Attorneys for inmates with HIV/AIDS segregated at the Limestone Correctional Facility in Alabama filed a federal suit against prison officials and medical provider Naphcare in Birmingham last November, contending that prisoners' living conditions and medical care constituted cruel and unusual punishment. Being admitted to Limestone with AIDS was akin to a death sentence, said Dr. Stephen Tabet, the plaintiffs' medical expert specializing in infectious diseases at the University of Washington.

Tabet, who reviewed 38 medical files of dead HIV-positive inmates at Limestone, noted the many instances of AIDS-related pneumonia and wasting that he said should not have been fatal. "Consistently patients died of preventable diseases," said Tabet, who issued a report critical of Limestone's patient care.

Many patients did not get their medication or understand the importance of taking it, Tabet said. Others told him that they could not tolerate the medicines on an empty stomach at the 3 a.m. medicine calls. Prisoners too sleepy or sick to stand in lines for up to 45 minutes missed out, the lawsuit maintains.

Alabama prisoners' AIDS-related death rate in 2000 was more than twice the national prison average, according to the Justice Department. Thirty-nine men with HIV have died at Limestone since 1999. A recent state-sponsored audit called the six AIDS deaths at Limestone in the first 10 months of 2002 a "remarkably high" number.

Alabama is one of 20 states that test all prisoners for HIV but the only one to segregate HIV-positive inmates from other prisoners in both its cells and prison programs. Courts have endorsed segregation of HIV-positive prisoners, noting that states that integrate their populations have many more new HIV infections among prisoners.

Citing the pending suit, prison officials declined comment but denied the prisoners' claims in legal papers. Naphcare, until recently Limestone's medical contractor, defended its work and disputes the state audit's conclusion, and is suing its authors for libel.

"The standard of care is good," said Dr. Colette Simon, previously with Naphcare and Limestone's sole doctor responsible for 1,823 prisoners, including 237 with HIV. "All they have to do is come when they are called," she said of the prisoners. People too sick or weak to take their medicine are "not in the dorm," Simon said. "They are in my infirmary."

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