ATLANTA — In his first week in prison in Alabama, Albert Knox, a former pimp convicted of cocaine possession, tested positive for H.I.V.
Afterward, he says, guards called out “dead man walking” as he passed through the halls. He was banned from eating in the cafeteria, working around food or visiting with classmates in his substance-abuse program.
The restrictions were the result of an unusual policy: Alabama and South Carolina are the only states where H.I.V.-positive inmates are isolated from other prisoners. The goal is to stop the spread of the virus, which causes AIDS, and to reduce medical costs. The Alabama Corrections Department’s concern is that H.I.V. will spread through consensual sex, through rape or through blood when inmates give one another tattoos.
But H.I.V.-positive prisoners like Mr. Knox say they are stigmatized by the isolation and are denied equal treatment. In an era when powerful antiretroviral drugs greatly reduce the risks of transmission, they say, Alabama’s system clashes with modern medicine and addresses H.I.V. differently from more rampant viruses like hepatitis B and C. Both forms of hepatitis are more infectious than H.I.V., with hepatitis B being 50 to 100 times more infectious than H.I.V., according to the World Health Organization.
“It felt like we were lepers,” said Mr. Knox, 46, who is living in Indiana on parole. “H.I.V. inmates don’t want anything special. All we want is to be treated like regular inmates.”
Now the policy is under review. A federal judge, Myron H. Thompson of the Middle District of Alabama, plans to rule on its legality before Thanksgiving. He held a trial in September in a class action brought by the American Civil Liberties Union.
The effectiveness of segregating H.I.V.-positive inmates has faced challenges before. In 1995, a federal court upheld Alabama’s policy. The Justice Department notified South Carolina in 2010 that it was investigating and might sue to stop the policy. Most states voluntarily stopped isolating infected inmates years ago.
“We won’t out anyone as having H.I.V.,” said Peter K. Cutler, a spokesman for the New York State Department of Corrections and Community Supervision. “Our system is an ‘opt-in’ system in that inmates are not required to self-identify as being H.I.V. positive when they come into our custody.”
In Alabama, inmates are tested for H.I.V. when they enter prison. About 270 of the state’s 26,400 inmates have tested positive. They are housed in special dormitories at two prisons: one for men and one for women. No inmates have developed AIDS, the state says.
Although these dorms for H.I.V.-positive inmates have certain perks, including air conditioning and private cell, life in them comes with many restrictions. Inmates eat alone, not in the cafeteria. They wear white plastic armbands identifying them as H.I.V. positive. They cannot hold jobs around food, even though fast-food restaurants employ inmates in the general population through work-release programs.
They cannot live in dormitories for elderly or religious inmates or transfer to prisons closer to their families. Until three years ago, they could not attend prisonwide church services.
“Nothing is more important for successful re-entry than to be within visiting distance of your family and to have real work experience,” said Margaret Winter, the associate director of the A.C.L.U.’s National Prison Project. “They are denied that.”
The state says its rules have health and financial benefits. Fewer doctors are needed if H.I.V.-positive inmates are kept in two prisons instead of across the state. Those two prisons, Limestone Correctional Facility and the Julia Tutwiler Prison for Women, can be what medical experts call centers for excellence, attracting doctors who specialize in treating H.I.V.
Kim T. Thomas, the Alabama Corrections Department commissioner, said at the trial that he planned to end the rule that prohibits H.I.V.-positive inmates from working around food. He said infected inmates were banned from the cafeteria for space reasons. And he said the plastic armbands identify their dorm, not the disease.
Brian Corbett, a Corrections Department spokesman, said, “It is a proven system that has effectively prevented the spread of H.I.V. — an incurable disease — within our system.”
The costs of treating H.I.V. are substantial, and both sides in the lawsuit agreed that Alabama provides high-quality care. Bill Lunsford, a lawyer for the Corrections Department, said the state spends an average of $22,000 per year on treating individual H.I.V.-positive inmates; the total is more than the cost of medicine for all other inmates.
“There is no way we could provide the current level of care if they were spread across the state,” he said.
But medical experts say isolation is unnecessary. Other states provide a daily cocktail of medicine to H.I.V.-positive inmates at all facilities. Experts say fears about transmitting the disease through food or airborne contact have long ago been debunked.
“Alabama is living in an incredibly anachronistic world,” said Dr. Frederick L. Altice, the director of the H.I.V. in Prisons Program at the Yale School of Medicine. “Time has changed, and they have not.”
During the trial, H.I.V.-positive inmates testified that prison workers bullied and ridiculed them. One, Dana Harley, said women with H.I.V. were placed in solitary confinement for a month while the state confirmed the diagnosis. And the warden limited her access to educational programs in self-esteem, parenting and anger management, she said.
Mr. Knox said he had been sent to solitary confinement for 36 days for eating a meal in the main cafeteria. Guards told healthy inmates to face a wall whenever he passed their cells, he said.
“It was so embarrassing,” he said. “Being locked up is bad enough. But being positive in there was unbearable.”
