are in foster care at any given time in the
    United States; 118,000 are up for adoption.
        There is a disproportionate number of children in the
    African-American community vis-a-vis the population. They
    comprise about 15 percent of the population and 39 percent of
    those waiting for adoption.
        We have a lot of work to do on this issue, but the counties
    and the locales that are dealing with this, in some cases
    cities, really need to help in developing special protocols.
    These are special kids with special needs, and I think that
    this money will go to developing those programs that can be
    used disseminated throughout the country to solve the problem.
        I thank the Chairman.
        Mr. Scott. Thank you.
        If there are no other questions, thank you, Mr. Cardoza,
    and we will excuse you at this point.
        Thank you for introducing this bill. The children you are
    talking about are at the highest risk of getting in trouble,
    and any investments we can make before they get in trouble will
    go a long way, as the gentleman from Georgia has indicated.
        As you have heard, we have got several votes, at least
    eight votes. So it is going to be some time. We will get back
    as soon as we can, but it will be at least a half an hour
    before we can get back. So we will get back as soon as we can
    and continue with the hearing.
        We are in recess.
        [Recess.]
        Mr. Scott. The Committee will come back to order.
        Representative Forbes is detained but specifically asked me
    to continue, so we will continue with the hearing.
        And I understand that the witnesses have been informed that
    Mr. Mitchell is on a time crunch. And we would ask him to
    testify at this point.
        Mr. Mitchell, you are recognized for 5 minutes.

       TESTIMONY OF WILLIE MITCHELL, CHAIRMAN OF THE BOARD, SAN
                 ANTONIO FIGHTING BACK, SAN ANTONIO, TX

        Mr. Mitchell. Thank you, Mr. Chairman.
        Let me say first of all, I am clearly elated to be here,
    and I appreciate the opportunity to come before you and your
    Committee to give some impact to the problem with HIV/AIDS to
    those who have been incarcerated and to those who are being
    incarcerated.
        From my perspective, I have worked with the Three Rivers
    Federal Penal Institution in Three Rivers, Texas, and the thing
    that I think is so unique is that this bill that you have
    designed and put together, I think everything that I know, as a
    practitioner and out in the community, everything is being
    addressed.
        The one thing that I know is beneficial is that those who
    come from those communities that really have the AIDS virus or
    have the potential of getting the AIDS virus and going into the
    penal institution, I think if tested before, that will help to
    serve and make sure that the finances to make sure that the
    people who have AIDS going in get the treatment that is
    necessary and reduce the problem with those who are
    incarcerated to where there are more people coming in with that
    same virus.
        And for those that are inside the prison, if they are not
    tested to see, then it just continues to spread and it will be
    widely known as they come out. If they are coming out with the
    virus and haven't been tested, that is not good for the
    community either, because the community is going to have to
    suffer and pay for that type of testing and the medicine that
    is needed. So the bill will certainly help those who are
    incarcerated, those who are not incarcerated.
        And from my perspective, I have a grant right now that is
    from the Center for Substance Abuse and Mental Health Service
    Administration, SAMHSA, and the Center for Substance Abuse
    Prevention, CSAP, and right now just what you are talking about
    we want to see being done for them, I am doing it already for
    the public.
        So if we can do it, and SAMHSA has the need to show that it
    is needed and necessary for the general public, why shouldn't
    we do it for those who have been incarcerated? That is one of
    the issues that I think makes it so unique and special.
        And we are doing free testing. So why wouldn't the Federal
    Government want to test these people before they enter the
    penal institution?
        That is why I am so strong and I feel so good about it, is
    because I am there, I am in the community.
        And within the penal institution you must realize that
    there will be some type of sexual activity going on among these
    men. If you don't test to make sure and then give them the
    information that is needed so that if I know what the
    possibilities are and the information is being given to me or
    we will looking at it, then we have a better chance of
    preventing it.
        But if we do the laymen thing and act as though it is not
    going to happen and say, well, we will deal with that later,
    then the penal institutions have the problems with the medical
    part of it, and then as they come out to the public, there is
    another problem.
        So I think the bill will serve not only the penal system,
    but it will serve the community to let them know that we are
    doing this testing to make sure that if a person has this
    virus, at least we will test to find out, so that we will have
    some indication of what is going in and what is going out.
        And then I have transitional housing, where I have
    transitional housing for those that come out of the penal
    institution. So when we talk about jobs and opportunities for
    them, the first thing they want to know, well, do they have any
    ailments, do they have any sicknesses, have they been tested
    for this. That is the first thing the employer wants to know.
    So if you do that and test them before they come out, then that
    means that also we save again, because they may have a better
    opportunity to get a job.
        So I am much in favor of it, and I appreciate the fact of
    being able to come and at least make the testimony before you,
    because I know that this is an important step in trying to make
    sure that we address this issue.
        That is basically about all I have to say about it. It is
    just that it is something that is needed. I appreciate the fact
    that you all are taking the initiative to put forth this bill.
    And I hope that anything that we can do and say in our
    community will help you.
        [The prepared statement of Mr. Mitchell follows:]
                     Prepared Statement of Willie Mitchell
        In 2006, the HIV/AIDS virus pandemic reached a milestone our world
    hoped it never would; 25 years of existence. The HIV/AIDS virus is one
    that has touched lives from all backgrounds regardless of class, race,
    gender, or geographic location. While there are many factors which
    contribute to the number of men and women infected with HIV/AIDS virus,
    those individuals who are or have been incarcerated are not to be
    excluded. According to an unpublished report done by the U.S.
    Department of Justice in a report done in 2002 titled Disease Profile
    of Texas Prison Inmates; ``. . . study shows that for a number of
    conditions, the prison population exhibited prevalence rates that were
    substantially higher than those reported for the general population.''
    \1\ Upon entry into the Texas Department of Criminal Justice (TDCJ)
    system for any duration of time, all inmates receive a medical and
    mental health examination; however it does not currently include
    testing for the HIV/AIDS virus.
    ---------------------------------------------------------------------------
        \1\ Disease Profile of Texas Prison Inmates Pg. 4-5, Baillargeon,
    Jacques Ph.D., Black, Sandra A. Ph.D., Dunn, Kim M.D., and Pulvino,
    John P.A.
    ---------------------------------------------------------------------------
        Therefore it would only be prudent for the state to do so in order
    to take a proactive approach and reduce the number of individuals
    infected along with the potential of infecting others with the HIV/AIDS
    virus. ``. . . infection with HIV was more common among black females
    than among either white or Hispanic females.'' \2\ The need for testing
    before and after incarceration is not only a social injustice; however
    it also has the potential to be an economic injustice. Social in the
    sense that individuals infected with the virus who are from low income
    backgrounds can only create future financial responsibilities to the
    state in addition to the country. Economic in the sense that it costs
    the state thousands of dollars each year to provide health care,
    medications, housing, along with other welfare benefits; all at the
    expense of both the state and the country. The federal government
    cannot wait for individuals to become infected with this virus; it must
    act now and address the issues with a proactive mentality. The report
    further indicates that, ``the high rates of HIV among prison
    populations are attributable to high-risk behaviors in which a number
    of criminals reportedly engage prior to incarceration. For example, 40
    to 80 percent of prison inmates are reported to have used intravenous
    drugs.'' ``Eleven percent of incarcerated men are reported to have had
    sex with a prostitute, while between two and group percent are reported
    to have engaged in bisexual or homosexual relationships.'' \3\ The lack
    of mandatory HIV/AIDS screening process in place within the TDCJ system
    during the study period may likely contribute to the underestimation of
    the actual cases that exist. The absence of a clear understanding of
    the number of cases is a danger not only to the individual who is
    infected, the community at large, and the many correctional facility
    professionals whose lives are at risk if an individual does not know
    their status. Furthermore, ``research indicates the following factors
    may contribute to prisoners' excess disease prior to incarceration: low
    socioeconomic status, poor access to health care in their home
    communities, and high risk behaviors. Following incarceration, a number
    of environmental factors including crowded living conditions, lack of
    temperature control, poor sanitation, and increase psychological stress
    may further contribute to excess disease among inmates.'' \4\
    ---------------------------------------------------------------------------
        \2\ Ibid Pg. 7
        \3\ Ibid Pg. 10
        \4\ Ibid Pg. 12
    ---------------------------------------------------------------------------
        Testing inmates for the HIV/AIDS virus is one of many that is
    needed to ensure the health and wellness of the incarcerated population
    and correction facility professionals who serve them everyday. The
    Hepatitis virus is another fatal illness that is often associated with
    high risk populations of which many incarcerated men and women are. The
    report also made reference to the increase rates of the transmittal of
    the Hepatitis virus through risky behavior such as multiple partners,
    male to male sex, and intravenous drugs. Currently in the state of
    Texas, it is a challenge to receive testing and aftercare in the event
    an individual becomes infected; this virus equally deserves the
    attention of our state and national government.

                                   ATTACHMENT

        Mr. Scott. Thank you very much, Mr. Mitchell.
        Let me just ask you one quick question; we usually defer
    questions until the end. But in your experience and education,
    how do you make sure that inmates actually learn the material,
    particularly when you consider that it has to be presented in a
    culturally sensitive manner?
        Mr. Mitchell. Well, the culturally sensitive manner, I
    don't have a problem with that, because I think with the virus
    as deadly as it is, if we don't do it, then we are not serving
    the community. I don't think that you can make this an easy
    thing to say. I don't think there is a special way to do it.
        I think that because they have been incarcerated and for
    what the problems are while you are incarcerated, I think you
    have to have more education in terms of educating the inmates
    to it and putting out or disseminating information that they
    can read, such as pamphlets. They have a lot of down time,
    where at night they could read the pamphlets about the AIDS
    virus and what it causes.
        So I think if there is some information given to them, that
    they can readily read--on bulletin boards. We all know the best
    way to get a product sold is through advertising, so if we want
    to sell this product, why don't we advertise it within the
    penal institution? And I think that is just a good business
    principle, that if you want to have some results, advertise it
    within the penal institution so that they will know what the
    cause and effects are.
        Mr. Scott. Thank you.
        Ms. Waters, do you have any questions for Mr. Mitchell? He
    has a plane to catch. He will be leaving.
        Ms. Waters. No. I want to thank Mr. Mitchell very much. I
    did have an opportunity to talk with him a little bit earlier
    when I was here. You were over there, and I should have been
    over there too.
        However, I do thank you for being here today, and I
    certainly appreciate the work that you are doing and for your
    particular knowledge about what is going on in our prisons.
        You are there. You see the inmates. You have a sense of how
    information is disseminated. You have enough knowledge about
    this to know that they can benefit from this program that we
    are trying to institute to save lives and to save the lives of
    mates on the outside.
        So I just thank you for being here today and coming from so
    far to share this testimony with us. Thank you.
        Mr. Mitchell. Ms. Waters, I appreciate that.
        It is one thing to know that within our community, within
    the African-American community, this virus has escalated, and
    the fact of the matter is that we need to make sure that there
    is an awareness brought about, and if we don't do that, then
    the virus continues to happen. Nobody will take the fact that
    we need to do something.
        And I think this is one step in saying that within the
    penal system, we are going to do something. And I think from
    the Federal level, it says a lot about you all as Members of
    the Committee who are trying to allocate money for it. The
    States may have a difficult time, but I think from a Federal
    standpoint you all are doing an exciting job in doing this.
        And I would just ask all of you, go visit a Federal penal
    institution, and it will help you to make some good choices on
    what is going on there. It may be a system that we have to
    house people that have committed certain crimes, but they do a
    tremendous job in trying to rehabilitate those people and give
    them an opportunity for other jobs as they come out so that
    they can become productive citizens. It is a wonderful system,
    and I wish the States would adopt some of the things that we do
    in the Federal institutions.
        Ms. Waters. Thank you very much.
        Mr. Scott. Thank you.
        Visit the prisons is on our agenda. Mr. Forbes and I are
    looking for prisons to visit right now, and we expect there to
    be more than one. So thank you for that recommendation.
        Mr. Mitchell. Thank you, Mr. Chairman.
        Mr. Scott. Mr. Brown, you are recognized for 5 minutes.

     TESTIMONY OF DEVON BROWN, DIRECTOR, DEPARTMENT OF CORRECTIONS
              FOR THE DISTRICT OF COLUMBIA, WASHINGTON, DC

        Mr. Brown. Good afternoon, Mr. Chairman and Members of the
    Subcommittee. I am Devon Brown, director of the District of
    Columbia Department of Corrections.
        I appear before you today as a 33-year correctional
    executive whose experience includes leadership at both the
    State and local levels within Maryland, New Jersey and the
    District of Columbia correctional systems. I do so in firm
    support of House Resolution 1943.
        Having spent the entirety of my career as a public servant
    in the proud membership of the correctional profession, I am
    acutely aware of the many challenges and demands of its
    operations and gravity of responsibilities.
        Having functioned as the director of the Montgomery County
    Department of Corrections and Rehabilitation in Maryland,
    warden of two of Maryland's maximum security institutions and
    as a forensic psychologist, I have faced many concerns and
    issues existing within prison walls but ultimately having
    impact upon all of society. None are more important than those
    addressed by H.R. 1943 as it recognizes the growing interface
    between public safety and public health.
        This bill, like similar ones enacted throughout the
    country, recognizes the critical significance of diagnosing,
    educating and treating, where appropriate, all inmates for HIV/
    AIDS as they enter, reside within and leave prison gates.
        The proposed legislation understands that, as we speak,
    over 2.2 million prisoners are currently incarcerated within
    our country's prisons and jails with over 600,000 of them
    returning to our communities each year. These individuals will
    be re-establishing themselves in our villages, our hamlets and
    neighborhoods, with many securing employment in fields
    requiring routine and close interaction with the public.
        Of acute concern is the realization that approximately 3 to
    5 percent of them will be released from confinement with HIV
    and AIDS, a statistic which is five times the rate of
    prevalence in the general population.
        These individuals will return to their families, resituate
    themselves and resume their lives infected with a highly
    pernicious, destructive and contagious disease. Many will be
    unaware that they are the host of this acutely devastating
    virus, nor will they know that their disorder has the potential
    of being innocently passed on to unsuspecting others both
    within and outside of prison gates.
        H.R. 1943 endeavors to promote public health for all of the
    country by ensuring that inmates are automatically tested for
    HIV and AIDS upon commitment to Federal custody, educated about
    the disease and treated. Moreover, they are again tested upon
    completing their term of incarceration.
        These provisions are consistent with the Centers for
    Disease Control recommendations and those of several other
    jurisdictions, among them the District of Columbia. As a means
    to offset the fiscal resources necessary to implement this
    legislation, funding is available through SAMHSA with guidance
    provided by the CDC.
        As correctional systems take on an increasing and more
    vital role in promoting the vibrancy of our communities, their
    efforts must include doing more to contain the spread of HIV
    and AIDS. Inasmuch as 90 percent of all HIV-positive cases
    detected in prisons reportedly involve those who have
    contracted the infection prior to incarceration, the proposed
    legislation will also play an important role in protecting the
    health of the brave men and women who serve the people of this
    country each day through their employment within correctional
    facilities.
        By diagnosing, educating and treating the inmate population
    who possess the disorder, it is less likely to be spread to
    prison staff as well. House Resolution 1943 recognizes this
    necessity. Its enactment is in the best interest of our
    correctional systems and the public they serve.
        In recognition of this reality, last June the District of
    Columbia Department of Corrections became the first municipal
    detention facility in the United States to comprehensively
    expand its existing inmate health care services to address the
    HIV pandemic by integrating automatic HIV testing into its
    routine medical intake operations and release procedures.
        As most correctional systems test for HIV under limited,
    voluntary conditions, our approach in automatically testing all
    detainees at the front and back end of incarceration is highly
    congruent if not identical with the elements of H.R. 1943 and
    stands as indisputable evidence of the feasibility as well as
    success of these procedures.
        Our condom distribution program, implemented during the
    early 1990's, was likewise one of the first initiatives of its
    kind in the Nation and complements our automatic HIV testing
    strategy by contributing to the deterrence of the disease's
    transmission. The condom distribution initiative began at a
    time when only a handful of correctional systems supported such
    a response to controlling HIV in correctional settings.
        It is important to note that while our departmental policy
    strictly prohibits sexual activity among inmates, the HIV/AIDS
    issue is considered more insidious than the consequences
    resulting from inmates committing consensual sex-related
    infractions.
        In conclusion, I leave you with these observations made in
    1929 by the National Society for Penal Information, as conveyed
    in a publication entitled, ``Health and Medical Service in
    American Prisons and Reformatories,'' by F.L. Rector. And I
    quote: ``Viewed from whatever angle, whether social, economic,
    administrative or moral, it is seen that adequate provision for
    health supervision of the inmates of penal institutions is an
    obligation which the State cannot overlook without serious
    consequences to both the inmates and the community at large.''
        These resounding words are as true today as when related
    over 7 decades ago. As it relates to HIV/AIDS transmission, the
    health of our Nation shall be greatly influenced by the manner
    in which we address our prisons.
        House Resolution 1943 affirms this truth. Recognizing the
    profound importance that this bill will have in furthering the
    health of all citizens, I enthusiastically support its passage.
        Mr. Chairman, this concludes my testimony.
        [The prepared statement of Mr. Brown follows:]
                       Prepared Statement of Devon Brown
        Good Morning Mr. Chairman and members of the Judiciary Committee, I
    am Devon Brown, Director of the District of Columbia Department of
    Corrections. I appear before you today as a 33-year correctional
    executive whose experience includes leadership at both the State and
    local levels within Maryland, New Jersey State, and the District of
    Columbia correctional systems. I do so in firm support of House
    Resolution 1943.
        Having spent the entirety of my career as a public servant in the
    proud membership of the correctional profession, I am acutely aware of
    the many challenges and demands of its operations and gravity of
    responsibilities. Having functioned as the Director of the Montgomery
    County Department of Corrections and Rehabilitation, warden of two of
    Maryland's Maximum Security institutions and as a forensic
    psychologist, I have faced many concerns and issues existing within
    prison walls but ultimately having impact upon all of society. None are
    more important than those addressed by H.R. 1943 as it recognizes the
    growing interface between public safety and public health.
        This bill, like similar ones enacted throughout the country,
    recognizes the critical significance of diagnosing, educating, and
    treating, where appropriate, all inmates for HIV/AIDS as they enter,
    reside within, and leave prison gates. The proposed legislation
    understands that as we speak, over 2.2 million prisoners are currently
    incarcerated within our country's prisons and jails with over 600,000
    of them returning to our communities each year. These individuals will
    be re-establishing themselves in our villages, hamlets, and
    neighborhoods, with many securing employment in fields requiring
    routine and close interaction with the public. Of acute concern is the
    realization that approximately 4-5% of them will be released from
    confinement with HIV/AIDS, a statistic which is five times the rate of
    prevalence in the general population. These individuals will return to
    their families, resituate themselves and resume their lives infected
    with a highly pernicious, destructive, and contagious disease. Many
    will be unaware that they are the host of this acutely devastating
    virus, nor will they know that their disorder has the potential of
    being innocently passed on to unsuspecting others both within and
    outside of prison gates.
        H.R. 1943 endeavors to promote public health for all of the country
    by ensuring that inmates are automatically tested for HIV/AIDS upon
    commitment to federal custody, educated about the disease and treated
    where warranted. Moreover, they are again tested upon completing their
    term of incarceration. These provisions are consistent with the Centers
    for Disease Control (CDC) recommendations and those of several other
    jurisdictions among them the District of Columbia. As a means to offset
    the fiscal resources necessary to implement this legislation, funding
    is available through the U.S. Department of Health Department with
    guidance provided by the CDC.
        As correctional systems take on an increasing and more vital role
    in promoting the vibrancy of our communities, their efforts must
    include doing more to contain the spread of HIV/AIDS. Inasmuch as 90%
    of all HIV positive cases detected in prisons reportedly involve those
    who have contracted the infection prior to incarceration, the proposed
    legislation will also play an important role in protecting the health
    of the brave men and women who serve the people of this country each
    day through their employment within correctional facilities. By
    diagnosing, educating, and treating the inmate population who possess
    the disorder, it is less likely to be spread to prison staff as well.
    House Resolution 1943 recognizes this necessity. Its enactment is in
    the best interest of our correctional systems and the public they
    serve.
        In recognition of this reality, last June the District of Columbia
    Department of Corrections became the first municipal detention facility
    in the United States to comprehensively expand its existing inmate
    health care services to address the HIV pandemic by integrating
    automatic HIV testing into its routine medical intake and release
    procedures. As most correctional systems test for HIV under limited,
    voluntary conditions, our approach in automatically testing all
    detainees at the front and back end of incarceration is highly
    congruent with the elements of H.R. 1943 and stands as indisputable
    evidence of the feasibility as well as success of these procedures. Our
    condom distribution program, implemented during the early 1990's, was
    likewise one of the first initiatives of its kind in the nation and
    complements our automatic HIV testing strategy by contributing to the
    deterrence of the disease's transmission. The condom distribution
    initiative began at a time when only a handful of correctional systems
    supported such a response to controlling HIV in correctional settings.
    It is important to note that while our departmental policy strictly
    prohibits sexual activity among inmates, the HIV/AIDS issue is
    considered more insidious than the consequences resulting from inmates
    committing consensual sex related infractions.
        In conclusion, I leave you with these observations made in 1929 by
    the ``National Society for Penal Information'' as conveyed in a
    publication entitled, Health and Medical Service in American Prisons
    and Reformatories, by F.L. Rector:

            ``Viewed from whatever angle, whether social, economic,
            administrative, or moral, it is seen that adequate provision
            for health supervision of the inmates of penal institutions is
            an obligation which the state cannot overlook without serious
            consequences to both the inmates and the community at large.''

        These resounding words are as true today as when related over 7
    decades ago. As it relates to HIV/AIDS transmission, the health of our
    nation shall be greatly influenced by the manner in which we address
    our prisons. House Resolution 1943 affirms this truth. Recognizing the
    profound importance that this bill will have in furthering the health
    of all citizens, I enthusiastically support its passage.
        Mr. Chairman, this concludes my testimony. I would be pleased to
    respond to any questions that you may have of me at this time. Thank
    you.

        Mr. Scott. Thank you, Mr. Brown.
        Mr. Jones?

      TESTIMONY OF VINCENT JONES, EXECUTIVE DIRECTOR, CENTER FOR
                   HEALTH JUSTICE, WEST HOLLYWOOD, CA

        Mr. Jones. Good afternoon, Mr. Chairman and Members of the
    Committee. My name is Vincent Jones. I am the executive
    director of the Center for Health Justice.
        The Center for Health Justice is the Nation's only
    nonprofit organization solely focused on HIV prevention and
    treatment education for incarcerated populations. Our mission
    is to empower people affected by HIV in incarceration to make
    healthier choices and to advocate for the elimination of
    disparities between prisoner health and public health.
        More specifically, we provide treatment adherence education
    to positive inmates, prevention education to incarcerated women
    and men at high-risk for HIV infection, and supportive services
    to positive parolees upon release.
        We are the Nation's largest provider of condoms inside
    correctional facilities, and run a nationwide toll-free
    prevention and treatment hotline for inmates. We also have an
    active policy and advocacy team.
        The Center for Health Justice was founded in 2000 by
    advocates with over 20 years' experience in the field to focus
    treatment, advocacy and prevention efforts for the incarcerated
    population, an often-forgotten subset of Americans.
        Our work is guided by the principle that prevention and
    treatment in correction facilities should be equal to that of
    the general public. We call this health justice.
        In general, positive people in the community have access to
    quality medical care, medications, treatment education and
    advocacy and support services, and so should positive
    prisoners. Positive and at-risk folks in the community have
    access to education, condoms and hotlines. So should prisoners.
        Our staff and board have examined H.R. 1943, the Stop AIDS
    in Prison Act, through the lens of Health Justice and decided
    to support this bill. We applaud Congresswoman Maxine Waters
    for recognizing the intersection of HIV and correctional
    facilities and thank her for her leadership on this very
    important issue.
        Before I tell you why we support the Stop AIDS in Prison
    Act, let me share some facts.
        In the United States, one in four people with HIV pass
    through a jail or prison each year; 26 years into the epidemic,
    a quarter of those with HIV are undiagnosed. Women, especially
    women of color, constitute an increasingly large proportion of
    new infections.
        And this might come as a surprise to some, but over 90
    percent of people in prison or jail return to their communities
    in a matter of months, bringing back to their communities the
    effects of poor HIV medical treatment and prevention efforts
    inside.
        But there is a silver lining. The simplest and most cost-
    effective way to address the HIV pandemic is through education
    and primary care providers, but incarcerated populations
    generally lack formal schooling and adequate health care.
    Hence, in-custody programs often mark their first and only
    opportunity for HIV prevention and treatment education and the
    best teachable moment, when they are sober, contemplative and
    in a single-sex environment.
        The Stop AIDS in Prison Act recognizes those facts and
    takes advantage of this public health opportunity incarceration
    presents without taking advantage of prisoners and their
    decreased capacity to decline or meaningfully consent to
    participation and intervention.
        It also encourages routine HIV testing in a manner that
    mirrors testing in the general public and approaches treatment
    holistically and also updates the formulary rules in a manner
    that will enhance confidentiality and help extend the lives of
    Americans living with HIV.
        Now for a few statistics. Controlling the epidemic begins
    with more people knowing their status. HIV testing upon request
    is the norm in the general public and should be the case inside
    correction facilities. We are delighted that H.R. 1943
    stipulates that an inmate's request for a test cannot be used
    against her or him in a punitive manner. The fewer
    disincentives to testing that exist, the greater likelihood
    that an individual would choose to be tested and begin to make
    healthier choices upon learning their HIV status.
        While we believe it is important for more people to know
    their status, we know that inmates are more likely to make
    healthier choices after learning their status if they choose to
    take the test themselves rather than have that choice imposed
    upon them. For that reason, we are happy that this bill
    provides a clear opt-out provision for inmates.
        The bill further requires that testing be offered upon
    entry and release and contrasts legislation proposed from other
    jurisdictions requiring testing only upon exit. Testing upon
    entry and release is preferable because it allows an individual
    receiving a positive diagnosis to do so in an environment where
    he or she can receive required care rather than just a
    diagnosis upon departure.
        We also like the strong pre-test and post-test counseling
    as it helps inmates to understand the ramifications of a
    positive or a negative result.
        We are also pleased that this bill calls for comprehensive
    treatment. Not only is comprehensive treatment the goal in the
    general public, but it is a more effective approach to reducing
    reinfection and prolonging lives.
        Providing for a formulary that will contain all the FDA-
    approved medications necessary to treat HIV and AIDS and
    providing for automatic renewal systems for medications and
    requiring that medical and pharmacy personnel provide timely
    and confidential access to medication are all essential to
    providing quality care in prison. And we are happy that these
    issues are addressed in the bill and reflect the authors'
    comprehensive understanding of the challenges of HIV care in
    incarcerated settings.
        At the Center for Health Justice, we assist inmates in
    developing pre-release plans that take their health into
    consideration and know the effectiveness of these types of
    tools. We are also happy that this bill provides a similar
    planning.
        Finally, the exposure incident provision in this bill is
    one in which we look forward to working with the author to
    improve. It could be argued that this provision makes prisoners
    living with HIV the subject of scrutiny rather than members of
    our community to be supported with increased counseling and
    testing and educational resources. We agree with the goal of
    reducing intramural HIV transmissions, including to staff, but
    we believe this can be done in a different manner.
        In closing, I cannot thank you enough for the opportunity
    to provide our expertise to those whose goals are consistent
    with our mission. The passage of this bill will help plug a
    huge gap in our Nation's plan to reduce the spread of HIV and
    extend the lives of Americans living with the virus.
        I welcome the opportunity to show any of you how our
    programs work in real incarcerated settings, as that can help
    you understand why we believe that the bill is so essential.
        Thank you.
        [The prepared statement of Mr. Jones follows:]
                      Prepared Statement of Vincent Jones
        Good morning. My name is Vincent Jones. I am the Executive Director
    of the Center for Health Justice, an organization based in Los Angeles.
    The Center for Health Justice empowers people affected by HIV and
    incarceration to make healthier choices and advocates for the
    elimination of disparities between prisoner health and public health.
        More specifically, Center for Health Justice provides treatment
    adherence education to HIV+ inmates, HIV prevention education to
    incarcerated women and men at high-risk for HIV infection, and
    supportive services to HIV+ parolees upon release. We are also the
    nation's largest provider of condoms inside correctional facilities,
    and provide prisoners access to condoms in the Los Angeles and San
    Francisco County Jail systems. Finally we run a nationwide HIV
    prevention hotline that prisoners may call collect while incarcerated.
        The Center for Health Justice was founded in 2000 by HIV advocates
    with over 20 years experience in the field to focus HIV treatment
    advocacy and prevention efforts on incarcerated populations, an often
    forgotten subset of the HIV community. But ignoring this population is
    the detriment of us all.
        Here are the facts: In the US one in four people with HIV pass
    through a jail or prison each year; 26 years into the epidemic a
    quarter of those with HIV are undiagnosed. Women, especially women of
    color, constitute an increasingly large proportion of new infections.
    And this might come to a surprise to some but over 90% of people in
    prison or jail return to their communities in a short period of time,
    bringing back to their communities the effects of poor HIV medical
    treatment and prevention efforts inside.
        The fundamental tenet of our organization is the principle that HIV
    prevention and treatment in correctional facilities should be equal to
    that of the general public. We call this health justice. In general,
    HIV+ folks in the community have access to quality medical care, HIV
    medications, treatment education and advocacy and support services:
    HIV+ prisoners should also. HIV+ and at-risk folks in the community
    have access to prevention education, condoms and HIV hotlines that
    provide information to reduce the risk of transmission: HIV+ and at-
    risk prisoners should to.
        Applying principle of Health Justice to the real world is not only
    the right thing to do but it is also good policy.
        Today, I am here to tell you that our staff and board have examined
    HR 1943, the STOP AIDS in Prison Act of 2007 through the lens of Health
    Justice and decided to support this legislation. We applaud
    Congresswoman Maxine Waters for recognizing the intersection of HIV and
    correctional facilities and thank her for her leadership on this very
    important issue.
        As you know the purpose of the bill is to stop the spread of HIV
    and AIDS among prisoners, to protect staff from HIV infection, to
    provide comprehensive medical treatment to prisoners who are living
    with HIV, to promote HIV awareness and prevention among prisoners, to
    encourage prisoners to take responsibility for their own health and to
    reduce the transmission of HIV in prison.
        We like the fact that many elements of this legislation conforms
    with existing standards and practices employed outside of correctional
    facilities. More specifically:

              Testing and Counseling upon intake is consistent with
            the provision of testing to individuals who are not
            incarcerated. The strong pre and post test counseling component
            of the legislation is critical because it helps inmates
            understand the potential ramifications of a positive OR a
            negative result. In either instance, it is incumbent upon them
            to make healthier choices and appropriate counseling and
            education makes that more likely.

              Improved HIV Awareness through Education is critical.
            The simplest and most cost-effective way to address the HIV
            epidemic is through education and primary care providers, but
            incarcerated populations generally lack formal schooling and
            adequate healthcare. Hence, in-custody programs often mark
            their first and only opportunity for HIV prevention education
            and in the best teachable moment: when constituents are sober,
            contemplative, and in single sex environments. In our
            experience while education is available to some portion of
            prisoners at some times in some facilities, all programs could
            benefit from increased access by community service providers
            and health departments and prisoner peer educators to provide
            HIV education. We particularly support the provision of
            educational materials to be available at intervals during
            incarceration including at orientation, in medical clinics at
            regular educational programs and prior to release. In our
            experience education, particularly about a sensitive topic as
            HIV, is best reinforced frequently and provided repeatedly to
            individuals who at various points during their lives and
            incarceration may be more open to receiving such information.

              Controlling the HIV epidemic begins with more people
            knowing their HIV status. HIV Testing upon request is the norm
            in the general public and should be the case inside
            correctional facilities as well. We are delighted that the
            legislation stipulates that an inmate request for an HIV test
            can not be used against her or him in a punitive manner. The
            few obstacles to testing that exist the greater likelihood that
            an individual will choose to be test and begin to make
            healthier choices upon learning their HIV status.

              The encouragement of HIV testing of pregnant women is
            also critical and is the norm in the general population. We
            know that we can stop the transmission of HIV from a mother to
            her child if the appropriate treatment is given at the right
            time.

              By doing HIV prevention and treatment education in
            correctional facilities for the past seven years, we know that
            HIV is often one a myriad of issues that our clients face. For
            this reason, we apply a holistic approach to treatment. We are
            pleased that this bill calls for comprehensive treatment as
            well. Not only is comprehensive HIV treatment the goal in the
            general public but it is a more effective approach to reducing
            re-infection and prolonging lives. The confidential counseling
            and voluntary partner notification aspects of this legislation
            are important too because they help to create an environment in
            which HIV positive inmates will seek out and adhere to
            treatment.

              Providing for a formulary that will contain all of
            the FDA-approved medication necessary to treat HIV/AIDS is
            essential. The science around HIV is constantly evolving and
            the disease affects people differently. One drug that does the
            trick for one person may not work at all for another. The
            provision of automatic renewal systems for medication is also
            essential and we're glad it's included in this bill. It is not
            uncommon for inmates to go without medications for weeks
            because their prescription expired after three months--but
            access to a physician to renew them took more than that time.
            We were able to resolve this issue with the Sheriff's
            Department of Los Angeles County, and we are happy to see that
            this specific issue was addressed in this bill. It reflects the
            author's comprehensive understanding of the challenges of HIV
            care in an incarcerated setting.

              Requiring that medical and pharmacy personnel provide
            timely and confidential access to medications similarly
            reflects that the author of the legislation understands that in
            correctional settings it is difficult to provide medications in
            a way that protects confidentiality. In our experience, HIV+
            prisoners' confidentiality is often violated when medications
            are distributed to folks in long lines and without a way to
            conceal the type of medication being distributed. And as you
            know, one's HIV positive status is a highly protected status in
            terms of confidentiality law in the general public and should
            be in incarcerated settings due to the many real negative
            implications that can and do result from being HIV positive in
            prison or jail.

              We assist inmates in developing pre-release plans
            that take their health into consideration and know the
            effectiveness of these types of tools. We are happy that this
            bill provides for similar planning especially. Many inmates
            often lack access to adequate health care but can be helped to
            surmount the obstacle with the proper planning

              To our knowledge, no population is required to take
            an HIV test. We are happy that this bill provides a clear opt-
            out provision for inmates. While we believe it is important for
            more people to know their status, we know that inmates are more
            likely to make healthier choices after learning their status if
            they choose to take the test themselves.

              The bill further requires that testing be offered
            upon entry and release, in contrast to legislation proposed in
            various other jurisdictions requiring testing only upon exit.
            Testing upon entry and release is preferable because it allows
            an individual receiving a positive diagnosis to do so in an
            environment where he or she can receive required care, rather
            than just a diagnosis upon departure.

              The exposure incident provision in the bill is one
            which we look forward to working with the author to improve. It
            could be argued that this provision making prisoners living
            with HIV the subject of scrutiny rather than members of our
            community to be supported with increased counseling and testing
            and educational resources. We agree with the goal of reducing
            intra-mural HIV transmission including to staff but we believe
            this could be done in a different manner.
                                 in conclusion
        We are pleased that the Congress of the United States has taken
    official notice of the issue of HIV among the incarcerated. We support
    efforts to increase HIV testing in a manner that mirrors HIV testing in
    the community, takes advantage of the public health opportunity
    incarceration presents without taking advantage of prisoners and their
    decreased capacity to decline or meaningfully consent to participation
    in interventions.
        Thank you for the opportunity to provide our expertise to those
    whose goals are consistent with our mission: to empower those affected
    by HIV and incarceration to make healthier choices.
        Thank you.

                                   ATTACHMENT

        Ms. Waters. Thank you.
        Mr. Scott. Thank you.
        Mr. Fornaci?

    TESTIMONY OF PHILIP FORNACI, DIRECTOR, D.C. PRISONERS' PROJECT,
       WASHINGTON LAWYERS' COMMITTEE FOR CIVIL RIGHTS AND URBAN
                        AFFAIRS, WASHINGTON, DC

        Mr. Fornaci. Good afternoon. Thank you. My name is Phillip
    Fornaci. I am director of the D.C. Prisoners' Project at the
    Washington Lawyers' Committee for Civil Rights.
        In that capacity, we work with folks who are incarcerated
    here in D.C. And as probably most of you are familiar, in D.C.,
    all folks who are convicted of felonies are sent into the
    Federal Bureau of Prisons. So we work very closely with folks
    who are held in the Federal Bureau of Prisons.
        I wanted to thank the Chairman for having this hearing and
    to especially thank Congresswoman Maxine Waters for her
    leadership on this bill. It is a very important step in curbing
    the spread of HIV, which has decimated so many communities in
    this country.
        We believe that testing combined with effective AIDS
    education efforts can help to prevent new HIV infections. This
    is really where we are going.
        About a dozen years ago, I used to run the largest legal
    organization in D.C. that was geared toward protecting people
    against discrimination based on HIV. A dozen years ago, things
    were a little bit different. It was very common to have
    landlords who would not rent to someone with HIV, employers who
    would not hire someone, doctors who would not even treat
    someone with HIV. And a lot of that has changed, in part
    because there has been such a massive public education effort
    that has gone on over the years and the awareness has grown.
        But I think we need to remember that in jails and prisons,
    it is different. They have not had that exposure, generally
    speaking, to those kinds of educational efforts. It has not
    reached them or in any case has not been received. It is not
    been clear I think to a lot of prisoners how HIV is spread, how
    it affects people who have it. And discrimination is rampant in
    the world of folks who are incarcerated, in a world that is
    marked by violence and desperation.
        We had a case a few years ago that we actually just settled
    last year involving someone in a jail facility who, because he
    had some dispute with a corrections officer, that corrections
    officer posted his medical records on a bulletin board that was
    in a common area of the jail. That inmate was subjected to
    physical violence, his bed was burned, and faced harassment for
    the rest of his stay in jail.
        So we want to be aware that those kinds of things do
    happen, and they will happen again in the future. We want to
    try to prevent it, but this is the culture into which we are
    dropping this bill, and I think it is important that we
    understand that.
        Some comments on the legislation specifically.
        We commend the idea of comprehensive HIV education and the
    testing protocol, and particularly we would also like to
    commend the inclusion of the opt-out provision. Testing in
    itself will do nothing unless people are willing to do
    something with the test results. We can't force people to get
    tested and say, ``Ha, ha, you are positive,'' and expect for a
    result to come out of it. It needs to be a voluntary process,
    as Mr. Jones has already testified, to make that effective.
        So I would urge you to certainly preserve the voluntary
    nature of the testing program, which is so crucial, and
    consider adding a written informed consent that is some kind of
    a sign-off for the individual prisoner to say, ``Yes, I have
    been told I can opt out of it; I have decided to get tested,''
    or, ``No, I have not.''
        We just want to make sure that there is no coercion in this
    whole process, which is very, very likely to happen without
    some kind of a formalistic process of informed consent.
        I have one concern with regard to the bill, and it is not
    so much concern about the bill but the environment in which we
    are bringing it into, is the confidentiality provisions. They
    could potentially be strengthened in the bill. And I wanted to
    give a few suggestions, and you may do with them what you may.
    They are in my written testimony. I will elaborate slightly.
        One is that we want to require that no non-medical staff
    have access to medical records. This is a basic premise, and it
    is generally the rule in most penal institutions but not
    always, and very often it happens that people have non-medical
    staff have access to medical records. When they do, it causes a
    problem.
        The other thing is there need to be swift and certain
    consequences, including potential job dismissal, for staff who
    allow confidential medical information, including information
    about HIV, to be released to another prisoner. This is where
    problems result, when the information becomes widely known and
    people become known as HIV-positive within a prison setting. It
    will lead to violence, undoubtedly.
        We also want to ensure that there is adequate staffing
    patterns so that people are protected from violence, which
    again we know is more common than we would like to think in
    these facilities. And there will be more of it when we are
    dropping in a situation where many, many people will be tested
    for HIV and many people who didn't know they were positive were
    find out they are positive.
        Finally, I want to raise the issue of the Prison Litigation
    Reform Act. Actually it creates a little bit of a barrier to
    enforcing the confidentiality provisions of this bill. If, for
    example, the instance that I brought up earlier of a person
    whose medical records are posted on the wall, there would be no
    remedy for that person because of the Prison Litigation reform
    Act. Because it did not cause a physical injury to them despite
    that it caused much humiliation and pain and suffering, they
    would not be entitled to any kind of litigation as a result of
    that confidentiality breach.
        Finally, I just want to make one statement with regard to
    the HIV testing on re-entry, which is a great idea and I
    commend you for including that in the bill. I would again,
    though, specifically include language that I have put in my
    written testimony, basically that a refusal to take an HIV test
    will not affect the program placement or the person's
    eligibility for a halfway house placement. And there is a very
    strong possibility of discrimination against people who decide
    they don't want to be tested for whatever reason and they need
    to get into a halfway house.
        We had an incident a few years ago, we had a case where one
    of our clients was to be released on parole, and it became
    known to the parole authorities that she was HIV-positive. She
    actually told them because she had taken coursework in how to
    live with your HIV diagnosis. She was denied parole. We had to
    bring actually a habeas corpus suit in that situation to win
    her release, in part because people didn't understand HIV in
    the parole process.
        So I just wanted to raise some cautionary remarks. But
    again, I want to commend this Committee and particular
    Congresswoman Waters for bringing this.
        Thank you very much.
        [The prepared statement of Mr. Fornaci follows:]
                      Prepared Statement of Philip Fornaci
        Thank you for this opportunity to provide testimony on H.R. 1943,
    the ``Stop AIDS in Prison Act 0f 2007.'' In particular, I would like to
    thank Representative Maxine Waters for her outstanding leadership on
    this issue, as well as the important roles played by Congressman
    Conyers, Congressman Smith, Congressman Scott, Congressman Forbes,
    Congresswoman Lee, and Congresswoman Christensen as co-sponsors.
        My name is Philip Fornaci. I am Director of the D.C. Prisoners'
    Project, a section of the Washington Lawyers' Committee for Civil
    Rights & Urban Affairs. Our organization represents D.C. prisoners held
    both locally in D.C. jail facilities as well as those held in the
    federal Bureau of Prisons (BOP), where those convicted of felonies in
    D.C. are sent. We advocate for appropriate medical care, protection
    from violence, and access to basic constitutional rights.
        Although D.C. prisoners are a small percentage of the overall BOP
    population, more than 7,000 D.C. prisoners are spread throughout 99
    separate BOP institutions, and our organization receives correspondence
    from individuals living in as many as 70 different facilities every
    year. Because we focus heavily on health care issues in the BOP, we
    have a great deal of experience with regard to medical care at a wide
    range of facilities. Additionally, because D.C. prisoners have a
    higher-than-average prevalence of HIV infection than other prisoners in
    the BOP, we have a broad perspective on issues facing people with HIV
    in these facilities. I appreciate the opportunity to comment on this
    legislation.
        The most significant aspect of the Stop AIDS in Prison Act is
    simply that it provides official recognition of the AIDS epidemic
    within the federal Bureau of Prisons (BOP). Because most prisoners in
    the BOP will eventually leave prison, BOP policies and procedures can
    have a strong impact on public health efforts to limit the spread of
    HIV outside of prison. Effective AIDS education programs, policies that
    encourage and support responsible behavior, and comprehensive medical
    treatment for people in BOP custody are therefore extremely important
    for all Americans.
                                  hiv testing
        The centerpiece of the Stop AIDS in Prison Act is its mandate for
    routine HIV testing in all BOP facilities in the context of pre- and
    post-test counseling. I commend the bill's sponsors for recognizing
    that ``routine HIV testing'' requires provisions to allow people to
    ``opt out'' of HIV testing if they choose to do so, while also giving
    prisoners an opportunity to receive this important information about
    their health.
        The opt-out provision is particularly important because, consistent
    with the goals of the legislation, it does not simply coerce prisoners
    into learning their HIV status. It recognizes that prisoners need to
    choose to be tested for the goals of the legislation to be achieved.
    Effective HIV prevention requires HIV education, along with testing, so
    that people can change their behaviors. The prisoner must enter the
    process voluntarily, be willing to learn about how to protect himself
    and others from infection, and use that information when he is
    released. A more coercive approach that does not allow a prisoner to
    decline testing is unlikely to be effective in achieving the
    educational purposes behind testing. HIV testing on its own does
    nothing to prevent the spread of HIV. What happens after testing is
    crucial.
        Recommendation: Written Informed Consent. To preserve the viability
    of the opt-out provision, and to ensure that all prisoners recognize
    that they have the ability to refuse testing, it is extremely important
    that the bill be amended to include provisions for written informed
    consent. Currently, there are no controls in place that will ensure
    that prisoners have free choice to exercise their opt-out right, and
    there is significant room for coercion. Remedying this need not be
    complicated. In order to ensure that prisoners are aware that they have
    the right to be tested, and the right to refuse to be tested, the BOP
    can design a simple form to that effect, which would remain in the
    prisoner's medical file. It would also ensure that, rather than simply
    telling prisoners that they have a free choice around testing, there
    are actual procedures in place documenting a prisoner's exercise of
    that choice.
                                 hiv treatment
        Another important aspect of the bill is the requirement that
    prisoners testing positive for HIV receive comprehensive HIV treatment.
    Although the BOP is required to provide constitutionally-mandated
    levels of medical care, it is not always delivered in every BOP
    facility. We frequently receive reports from men and women who have
    been denied consistent HIV treatment while in the BOP, with frequent
    treatment interruptions. Some BOP facilities tend to provide only the
    most minimal treatment for HIV, changing medications in favor of the
    least-expensive treatments, regardless of their effectiveness. (This is
    particularly a problem in privately-owned facilities that contract with
    the BOP.) Other facilities have chaotic health care delivery systems
    that result in prisoners missing treatments or receiving the wrong
    medicines.
        It is important to recognize that treatment for HIV also requires
    that facilities provide adequate levels of general health care. People
    with HIV often also have hypertension, diabetes, or hepatitis.
    ``Comprehensive medical treatment to inmates who are living with HIV/
    AIDS'' (section 2(b)(1)) must also include treatment for non-HIV
    conditions for people who also have HIV.
        It is my hope that, with enactment of this legislation, the BOP
    will take this legislative mandate seriously, effectively monitoring
    its facilities to ensure that every prisoner's serious medical needs
    are being met. At this point, no such effective monitoring process is
    in place.
                            confidentiality concerns
        The bill contains language aimed at protecting the confidentiality
    of HIV-related medical information (section 3(7)), but this language is
    unfortunately inadequate for the important task at hand. Although
    stigma and prejudice associated with HIV infection have decreased to
    some extent in the broader society over the last twenty years, people
    with HIV still suffer from job and housing discrimination as a result
    of their HIV status. Despite many years of public education, huge
    segments of the U.S. population still retain false information about
    HIV and about the people who live with it. Unfortunately, HIV is not
    treated like other diseases.
        Within the walls of any BOP prison, however, the situation is far
    worse. HIV is not treated like diabetes or hypertension. People with
    HIV in jails and prisons across the U.S. are isolated and singled out
    for violent treatment. Outmoded beliefs about how HIV transmission
    occurs, as well as false stereotypes about people infected with HIV,
    are commonplace. It becomes fodder for homophobic attacks and physical
    violence. Ignorance about HIV runs rampant not only among prisoners but
    among correctional and even medical staff as well. In the prison
    setting, where violence (including sexual assault) is ever-present,
    persons with HIV must keep their HIV status private for their own
    protection. Identifying as a diabetic or even someone with mental
    illness does not place people at risk of violence; identifying as HIV-
    positive may cost a prisoner his life.
        One example may be instructive. Our organization represented a man
    who, for reasons that remain unknown, had apparently gotten into a
    dispute with a correctional officer. That officer posted the man's HIV
    medical records on a bulletin board in a common area in the facility.
    As a result, our client was threatened repeatedly through anonymous
    notes and, when he was moved to another facility, the threats continued
    and his bed was burned. Although he survived, he lived the rest of his
    sentence in fear of further attacks, knowing that both staff and
    prisoners were potential assailants.
        However, unlike in our case, where we were able to bring litigation
    under local law, the federal Prison Litigation Reform Act (PLRA) will
    prevent any BOP prisoner whose confidentiality has been breached from
    enforcing this provision of the bill. There is no way for a prisoner to
    enforce the confidentiality provisions of this bill, nor is there any
    way to recover damages for the terror, mental anguish, and threats that
    would result from a confidentiality breach.
        Recommendation: Strengthen the confidentiality provisions of this
    bill. As in the case described here, corrections staff themselves
    sometimes use HIV information to manipulate and harass prisoners, just
    as some staff commonly use information about a prisoner's sexual
    orientation or alleged status as a ``snitch'' to enforce a code of
    behavior. Simply educating staff about the importance of
    confidentiality will do little to deter such actions. In the context of
    this bill, where thousands of people with HIV will be identified, it is
    imperative that the BOP adopt strict procedures to protect prisoners
    potentially stigmatized by their HIV status. Specifically, enhanced
    confidentiality protections should include:

              A requirement that no non-medical staff have access
            to confidential prisoner medical information. There is no
            security-based reason why a corrections office would need to
            know any confidential medical information, whether HIV status,
            a mental illness diagnosis, or cancer.

              The guarantee of swift and certain consequences,
            including job dismissal, for staff who allow confidential
            medical information (including information about HIV status) to
            be released to another prisoner.

              Adequate staffing patterns and transparent
            institutional rules protecting prisoners against violence from
            other prisoners, regardless of the cause of the violence.

              Include under this bill an exemption from the PLRA's
            physical injury and exhaustion of administrative remedies
            requirements to allow prisoners to file individual lawsuits to
            enforce this provision when corrections staff fail to protect
            their confidential medical information.
                             hiv testing and parole
        The requirement that prisoners be tested prior to release is a
    useful opportunity, and probably the most appropriate time for HIV
    testing. However, individuals may have their own reasons for not
    wanting to be tested while incarcerated and wish to exercise their opt-
    out rights.
        A few years ago, our organization represented a woman whose parole
    was denied because parole authorities found out she was HIV-positive.
    They discovered this because the woman revealed this fact herself,
    citing as proof of her educational achievements that she had completed
    a course in ``Dealing with Your HIV Diagnosis.'' The parole
    authorities, expressing a level of ignorance not uncommon in some parts
    of the broader community, decided that she would be a risk to the
    community. We had to file a habeas corpus petition to secure her
    release on parole, which was successful largely because the case
    generated some media attention.
        There are many other reasons why prisoners may not want to be
    tested prior to release, both practical and psychological. Their rights
    to refuse should not be taken lightly.
        Recommendation: Explicitly endorse the right to opt-out of testing
    prior to reentry. Although the bill refers back to the opt-out
    provision, that provision does not address issues like release to
    halfway house or other pre-release issues. Section 3(9) should also add
    language similar to: ``However, the inmate's refusal shall not be
    considered a violation of prison rules, result in disciplinary action,
    or affect program placement, including eligibility for halfway house
    placement.
        Thank you for this opportunity to provide comments on this
    important piece of legislation. I am available to answer any questions
    you may have.

        Mr. Scott. Thank you.
        Admiral Kendig?

      TESTIMONY OF REAR ADMIRAL NEWTON E. KENDIG, M.D., ASSISTANT
    DIRECTOR, HEALTH SERVICES DIVISION, FEDERAL BUREAU OF PRISONS,
               U.S. DEPARTMENT OF JUSTICE, WASHINGTON, DC

        Admiral Kendig. Good afternoon, Chairman Scott, Ranking
    Member Forbes and Members of the Subcommittee. Thank you for
    the opportunity to discuss the Bureau of Prisons' Infectious
    Disease Management Programs and the Stop AIDS in Prison Act of
    2007.
        My name is Newton Kendig, and I serve as the medical
    director for the Federal Bureau of Prisons. Prior to my current
    position, I served as the Bureau of Prisons' chief of
    infectious diseases. Previously I was medical director for the
    Maryland Department of Correction and Public Safety and, prior
    to that, infectious disease fellow at Johns Hopkins University.
        I am board-certified in infectious diseases and internal
    medicine. I am also on faculty at Johns Hopkins University,
    where I provide care to patients with HIV infections and AIDS
    in a clinic at the university hospital.
        I believe the Stop AIDS in Prison Act of 2007 addresses an
    issue that is of great significance and importance to all of us
    who work in corrections and particularly to physicians who
    provide care to patients who are infected with HIV.
        Bureau of Prisons has a comprehensive infectious disease
    management program that has been remarkably effective in
    diagnosing and treating inmate patients with HIV infections as
    well as controlling the spread of HIV within the Federal prison
    system.
        The prevalence of HIV in the BOP's inmate population has
    been between 0.9 percent and 1 percent, based on multiple
    surveillance testing. Currently the prevalence of diagnosed HIV
    infection is 0.9 percent.
        Acquisition of HIV infection among inmates in the Bureau of
    Prisons is exceedingly rare. In a 1999 admission cohort, 4,826
    inmates without HIV infection were retested several times over
    a 2-year period, with only one conversion.
        All sentenced inmates in the Bureau of Prisons receive a
    physical examination within 14 days and a preventative health
    assessment within 6 months of arrival at an institution. The
    assessment includes screening for signs and symptoms of HIV
    infection. HIV testing is conducted for all inmates with risk
    factors for infection and when otherwise clinically indicated.
        Inmates are reassessed at least every 3 years through their
    incarceration as part of our preventive health care program.
        Inmates are also subject to health care assessments during
    routine and non-routine physical examinations and during
    chronic care appointments. These visits provide ongoing
    opportunities for HIV testing throughout incarceration,
    including testing prior to release.
        With our infectious disease management program, the Bureau
    of Prisons has the following general categories of inmates for
    the presence HIV: inmates who volunteer at any time, when
    testing is clinically indicated, following a blood exposure
    event and during surveillance testing conducted randomly or
    serially.
        We are aware of the newly issued guidelines by the Centers
    for Disease Control and Prevention that recommend community
    standards be changed to include HIV screening as a part of
    routine clinical care in all health care settings. We have
    concerns, however, with the requirement in this bill to test
    all Federal inmates upon release, even in the absence of
    clinical indications.
        The Bureau of Prisons believes this testing requirement is
    not consistent with practical medical judgment for the Federal
    inmate population. Our available incident data and clinical
    experience indicate that Federal inmates are rarely contracting
    HIV infection while incarcerated in the BOP.
        We have been extremely successful in controlling HIV
    transmission within our facilities through a combination of
    inmate education, a medically practical testing program and
    prevention of the behaviors linked to the transmission of HIV
    infection.
        We are concerned that the use of health care staff to test
    all inmates upon release will take away from the time these
    staff spend on other critical health care services. We need to
    ensure that important public health measures, such as securing
    post-release access and necessary medical care are provided to
    inmates.
        The BOP believes we should not risk shifting limited
    resources away from important post-release health care needs.
        Chairman Scott, this concludes my formal statement. And
    again, thank you for the opportunity to comment.
        [The prepared statement of Admiral Kendig follows:]
                     Prepared Statement of Newton E. Kendig

        Mr. Scott. Thank you.
        Did you want to start?
        Ms. Waters. Thank you very much.
        First, Mr. Chairman, I would like to thank all of our
    panelists who are here today sharing such valuable information
    with us. Just sitting here listening to you, I have learned an
    awful lot. And I do have several questions.
        Mr. Brown, given the fact that you guys are leaders in
    testing inmates, what is the reaction of the inmates to the
    idea that they are being tested for HIV/AIDS? Is it done as
    part of a comprehensive examination when they come in, for
    example? How do you do it?
        Mr. Brown. First of all, the inmates are very receptive to
    it, very receptive to it. We do have the opt-out provision, as
    your bill calls for.
        Ms. Waters. Yes.
        Mr. Brown. Those that choose to opt out usually do it
    because they already know their HIV status. It is part of our
    routine medical screening, just as we test for tuberculosis or
    venereal disease, we test for HIV. And as I said, there is the
    opt-out provision.
        Ms. Waters. Mr. Brown, we have built-in confidentiality
    protections in the bill. Have you had a problem with people
    being exposed and being harmed in any way, similar to what has
    been described today?
        Mr. Brown. Well, what was described was something that
    happened reportedly years before the initiation of this
    program. No, we have not had not one single case where there
    has been a breach of confidentiality. As Mr. Fornaci points
    out, if that should happen there will be swift consequences to
    anyone that is guilty of that violation.
        Ms. Waters. Do you have anyone other that medical personnel
    that is handling medical records?
        Mr. Brown. No, only medical personnel.
        Ms. Waters. Okay.
        Dr. Kendig, what is the incubation period for the HIV
    infection that leads to AIDS? How long does it take?
        Admiral Kendig. From the time of infection to the
    progression to AIDS on average is 10 years without
    antiretroviral therapy, on average.
        Ms. Waters. So given that you don't do routine testing,
    that it is only testing when it is indicated, or if there is an
    incident where there could have been transmission and you are
    trying to protect the workers there, is it possible that you
    could have inmates who could serve 5 or 6 years in prison and
    their HIV/AIDS status cannot have been detected by anybody?
        Admiral Kendig. Certainly it is possible.
        I do want to emphasize, though, that we are very concerned
    about identifying all infected inmates upon entry to our
    system. Last year we tested well over 24,000 inmates.
        Our clinical practice guidelines make it very clear to our
    clinicians they should have an extremely low threshold for
    testing. And so if there is any indication at all that there
    are risk factors for HIV acquisition, we test those inmates
    upon entry and we repeatedly go back then, because we think it
    is critical to get them treatment.
        Ms. Waters. Well, let us be clear. Let us be clear, because
    we don't want to be confused. You do not have routine testing
    for all inmates coming into the system?
        Admiral Kendig. Correct.
        Ms. Waters. It is only done if it is indicated, or you
    mentioned something about a kind of surveillance or something
    like that. But you don't have routine HIV/AIDS testing for
    inmates entering or exiting prison. Is that correct?
        Admiral Kendig. If by ``routine'' you mean we offer testing
    to every inmate, no. But we do also in addition to the testing
    categories you mentioned, we have testing upon request, inmate
    request, at any time.
        Ms. Waters. But again, we are clear, you don't have it
    routinely for all inmates entering or exiting. And there is
    this incubation period that you just described, which it is not
    unreasonable to believe someone could serve time in prison, 2,
    3, 4, 5, 6 years, and not be detected. Is that possible?
        Admiral Kendig. It is possible.
        I would just mention, with all respect, that it is also
    possible with opt-out. Our testing that is risk-based is
    mandatory. With an opt-out provision, there is also the
    potential that inmates that have injection drug use histories
    or other high-risk behaviors would also not be detected.
        Ms. Waters. Based on the question that I asked Mr. Brown
    about the reaction of inmates to the knowledge that they have
    testing available, it seems that what I am hearing is that most
    of the inmates want to know whether or not they are infected
    and they would welcome treatment and would be better positioned
    when they leave to manage their infection and not to infect
    others.
        Would you agree with that?
        Admiral Kendig. I would. And that, ma'am, would certainly
    be our hope. We do show a videotape to all of our inmates
    currently where former Bureau of Prison inmates, both genders,
    all races, talk about their experience with HIV infection and
    encourage our inmates to be tested. And with this bill, we
    would continue to approach this with peer oriented education.
        Ms. Waters. What percentage of your inmates are actually
    tested? What percentage of the people ask to be tested?
        Admiral Kendig. I don't have the answer to that question.
        Ms. Waters. Describe your surveillance testing to me.
        Admiral Kendig. We have two types of surveillance testing
    that are permitted through our policy and rules language.
        One is random testing, and that is to assess the
    prevalence, so it is broad-based, where we test across the
    Bureau of Prisons, to determine our prevalence.
        Ms. Waters. How often is that done?
        Admiral Kendig. It is done periodically.
        Ms. Waters. But no set----
        Admiral Kendig. No.
        Ms. Waters. And when was the last time?
        Admiral Kendig. In 1999.
        Ms. Waters. In 1999?
        Admiral Kendig. Yes.
        Ms. Waters. This is 2007?
        Admiral Kendig. Yes.
        Ms. Waters. That is a long time.
        Admiral Kendig. It is.
        Ms. Waters. I would like to thank Mr. Jones for coming from
    my hometown. And I would like to thank you for your testimony.
        I am particularly interested in how you assist inmates who
    are exiting to be able to continue and maintain care.
        Mr. Jones. We help them by putting together a pre-release
    health plan, and it addresses a number of issues in their
    lives, because oftentimes for these clients HIV is a small part
    of what they have to deal with. Oftentimes, they are homeless,
    unemployed, so on and so forth. So we help them to address all
    of the issues going on in their life as well as HIV.
        And if they are positive, currently in L.A. County or in
    most of California, there is a transitional case management
    program. So if you are positive, you get linked on care on the
    outside. You get linked to a doctor, to housing in some cases.
        Our programs focus people who don't know their status or
    have not been tested positive. We try to make sure that they
    stay negative, if they are negative.
        Ms. Waters. And do you have some suggestions for us? In our
    bill we talked about on exit the counseling, 30-day supply of
    medicine and referral or follow-up. Do you have some way that
    you can suggest we should strengthen that?
        Mr. Jones. I think that it is great that you definitely
    include that in there, because the link from incarceration to
    being released is very critical, and if people are just kind of
    put out there into the community with no support, then it is a
    missed opportunity, especially because for most of the
    population they don't get any public health messages. So I
    think the fact that you are giving them the medication and the
    counseling, that is great.
        Perhaps some education could happen for parole officers. In
    our experience, we have found that some parole officers don't
    know how to deal with that type of information. And sometimes
    they use it against them. And so if we can help to strengthen
    the support of parole officers to support those inmates, that
    can be helpful.
        Ms. Waters. Thank you very much.
        Mr. Scott. Thank you.
        Mr. Forbes?
        Mr. Forbes. Thank you, Mr. Chairman.
        I would like to echo Congresswoman Waters in thanking you
    all for being here, especially for your patience in putting up
    with us having to go back and forth today.
        I support this bill and am a cosponsor of the bill, but I
    do want to ask some questions that I think are important for us
    to try to understand.
        Mr. Jones, just a quick question for you, because I only
    have a few minutes. Did I understand you to say that you felt
    prisoners should have a right to have condoms?
        Mr. Jones. Correct.
        Mr. Forbes. Admiral, let me ask you a couple of questions
    too.
        On this risk-based assessment, you have two population
    groups. One is the group of people that you would determine to
    have a risk assessment that would lend themselves to be testing
    positive for HIV. And then the other set would be obviously
    individuals that do not fall in that category.
        As to those who have a higher risk factor, your testing
    right now is actually greater than the testing that would be in
    this bill since there is an opt-out factor. Is that fair to
    say?
        Admiral Kendig. I am not sure. And I agree, I don't know
    whether or not we will identify more inmates or fewer inmates.
    They are two different strategies and it is----
        Mr. Forbes. I am just talking about for the risk-assessed
    group, that one group.
        Admiral Kendig. I think because it is mandatory we are more
    sure that we will be able to----
        Mr. Forbes. Is there anyway you could argue that a
    mandatory, where you are testing everybody, would be less
    likely to pick it up than one with an opt-out provision?
        In other words, it looks like to me, if I am testing
    everybody, I have got a greater net to pick up everybody than
    if I had a provision where I am allowing people to opt out. Am
    I missing something on that?
        Admiral Kendig. Correct. Correct.
        Mr. Scott. Can they opt out now?
        Mr. Forbes. I think the admiral said there is no opt-out
    provision for that set of people with risk assessments.
        Admiral Kendig. Correct.
        Mr. Forbes. As for that other population group, the ones
    that you don't do the risk assessment, how much more likely are
    they to have HIV than the general population outside of prison?
        Admiral Kendig. First of all, I just want to clarify,
    everyone does get a risk assessment, regardless of their
    criminal history, their medical history, they get asked
    questions upon incarceration, and that is repeated during
    preventative health visits.
        We have an incredibly diverse population in the Bureau of
    Prisons and we have a subset of inmates who really are at very,
    very low risk for HIV, and that has been our strategy, because
    of that, to go through risk-based sting. But I can't really
    quantify that for you.
        Mr. Forbes. This isn't a trick question. I am just trying
    to get an answer.
        You bring the entire population in, in the prisons, and you
    do your risk assessment for everybody as they come in.
        Admiral Kendig. Correct.
        Mr. Forbes. There is a group of people that you identify
    and say they have a higher risk factor for having HIV than the
    other group. Is that correct?
        Admiral Kendig. Correct.
        Mr. Forbes. As to those individuals in that set, you have
    mandatory testing that they cannot opt out of?
        Admiral Kendig. Correct.
        Mr. Forbes. So as to that set, you have got 100 percent
    testing. As to the other group, the group that you did not feel
    met that criteria for having a higher risk assessment, how much
    more likely would that group be to have HIV than the general
    population outside of the prison?
        Admiral Kendig. I think it would be fairly comparable.
    Again, we do have diverse subsets.
        Mr. Forbes. I understand that. But it would be fairly
    comparable?
        Admiral Kendig. Yes.
        Mr. Forbes. In fact, it might even be lower because outside
    you are going to have some people who if you did an assessment
    you would say they have a high risk factor for having HIV.
        My point is, we don't give testing to people outside the
    prison for HIV on a regular basis, do we?
        Admiral Kendig. Well, the Centers for Disease Control new
    guidelines recommend routine care in all health care settings
    in this country if the prevalence is less than .1 percent.
        Mr. Forbes. What about other illnesses?
        Because I think one of our concerns is this--and this is a
    leading question. I am not saying this is what she was asking,
    but I heard Congresswoman Waters, maybe you just raised the
    question, that in a 10-year period of time somebody could go
    from HIV to AIDS, and I think one of our concerns is we would
    hate to have somebody in prison in that period of time,
    granted.
        But there are a lot of other illnesses that I would be
    equally concerned about. I am thinking about colon cancer,
    prostate cancer, lung cancer, pancreatic cancer, all of which
    if you miss you may have a smaller window than 10 years. Would
    that be correct?
        Admiral Kendig. Correct.
        Mr. Forbes. Are you doing any testing on any of those
    illnesses?
        Admiral Kendig. It is part of our preventative health care
    program. We have age-based, but this is all, again, risk-based
    criteria. We follow the U.S. Preventative Task Force guidelines
    for the most part on when to screen for chronic illnesses, like
    diabetes and hypertension, for cancers such as cervical cancer,
    breast cancer, and for any chronic infectious diseases.
        So we do have published specific guidance on when to screen
    for all of these different infections and it is all risk-based.
        Mr. Forbes. Mr. Brown, are you doing testing that is the
    same kind of testing on all of your inmate population that you
    do on HIV? Do you do that for the other illnesses, such as
    colon cancer, prostate cancer, pancreatic cancer, all of the
    ones that would have, actually, a lower window than 10 years
    before we may be in a terminal situation from those?
        Mr. Brown. Keep in mind, we operate a municipal detention
    center, not a prison. But my response is the same as the
    doctors. There is a risk-based criteria that we use in making
    those type of assessments. They are done, but there is certain
    criteria.
        Mr. Forbes. Risk-based?
        Mr. Brown. Yes, sir.
        Mr. Forbes. So HIV is the only one that you do that is not
    risk-based?
        Mr. Brown. No, sir.
        Mr. Forbes. Oh, I am sorry.
        Mr. Brown. No, sir. In addition to HIV, when people come in
    our system we test for tuberculosis, we test for venereal
    disease. There is a serious of contagious diseases that all
    prison systems, including the Bureau, would test for if it met
    the ACA, the American Correction Association standards.
        So it is not just HIV. That is the exception, actually.
        Mr. Forbes. I understand.
        Last question that I would just ask, Admiral, you and Mr.
    Brown both, what do you have in terms of tangible evidence from
    individuals that you have tested, you have found that they have
    tested positive, how did that get us a better result? I mean,
    what behavioral patterns did you see change in them? How were
    we able to help them, treating them and those particular
    findings?
        Could both of you just address that for us?
        Mr. Brown. Keep in mind that our testing results have
    indicated approximately 3 percent of our intake of 19,000 that
    come through our walls each year test positive for HIV.
        Now, it is not just a matter of giving them pamphlets, it
    is not just a matter of showing a videotape. We constantly,
    just as you would go to your physician and while you are
    waiting you might see a series of health related videos on the
    TV, we have that.
        The good congresswoman asked my colleague here what in
    addition would we ask to be done to improve the bill. Keep in
    mind, the average inmate reads at less than an 8th-grade
    reading level. It is not a matter of a pamphlet. You have got
    to bring groups in that prison and educate them constantly, not
    one time but constantly, keep this at the front burner, and
    that is what we do at the District of Columbia.
        Mr. Forbes. And Admiral?
        Admiral Kendig. First of all, I hope I have shared my
    concern and my support for identifying people that are living
    with HIV infection. Unlike 10 or 15 years ago, we can provide
    life-saving intervention, so that is first key and paramount.
        But secondly, from a prevention and infection control
    standpoint, it is an opportunity to counsel the inmates about
    safe activities as far as blood exposures with cellmates that
    they need to avoid and obviously participation in prohibiting
    behaviors such as tattooing, injection drug use or sexual
    contact with other inmates that could transmit the virus to
    others. And then also pre-release, as far as going back to live
    with their families and the important measures they need to
    take to protect their loved ones.
        Mr. Forbes. Thank you all.
        Thank you, Mr. Chairman.
        Mr. Scott. Thank you.
        We are going to try to complete the questioning so we don't
    have to keep you another half-hour.
        Do you have questions, any questions?
        Mr. Coble. I was just going to apologize for my not being
    here, Mr. Chairman.
        I want to thank the admiral for the very cooperative
    exchange I have had with the BOP staff. Convey my best to
    Harley.
        I will hold my questions for later, Mr. Chairman.
        Mr. Scott. We are not coming back.
        Mr. Forbes. Now is later. [Laughter.]
        Mr. Fornaci, can you say a little about the consent form
    you had mentioned?
        Mr. Fornaci. Yes. I believe that is even the procedure that
    is used at the DCJ with their HIV testing. And it basically
    says, ``Yes, I have been told that I can opt out, and I have
    decided not to opt out.''
        Mr. Forbes. How does that differ from what is in the bill?
        Mr. Fornaci. Because the bill basically says we will give
    information, a written piece of paper that says that you can
    opt out. It doesn't necessarily mean anyone is ever reading it.
    It doesn't mean that anyone has ever acted on it. It something
    you stick in the person's file saying, ``Yes, I know about
    it,'' and it is a little measure of control.
        Mr. Forbes. And, Dr. Kendig, what services are available
    after someone is released from prison that tested positive?
        Admiral Kendig. Well, the Bureau of Prison's philosophy is
    if possible to have all inmates go to halfway houses, as a part
    of re-entry, so we can facilitate their transition to the
    community services. And so optimally we would be linking
    inmates to HIV services through the halfway house program.
        If they are a direct release, then we put together a
    transition care plan with their case manager and work with the
    social workers, particularly at our medical centers and some of
    our other facilities where we house large numbers of HIV-
    infected inmates to help with that transition plan.
        Mr. Forbes. If someone tests positive, do you consider that
    in their placement in prisons?
        Admiral Kendig. Yes. We, several years ago, implemented a
    medical classification system in the Bureau of prisons, so we
    now actually designate inmates not just based on security
    needs, but based on their medical needs. We have some prisons
    in very remote parts of the country. We have had this occur,
    where we have had doctors in remote parts of the country in the
    community who say I have never taken care of an AIDS patient in
    my career.
        Because of that, we are strategically designating inmates
    with HIV infection throughout the Bureau of Prisons----
        Mr. Forbes. But that is for medical treatment, not to
    segregate them from the population?
        Admiral Kendig. Correct, it is for medical treatment and it
    is throughout our system, but there are a few remotely located
    prisons where we would not house HIV patients for----
        Mr. Forbes. We just have a few seconds.
        Ms. Waters, do you have another question?
        Ms. Waters. Yes, I wanted to be clear about what the
    admiral said about mandatory testing in response to Mr. Forbes'
    question.
        When you say ``mandatory,'' is that really mandatory? I am
    told that if the inmate refuses the test, that he or she is
    written up for refusal to obey an order. And only in the event
    of an exposure incident involving a guard is an inmate forced
    to be tested.
        Admiral Kendig. Correct. We do not do forcible testing.
        Ms. Waters. I think it is important for you to have that
    cleared up because I think the way you were asked the question
    and the way it was answered, you were led to believe that in
    this testing procedure, that it was mandatory.
        Mr. Scott. That there was no opt-out.
        Ms. Waters. There was no opt-out.
        Mr. Forbes. That is what I thought it was.
        Admiral Kendig. Well, I mean, it is different than opt-out.
    We don't tell the inmates they have an opportunity to opt out.
    We say it is mandatory for the sake of your health and also for
    prevention purposes.
        Ms. Waters. But if they choose to opt out, that is what I
    am describing, they can opt out?
        Admiral Kendig. With sanctions, yes.
        Ms. Waters. Well, the sanction is to be written up for
    refusal to obey an order.
        Admiral Kendig. Yes.
        Ms. Waters. Is that correct?
        Admiral Kendig. Yes.
        Mr. Forbes. What is the sanction for that?
        Admiral Kendig. It would depend on the specific case, and
    they would go through a disciplinary hearing process.
        Mr. Forbes. Did you indicate you tested 24,000 inmates?
        Admiral Kendig. Yes, sir.
        Mr. Forbes. How many tested positive?
        Admiral Kendig. Two and one-tenth percent.
        Mr. Forbes. Where did we get .1 percent from?
        Admiral Kendig. That is our diagnosed prevalence, if you
    take our diagnosed number of inmates and divide it by our
    denominator. Two and one-tenth percent is when we do risk-based
    testing, we identify about twice as many individuals compared
    to our baseline prevalence.
        Mr. Forbes. Any other questions?
        We want to thank you for your testimony. This has been very
    helpful. I would like to thank the witnesses for their
    testimony.
        Members may have additional written questions which we will
    forward to you, and answer as promptly as you can in order that
    they may be part of the record.
        Without objection, the hearing record will remain open for
    1 week for submission of additional materials.
        Further, without objection, the Committee stands adjourned.
        [Whereupon, at 4:05 p.m., the Subcommittee was adjourned.]
                                A P P E N D I X

                                  ----------

                   Material Submitted for the Hearing Record

    Prepared Statement of the Honorable Maxine Waters, a Representative in
      Congress from the State of California, and Member, Subcommittee on
                    Crime, Terrorism, and Homeland Security
        I would like to thank Chairman Bobby Scott and Ranking Member Randy
    Forbes for organizing this hearing on H.R. 1943, The ``Stop AIDS in
    Prison Act,'' which I introduced last month. I would also like to thank
    both of them, as well as Judiciary Committee Chairman John Conyers and
    Ranking Member Lamar Smith, for all of their recommendations and
    assistance in drafting this bill.
                              hiv/aids in america
        Twenty-five years after AIDS was discovered, the AIDS virus
    continues to spread. About 1.7 million Americans have been infected by
    HIV since the beginning of the epidemic, and there are 1.2 million
    Americans living with HIV/AIDS today. Every year, there are 40,000 new
    HIV infections and 17,000 new AIDS-related deaths in the United States.
        HIV/AIDS is spreading especially rapidly among women and racial
    minorities. In 1985, women accounted for a mere 8% of new AIDS cases;
    by 2005 they accounted for 27%. In 1985, Hispanic Americans accounted
    for only 15% of new AIDS cases; by 2005 they accounted for 25%. In
    1985, African Americans accounted for a quarter of new AIDS cases; by
    2005 they accounted for half. African American women account for an
    astonishing 67% of new AIDS cases among women, and over 70% of new AIDS
    cases overall are found among people of color.
                          hiv/aids in american prisons
        HIV/AIDS is also spreading in our nation's jails and prisons. In
    2005, the Department of Justice reported that the rate of confirmed
    AIDS cases in prisons was three times higher than in the general
    population. The Department of Justice also reported that 2.0% of State
    prison inmates and 1.1% of Federal prison inmates were known to be
    living with HIV/AIDS in 2003.
        However, the actual rate of HIV infection in our nation's prisons
    is unknown because prison officials do not consistently test prisoners
    for HIV. There is little knowledge about the lifestyles of those who
    enter our nation's prisons, and there is usually no official
    acknowledgement that sexual activity--whether consensual or otherwise--
    is taking place in prisons. The only way to determine whether HIV is
    being spread among prisoners is to begin routine testing. Furthermore,
    if prison inmates are exposed to HIV in prison and then complete their
    sentences and return to society without knowing their HIV status, they
    could infect their spouse or other persons in their community.
        While we don't know the rate of HIV infection in Federal prisons,
    we do know that racial minorities have high incarceration rates.
    According to Department of Justice statistics, 40% of Federal prison
    inmates in 2003 were black and 32% were Hispanic. So if prisoners leave
    prison with HIV/AIDS and don't know it, the virus will continue to
    spread among minority communities.
                        the importance of hiv screening
        HIV screening is essential to stop the spread of AIDS. About one
    quarter of the people living with HIV/AIDS in the United States do not
    know they are infected. The Centers for Disease Control and Prevention
    (CDC) reports that many infected persons decrease behaviors that
    transmit the AIDS virus to sex or needle-sharing partners once they
    find out about their infection. The CDC theorizes that sexually
    transmitted HIV infections could be reduced by more than 30% per year
    if all HIV-infected persons found out about their infection and changed
    their behavior in a manner comparable to those who already know of
    their infection. When people know their HIV status, they are more
    likely to act responsibly--to protect their partners and themselves.
        On September 21, 2006, the CDC published new guidelines for HIV
    screening in health care settings. These guidelines recommend routine
    HIV screening for all patients between the ages of 13 and 64,
    regardless of risk factors, under an ``opt-out approach,'' in which
    patients are notified that an HIV test will be included in their
    routine health care and they can refuse to take the test. However,
    separate written consent for the HIV test is not required. Instead,
    consent for an HIV test can be included in the general consent for
    medical care.
        The CDC's new guidelines are an expansion of the CDC's guidelines
    for HIV screening of pregnant women, which were issued in 2001. The
    2001 guidelines recommended routine HIV screening for all pregnant
    women using an opt-out approach. The 2001 guidelines led to a dramatic
    95% decline in perinatal AIDS cases.
                         description of the legislation
        The ``Stop AIDS in Prison Act'' would require the Federal Bureau of
    Prisons to develop a comprehensive policy to provide HIV testing,
    treatment and prevention for inmates in Federal prisons. This bill
    requires the Federal Bureau of Prisons to test all Federal prison
    inmates for HIV upon entering prison and again prior to release from
    prison, unless the inmate opts-out of taking the test. The bill also
    requires HIV/AIDS prevention education for all inmates and
    comprehensive treatment for those inmates who test positive for HIV.
    This bill has 28 cosponsors and bipartisan support.
                          criticism of the legislation
        The legislation I introduced may be considered controversial by
    some people. There is a large and diverse group of stakeholders
    involved in HIV/AIDS policy debates, including HIV/AIDS advocacy
    organizations, gay and lesbian organizations, civil rights groups,
    churches and religious groups, the medical community, and even the
    entertainment industry. Everyone involved in these policy debates
    shares the same goal: the prevention and eradication of HIV and AIDS,
    but not everyone agrees on the most effective ways to accomplish this
    goal.
        One common concern that has been expressed about the ``Stop AIDS in
    Prison Act'' is that the bill does not require the Bureau of Prisons to
    obtain separate written consent from prisoners prior to an HIV test. I
    believe that requiring separate written consent as a pre-condition for
    an HIV test would defeat one of the main purposes of the bill, namely
    to help prisoners find out if they have HIV. Prisoners already have the
    right to obtain an HIV test upon request if they believe they are at
    risk. My bill would enable prisoners who do not know they are at risk
    to find out if they are infected.
        My bill does give inmates the right to ``opt-out'' or refuse
    routine HIV testing, and it requires the Bureau of Prisons to inform
    inmates both orally and in writing of this right. The claim that
    separate written consent should be required for HIV tests within
    Federal prisons is especially ironic, given the fact that the Bureau of
    Prisons' current procedures do not allow prisoners to opt-out of an HIV
    test. Prisoners who refuse an HIV test are written up for refusal to
    obey an order and could face disciplinary action. Under the bill,
    prisoners could refuse an HIV test without fear of disciplinary action.
    Nevertheless, I would be pleased to work with concerned individuals to
    ensure that the opt-out language is effective at protecting prisoners'
    rights.
                          support for the legislation
        I am honored that several prominent HIV/AIDS advocacy organizations
    are supporting the ``Stop AIDS in Prison Act.'' These include AIDS
    Action, The AIDS Institute, the National Minority AIDS Council, and the
    AIDS Healthcare Foundation. The bill also has been endorsed by the Los
    Angeles County Board of Supervisors. I request unanimous consent to
    submit letters and statements of support for inclusion in the hearing
    record.
                                   conclusion
        I firmly believe that the ``Stop AIDS in Prison Act'' will help
    stop the spread of HIV/AIDS among prison inmates, encourage them to
    take personal responsibility for their health, and reduce the risk that
    they will transmit HIV/AIDS to other persons in the community following
    their release from prison. I look forward to hearing the testimony of
    the witnesses on how this legislation would contribute to our nation's
    efforts to stop the spread of AIDS and provide effective, compassionate
    care to people who are living with HIV.