In every year since 1991, the rate of confirmed AIDS cases among U. S. prison inmates has been higher than in the general population. At yearend 2004 the rate of confirmed AIDS cases in State and Federal prisons was more than 3 times higher than in the total U.S. population [1]. In California there are over 1,600 prisoners or parolees identified as HIV+; approximately half are diagnosed with AIDS [2]. Current state law does not require mandatory testing to identify all HIV+ inmates, and the actual number of HIV+ prisoners is thought to be much higher, in the range of 5,000 - 8,000 [3].

Clinicians in correctional settings face extraordinary challenges in caring for HIV-infected patients, and frequently lack specialized training in HIV therapeutics and care. Medical care staff in correctional facilities often interact with HIV+ patients who may not have previously accessed care. In addition to HIV/AIDS, incarcerated populations are also disproportionately affected by higher rates of other communicable and chronic diseases such as tuberculosis and hepatitis [4]. Prison conditions often undermine adherence efforts essential to effective antiretroviral therapy, and gaps in treatment are common due to frequent transfers of inmates among correctional facilities [5]. Transitional care planning for HIV+ parolees is also challenging because of inconsistent access to care before, during and after incarceration. Because many inmates with HIV infection eventually return to the community, how correctional health care providers deal with HIV treatment within their institutions has important implications to the overall care of HIV-infected people in the community [6].