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V. Findings

The US Department of Homeland Security (DHS) fails to collect basic information to monitor immigrant detainees with HIV/AIDS, has sub-standard policies and procedures for HIV/AIDS care and services, and inadequately supervises the care that is provided. These policies are discussed in section VI below.

The consequence of these policies is sub-standard care. ICE fails to ensure that detainees with HIV/AIDS receive medical care that reflects human rights standards, or best medical practice. Nor does the care provided comply with community, national, or international standards for correctional health care. The statements of current and former immigrant detainees, set forth in detail below, demonstrate delayed, inconsistent, and insufficient care as well as a failure to protect confidentiality for a vulnerable population.

Deficient medical care included:

1) Failure to consistently deliver anti-retroviral medications.

Sometimes I will get no medication at all. Other times I will get 1 or 2 out of 3. —Peter R., a 43-year-old Jamaican man detained at Hampton Roads Regional Jail in Portsmouth, Virginia. Peter’s diary for July 2007 showed that he received a full dosage of HIV/AIDS medication only 65 percent of the time.

Detainees frequently missed entire dosages or only partial doses were delivered. The risk of drug resistance created by this practice not only endangers the detainee but is a serious threat to public health. 

2) Failure to conduct necessary laboratory tests in a timely manner, including CD4 and viral load testing as well as resistance testing.

I have no idea what my T cells are, or how I am doing with this virus.

—Diane P., a 41-year-old woman from Trinidad detained at Monmouth County Correctional Institution in Freehold, New Jersey.

Regular laboratory monitoring is critical to effective ART treatment for patients living with HIV and AIDS. CD4 and viral load testing indicate whether ART regimens should be initiated and how effectively they are treating HIV/AIDS. Resistance testing is imperative to identify whether the patient has developed resistance to certain classes of drugs and, if so, how to adjust the ART regimen. 

3) Failure to prevent opportunistic infections.

Independent medical review of detainee records found consistent failures to provide appropriate, timely treatment to prevent opportunistic infections. HIV attacks the body’s immune system, leaving patients vulnerable to serious opportunistic infections such as PCP (pneumocystis pneumonia) and toxoplasmosis.

4) Failure to ensure continuity of care including access to necessary specialty care.

I have been here for six months now and I haven’t seen a specialist on chronic disease. When I was in Arizona, the health care provider  scheduled me to see a specialist….But I wasn’t able to go because I [was transferred] back to California.

—Letter to Human Rights Watch from Samuel L., detained at the San Pedro Service Processing Center (see text box.)

In ICE custody, continuity of care for this complex, chronic disease is frequently interrupted by frequent transfer of detainees within the system and failure to transfer medical records between detention facilities.

5) Failure to ensure confidentiality of medical care, exposing detainees to discrimination and harassment.

Are you the one that’s HIV positive?

—Question asked by ICE officer to Anna F. in front of other detainees, at the Varick Street facility in New York City.

Detainees described crowded, hectic pill distribution systems and staff insensitivity that failed to protect the confidentiality of prisoners with HIV/AIDS. Still stigmatized, HIV-positive, gay, and transgender detainees face abuse and harassment from staff and other prisoners in the absence of any ICE policies designed to prevent or punish discrimination.

These treatment deficiencies are demonstrated by the following testimony and medical review.

Statements and Information from Immigrants in Detention Living with HIV/AIDS

Peter R.

There seemed to be no system for giving us the AIDS drugs.

—Testimony of Peter R., a 43-year-old Jamaican man detained at Hampton Roads Regional Jail in Portsmouth, Virginia

Peter R.⁴¹ is a 43-year-old man from Jamaica, trained as a pharmacist and a resident of the United States for 23 years. After serving time at the Washington, DC Jail, he was transferred to ICE custody in September 2006. He spent the first three months at the Piedmont Regional Jail in Farmville, Virginia. In December 2006 he was transferred from Piedmont to the Hampton Roads Regional Jail in Hampton Roads, Virginia. He has filed a claim for relief from deportation on the grounds that he will be persecuted in Jamaica because he is gay.

Peter was diagnosed as HIV positive in 1988 while living in Washington, DC. He began treatment in 1997, and was on an anti-retroviral regimen when he arrived at Piedmont Jail. ICE officials permitted him to bring one week’s supply of medication with him upon transfer, but when the medication ran out after one week, they had not yet ordered more. “They told me, we don’t have those meds, we’ll have to order them, and get ICE to authorize them.” He received no HIV/AIDS medications for two and a half weeks. Over the next 3 months, there were two additional one week interruptions in his medications. Each time they told him they had to “re-order” the prescription. As Peter stated, “There seemed to be no system for giving us the AIDS drugs.”

At Piedmont Jail, Peter found it necessary to advocate for himself in order to receive medical care. “The doctor at Piedmont wouldn’t touch me. I had to beg them to do lab work to find out my CD4 (count) and my viral load.”

At night, I was coerced into sex- they would line up and I would have to perform, you know, oral sex on them. I reported this to the guards but they did nothing. After the shower incident (in which Peter was threatened with rape) I wrote to my lawyer and she got me transferred to Hampton Roads.

Piedmont Jail transferred Peter with only two of his three anti-retroviral medications. At Hampton Roads Jail, medical staff told him that he would have to see the doctor before they could renew his medications. They took away the medications he arrived with, and two and a half weeks passed before he returned to a medication regimen. According to Peter, the medication supply situation at Hampton Roads was even worse than it was at Piedmont. “The supply situation with AIDS meds is totally a mess- I have had to beg for my medicine every month for six months, because every month they run out and they don’t have any more meds on hand.” Peter states that he has had repeated two to three week delays in receiving his AIDS medication.

Peter was initially housed at Hampton Roads in the ICE unit with other detainees but he was once again harassed. Now housed in a non-ICE unit with county jail prisoners, he feels safer. However, he continues to experience delays and interruptions in his medications. “On the ICE pod, they let me self-administer the drugs so I took them at regular times. Now, on the other pod, they won’t let me self-administer so my medications arrive at all times of the day…Sometimes I will get no medication at all. Other times I will get 1 or 2 out of 3.”

Peter kept a diary in July 2007 to record his medication delivery. This diary shows an erratic delivery of HIV/AIDS medication in which he received a correct dosage (3 pills in the morning, 3 pills in the evening) only 65 percent of the time.

A pharmacist by profession, Peter is knowledgeable about his own health. “I know more about HIV/AIDS than the doctors do. I told him that Vitamin C was good for me,

so he said I could have it. I knew to look out for the triglyceride levels due to Kaletra, but he wasn’t aware of that.”

             

Independent Medical Review

Mr. R. was on an appropriate antiretroviral medication combination.

Mr. R’s medical records document some findings that suggest inconsistent ART delivery.

o On May 14, 2007 a clinic note documents that “patient reports no Kaletra (Lopinavir/Ritonavir) given.”

o According to medication administration records, several doses of Mr. R’s antiretroviral medications were not given in March 2007.

o The records indicate inconsistent delivery of Mr. R’s psychiatric medications during several months in 2007. These medications should be taken regularly to be effective.

The medical records reviewed ended in May 2007.  If Mr. R’s medication diary for July 2007 is accurate, such inconsistent medication delivery for July 2007 is quite concerning and potentially dangerous.

o Of 51 doses recorded, he received only 33 as prescribed, or 65 percent of doses. The goal should be as close to 100 percent as possible.

o Taking only a partial ART regimen puts one at high risk for developing drug resistance. This in turn can increase the risk of becoming sicker sooner, having limited treatment options later, as well as having a potentially harmful impact on public health.

Mr. R’s blood work (including CD4 count, viral load, triglycerides, etc.) was monitored with appropriate frequency. Viral load results, however, suggested that his medication regimen was failing, and that his ART regimen should have been reevaluated. The chart documents continued use of the same regimen without evidence of such reevaluation. ⁴²

According to medical request forms in the chart, Mr. R. was charged fees for his sick call requests.

Anna F.

Almost every other day one of my pills is missing. I get my full dose only 60 percent of the time.

- Anna F., a 51-year-old woman detained at Bergen County Jail in Hackensack, New Jersey.

Anna F.⁴⁶ was born of Latvian parents in a refugee camp in Germany. She has lived in the United States since she was four years old, primarily in Brooklyn with her son and daughter (both US citizens) and her father. Doctors diagnosed Anna with HIV in 1987. Anna stated that she also has a deteriorating hip joint, high blood pressure and depression.

In May 2007, Anna was arrested on a drug offense and spent a month in jail at Rikers Island. At Rikers Island, they told her that her CD4 count was 33, and she was given anti-retroviral medications.  On the day she was to be released from Rikers, she was transferred by ICE to immigration detention at the Bergen County Jail, where she has been detained for four weeks.

Bergen County Jail conducted an intake medical exam within 24 hours of Anna’s arrival. Anna was suffering badly from methadone withdrawal. Anna had taken methadone on a regular basis for 27 years. At Rikers she received methadone, but at Bergen County she said she was told flatly that “we don’t give methadone.” Anna lay ill for 6 days in the infirmary. “I couldn’t even think about my AIDS medication because I was so sick from going cold turkey- I didn’t think I was going to make it through that.” After 6 days in the infirmary, she moved to the dorm and it took another week to get her AIDS medication started.

 Anna makes notes in her diary of the days she does not get all of her medications. She states that “almost every other day one of my pills is missing. I get my full dose only 60 percent of the time.”  Anna describes the medical staff at Bergen as very disorganized. For example, she stated, the other day they gave her someone else’s medication and just before she was about to take it, they realized their mistake and stopped her.

The medical people are also very rude to us (immigration detainees). The doctor’s first question was ‘when are you leaving?’ How do we know when we’re leaving? ⁴⁷

Concerned about the confidentiality of her HIV status, Anna tells the following story. At the ICE detention facility on Varick Street in New York City where she was held for a day between Rikers and Bergen County Jail, an ICE officer said to her, in front of other detainees, “Are you the one that’s HIV positive?”  Among those who overheard this question was a detainee on her way to Bergen County Jail and she has told other detainees of Anna’s HIV status. Anna stated that the pill distribution procedure at Bergen County Jail is not confidential. Prisoners and detainees crowd up to the pill cart, where individual medical files are sometimes left open with the contents visible.

At Bergen County Jail they house the female immigration detainees in the “medical clearance” dormitory. According to Anna, this dorm is where newly arrived prisoners are housed until they receive medical clearance to be housed in other dorms. Anna worries that with a compromised immune system, she is being exposed to contagious medical conditions. Also, Anna is very upset that her daughter cannot visit her at the facility—Bergen County offers no visiting hours on the weekends for immigration detainees. Because her daughter works Monday through Friday, she has not been able to visit her mother.

Anna has received no HIV counseling, education, or information at the Bergen County Jail.

Independent Medical Review

Ms. F. received a full medical and mental health assessment upon arrival at the facility.  The chart suggests appropriate psychiatric evaluation and care during her incarceration.

 She was prescribed an appropriate ART regimen which included the drugs Truvada (Emtricitabine/Tenofovir) and Kaletra (Lopinavir/Ritonavir).

HIV patients, particularly someone with a history of substance use, should be screened for hepatitis B and C. People taking Truvada (Emtricitabine/Tenofovir) in particular should also be screened, as its discontinuation can cause Hepatitis B to flare up. These results were not present in the record.  

With low CD4 counts of 57 and then 87, Ms. F.  should be taking prophylaxis against opportunistic infections such as PCP and possibly toxoplasmosis. The chart does not indicate that such action was taken, nor does it document any contraindications to such treatment. ⁴⁸

Medication administration records were not available. If Ms. F. received her complete ART regimen only 60 percent of the time, it would not be surprising if she developed drug resistance.

Diane P.

I have no idea what my T cells are, or how I am doing with this virus.

—Diane P., a 41-year-old woman from Trinidad detained in New Jersey.

Diane P.⁴⁹ is a 41-year-old woman detained at the Monmouth County Correctional Institution (MCCI) in Freehold, New Jersey. Originally from Trinidad, Diane has been in the United States since 1983. She spent two months in jail at Rikers Island on criminal charges, and then transferred to ICE custody in January, 2007.

Diane received her HIV/AIDS diagnosis in 2002 when she was living in Poughkeepsie, New York. Quite ill at the time, she was told by doctors that she had fewer than 50 CD4+T cells. She began anti-retroviral treatment at that time. During her incarceration at Rikers Island, lab work showed that her CD4 cell count was up to 400. The medical staff at Rikers Island continued her medication regimen.

When she was transferred to ICE custody at MCCI, no bloodwork was done to evaluate her CD4 count or viral load.  She brought her medications with her but they were confiscated, and two days passed before new medications were provided. Diane told Human Rights Watch that despite the fact that she had recently had very low CD4 counts, no lab work had been conducted for six months. She said “I have no idea what my T cells are, or how I am doing with this virus.”

Diane said that she has pain in her hands, a condition she believes to be HIV/AIDS-related neuropathy. After filling out “many” sick call requests, Diane saw a doctor who prescribed ibuprofen, which she must purchase herself from the commissary. She stated that the symptoms of pain and stinging have not subsided. Diane described the attitude of the nursing staff to sick call requests: “They try to discourage you from putting in a sick call request. I had one nurse tell me ‘don’t put in a request unless it’s an emergency.’”

Diane describes the pill distribution at MCCI as irregular. Diane said that detainees who participate in programs risk missing the pill delivery. “The meds are given out at completely random hours; literally, they are never given out at the same time two days in a row… On Saturdays when I go to Bible class I miss my morning pills altogether because they don’t come back to the dorm and find the people who were at work or at class.” Diane says she was prescribed vitamins and was receiving them for a time, but they have recently been stopped without explanation.

Diane stated that the pill line procedure fails to protect confidentiality. “There is no order to it and no private space,” she said. Prisoners jostle each other around the cart and medical records on the top of the cart are visible to all. “The other detainees are too interested in my condition and ask me why I take so many meds.” One male nurse even calls out the names of the medications sometimes, and once he called out the names of Diane’s medications as he administered them to her.

Diane has received no HIV counseling, education or information at MCCI.

           

Independent Medical Review

The chart indicates that Ms. P. received medical and mental health assessments when she arrived at the facility.

The chart documents some, but not all, lab results from Rikers from January 2007. Ms. P. received some, but not all, necessary lab work in May 2007, four months after arrival at the facility.

The chart indicates that Ms. P. was prescribed an appropriate ART regimen. Medication administration records indicate reliable medication distribution during some months but missed doses during others.

Ms. P’s viral load was not suppressed as should be expected after months on ART; therefore her ART regimen should have been reevaluated. There is no indication that a reevaluation occurred.

The chart indicates that Ms. P. was charged a fee for medical  visits.

Nargis R.

The doctor ‘recommended’ that I start treatment, but she wasn’t forceful about it so ICE ignored it. I never went on (HIV/AIDS) medication at York.  

—Nargis R., a 31-year-old woman from Trinidad detained in ICE custody for three and a half years.

Nargis R.⁵⁰ is a 31-year-old woman from Trinidad who has been in the United States since she was 9 years old. After serving a 69-day sentence for a misdemeanor fraudulent check charge, Nargis spent three-and-a-half years in immigration detention. With the assistance of her lawyer, she obtained release in 2004 and is living in a homeless shelter in New York City.

Nargis lived most of her life in upstate New York.  A Legal Permanent Resident, she graduated from high school in Albany, New York and worked as a secretary. Nargis contracted HIV from her first husband, who died of AIDS several years ago. He was a US citizen, but lacked the financial means to sponsor her for citizenship. Nargis has since remarried, again to a US citizen, but he too lacks the requisite resources to finance a sponsorship application.  Nargis’ family, including her parents, siblings, nieces and nephews, lives in the United States. She has not been back to Trinidad since she arrived in the United States 22 years ago. 

After Nargis had served 69 days for the misdemeanor charge, ICE placed a hold on her case and immediately transferred her into ICE custody at the York County Jail in York, Pennsylvania. She recalled the medical care she experienced at the York County Jail. They told her that according to her lab work, her CD4 counts were high enough that she did not need HIV/AIDS medication. She fell ill, however, with severe stomach pain and boils on her skin. “The pain was so bad that sometimes I couldn’t get out of bed.” She was moved to a unit used to isolate jail prisoners for both medical and disciplinary reasons.

The doctors at York requested from ICE that she be permitted a visit with an HIV specialist. ICE denied this request and continued to deny it for more than a year. Nargis and her attorney persisted and after the appeal went to the level of the ICE District Director she was permitted to see a specialist. The specialist told her that her CD 4 count was dropping and her viral load was increasing. “The doctor ‘recommended’ that I start treatment, but she wasn’t forceful about it so ICE ignored it. I never went on [HIV/AIDS] medication at York.”

Nargis said that confidentiality was a problem at York.  Security officers remained in the room during sick call visits, overhearing all that was said between the detainee and the nurse. She believes that the guards talked about her condition in front of the other detainees. She once offered to serve the meals to the other detainees in the dorm, but the detainees told her that they did not want her to touch their food. “The guards said that the detainees were right, and that I should clean the toilets instead.”

In the meantime, Nargis became seriously ill with repeated urinary tract infections and stomach pain. The medical staff treated her only with Tylenol, and her condition worsened. One night in the dorm she could not move, her skin was a dark color, and her stomach was bloated.  “The officer on duty noticed how sick I looked and called the medical team to the dorm. They rushed me to the hospital, where I spent three days with a severe kidney infection. They gave a morphine drip every ten minutes for the pain.”

After 14 months at York County Jail, Nargis was transferred to Denton County Jail in Denton, Texas and then to the Rolling Hills Regional Jail and Detention Center in Haskell, Texas. At Denton County Jail, the doctor placed Nargis on an inappropriate regimen not recommended for treatment of HIV/AIDS.  After several months of legal advocacy, the doctor at Rolling Hills rectified the mistake and Nargis received an appropriate three-drug anti-retroviral regimen. ⁵¹

Juan L.

I didn’t get the full dose every day.  

—Juan L., a 45-year-old man from Aruba who spent five months in immigration detention in Virginia. 

Juan L.⁵² is a 45-year-old man from Aruba, a Netherlands territory. Juan served a sentence in federal prison until April 2005, when he was transferred into ICE custody. He spent one month at the Federal Correctional Institution in Petersburg, Virginia, and four months at the Piedmont Regional Jail in Farmville, Virginia. He was deported to Aruba and now lives in the Netherlands. His wife, a US citizen, lives in Brooklyn, New York.

A carpenter by trade, Juan was diagnosed with HIV/AIDS in 1987, when he was living and working in the Bronx. He began taking anti-retroviral medication while in federal prison, and the prison medical staff gave him a month’s supply of his medication to take with him when he was transferred to ICE custody. When he arrived at the Petersburg, Virginia facility the officers took his medication away, and he was without medication for 4 days. After that, he received anti-retroviral medication but the delivery was irregular. Juan told Human Rights Watch, “I didn’t get the full dose every day.”

Upon transfer to Piedmont Regional Jail, Juan experienced a two week delay in receiving his HIV/AIDS medications. “They told me they had to wait for an order to come through…When they finally arrived, they made a big deal out of the fact that they had to buy a refrigerator to put my medication in. They made me feel like I was causing a lot of trouble.” 

The Piedmont Regional Jail charges its prisoners for medical, dental and mental health care. Piedmont Superintendent Lewis Barlowe told Human Rights Watch that ICE detainees are exempt from these fees.⁵³ However, Juan recalled:

At Piedmont, I had a big fight with the Lieutenant about paying for my treatment. They wanted to charge me to see the nurse or the doctor. The only way they didn’t charge me is that I called my consulate.”

 When I was deported, they told me they would give me a two week supply of my [HIV/AIDS] medications. But when it came time to get on the plane, they could not locate them, so I was deported without any meds. Neither ICE nor my embassy would give me any information about HIV/AIDS care in Aruba. We’re not only deported, we’re sentenced to death because they don’t care about us.⁵⁴ 

James L.

James L.⁵⁵ is a 44-year-old former musician and drum instructor from Haiti. In 2006, James served time for drug charges at Rikers Island, where he participated in an intensive drug and mental health counseling program. This program had an outpatient component, and James planned to continue with the program upon his release. On the final day of his sentence, however, ICE placed a hold on his case and transferred him to ICE custody at the Monmouth County Correctional Institution (MCCI) in Freehold, New Jersey.  James spent approximately one month at Monmouth. During this time, the Legal Aid Society investigated possible representation in his immigration case. Before the representation could be formalized, however, ICE transferred James to Perry County Correctional Facility (PCCF) in Uniontown, Alabama. After three months, James was transferred to Tensas Parish Detention Center in Waterproof, Louisiana. Recently released from custody, James now lives in a homeless shelter in New York City.

James suffers from both HIV/AIDS and mental illness. When Human Rights Watch interviewed James in detention in Alabama, he had been living in the segregation unit for more than six weeks. Extremely agitated, he did not know why he had been placed in segregation. James stated that the jail officials told him it was because of a sore on his leg, but he said that the sore had healed so he did not understand why he had to be isolated. He stated that he was severely depressed and upset by the continuing isolation and that “I feel like hanging myself in my cell.”

James told Human Rights Watch that he was receiving both HIV/AIDS medications and psychiatric medications. He said that he has asked to see the counselor but was told that he comes only once a month. He showed Human Rights Watch a sick call request dated 5 days earlier, and said he had still not seen the doctor.

Officials at PCCF told Human Rights Watch that James was segregated due to a staphylococcal infection that was not responding to antibiotics. Warden David Streiff denied that James had been placed in segregation for reasons related to his HIV status.⁵⁶  According to Warden Streiff, medical staff had placed James on “visual observation” status for suicide prevention. Warden Streiff stated that there is a doctor on site four times a week, and a psychiatrist on site 3 times a week. The warden further stated that James had seen the psychiatrist.

Independent Medical Review

Mr. L. was on an appropriate ART regimen and appropriately started on prophylaxis for PCP. 

 Lipids were checked appropriately as they should be for someone on Kaletra (Lopinavir/Ritonavir). However, there is no record of screening for hepatitis B, as he should be if taking Truvada (Emtricitabine/Tenofovir.)

There was no documentation of viral load testing in the chart, critical for assessing response to ART.

Lab work indicated abnormal levels of protein and blood in Mr. L’s urine as well as low serum albumin. Such highly abnormal findings should prompt further investigation and possible referral to a nephrologist. The chart did not show evidence of further work-up or referral.⁵⁷

Antonio O.

The guards yell at me, make fun of me, they look at me with disgust. They look at us as if we’re inferior, not only because we’re gay but because we’re immigrants. To them, we’re nothing but maggots from another country that need to be swept out. They don’t even treat us like people. One of them told me, ‘you don’t have any rights, you’re not a US citizen.’ But we’re human beings, we have human rights. We have the right to keep our dignity.

—Antonio O., a 33-year-old man from El Salvador, detained at the San Pedro Service Processing Center in San Pedro, California.

Antonio O.⁵⁸ is a 33-year-old man from El Salvador detained at the San Pedro Service Processing Center in San Pedro, California. Antonio is a Legal Permanent Resident of the United States. Before his arrest on a minor drug offense, he worked as an x-ray technician. Antonio spent one month in the Los Angeles County Jail. Transferred into ICE custody on the day of his release, he had been detained at San Pedro for approximately one month.

Antonio was diagnosed with HIV/AIDS in 2005, and he began taking anti-retroviral medication treatment right away. He has been struggling to maintain his medication regimen since his incarceration. At the Los Angeles County Jail, it took three days to begin his medication regimen. He said “They wanted to give me two out of the three medications. They said they didn’t have one of them. I told them no, you can’t take two out of three, it’s bad for you. They finally gave me all three.”

When Antonio arrived at San Pedro, officials confiscated the ten day supply that he had taken with him from the county jail. He had no medication for three days. No medical records accompanied him. Antonio recounts, “They didn’t even take my blood pressure. They didn’t verify that those were the [HIV/AIDS] meds I was on, they just took my word for it. I told them my T cell count and viral load, and they just entered it into the computer, based on what I told them. I haven’t had any lab work done here.”

Antonio told Human Rights Watch that he was experiencing numbness in his toes. He had put in a sick call request 6 days previously but had not received a response.

San Pedro provided no HIV/AIDS education, counseling or information.

Antonio is an openly gay man. He told Human Rights Watch that the guards at San Pedro harass him and make fun of him, and will “send him to the hole” (disciplinary segregation) for the slightest physical contact with other detainees, however innocent it might be. Antonio explained, “It’s ok to write us up if we’re being sexual… but it gets applied to us no matter what.” According to Antonio, the housing units, called “pods”, are run not by the security staff but by certain detainees called “pod leaders.” The leader of his pod permits the gay and transgender detainees to place their bunks together in one area of the pod, where he said, “there is safety in numbers.” The transgender detainees, stated Antonio, get “sent to the hole” even more frequently than the gay detainees.

Antonio told Human Rights Watch that his pod was very overcrowded a few weeks ago, with 15-20 detainees sleeping in “boats”⁵⁹ on the floor. He said that ICE finally moved some of them out after the detainees in his pod held a protest, threatening to go on hunger strike if the overcrowding and medical care did not improve. ⁶⁰

Gloria M.

[At McHenry] they told me they would not put me on AIDS meds because I was a resident of Indiana, not Illinois, so the state would not pay.

—Gloria M., a 43-year-old woman from South Africa who was detained at McHenry County Jail in Woodstock, Illinois.

Gloria M.⁶³ is a 43-year-old woman from South Africa. In 1995 Gloria served jail time on a criminal charge, but after release obtained her green card and worked as an AIDS counselor at a non-profit agency in Indiana. She has two American-born children and her fiancé is a US citizen.

In 2003, she was detained at the airport while returning from a trip to South Africa. She was released, but immigration officials kept her green card and told her she would be notified where to pick it up at a later date. In January 2004, immigration advised her that she could pick up her green card at an office in Chicago. Upon her arrival at the office, she was told that they planned to deport her because of her 1995 criminal conviction. ICE officials directed her to change into an orange jumpsuit, and then they handcuffed her and placed her in a van. Her hands and feet were shackled during the three hour trip to McHenry County Jail in Woodstock, Illinois.

Gloria recalled, “I was devastated. I had two small children at home, and a fiancé, and a job. They processed us like criminals…The McHenry facility was chaos. They told me they would not put me on AIDS medication because I was a resident of Indiana, not Illinois, so the state would not pay. I begged them to let my fiancée bring me my medicine from Indiana, and that is how I stayed on my medicine.”

At McHenry, no intake medical exam was conducted and Gloria received no HIV/AIDS education, counseling or information.

Gloria’s HIV/AIDS status was a major issue at her deportation hearing. Gloria recalled that the prosecutor focused on it as a basis for deporting her. “He said that ‘the American taxpayers are paying for her AIDS medications’. He said this despite the fact that I had a job as an AIDS counselor, and my employee health plan paid for my medication.”  Gloria’s attorney brought in her employer and other character witnesses. Gloria was released after nearly a month in detention.

Jean P. 

“The pill cart comes in, everyone crowds around it, there’s no privacy in getting your meds. Your pill order can be lying open on the cart.

—Jean P., a 35-year-old man from Haiti detained at Perry County Correctional Center in Uniontown, Alabama.

Jean P.⁶⁴ is a 35-year-old man from Haiti who came to the US in 1991 with his father. Jean witnessed his mother’s decapitation during an outbreak of violence and destruction in his country. Jean told Human Rights Watch that he “fell in with the wrong crowd and got into trouble with drugs.” Jean served a two-year sentence in a Florida state prison before his transfer to ICE custody in May, 2005. Since 2005 Jean has been detained at the Manatee County Jail in Bradenton, Florida; the Krome Service Processing Center in Miami, Florida and the Perry County Correctional Center (PCCC) in Uniontown, Alabama.⁶⁵

Jean’s medical conditions include HIV/AIDS and hypertension.  In 1997 he had what he terms a “stroke” which left him blind in one eye and limping on his left side. He stated that the medical care at the Krome Service Processing Center was better than at either Manatee County Jail or at PCCC in Alabama. “At Bradenton they tried to kill me. There was one nurse who would always give out the wrong medication. One time after I took my meds they had to rush me to the hospital (because) my heart was beating so fast. I think they were somebody else’s meds…The doctor didn’t seem to know much about HIV either, I think he was a trainee, from the questions he asked.”

Jean described the medical care at PCCC as “very bad. I’ve been here since March, and I haven’t seen a doctor. I always ask to see the doctor but nothing happens. I don’t even know if the doctor is a woman or a man.” Jean told Human Rights Watch that they drew his blood when he first arrived at the facility. He never received the results, and when he asked them about it, they said “Have you had blood drawn?” They had lost the specimen. They drew the blood again, but that was weeks ago and he still has not received any results. There was no delay or interruption in his anti-retroviral medications when he was transferred. However, he worried, “They look different than the ones I took at Krome, and nobody has explained that to me.” PCCC has provided no HIV/AIDS education, counseling or information.

Jean told Human Rights Watch that he is very concerned about the lack of treatment at PCCC for his hypertension. Jean stated that his blood pressure has been taken only two times since he arrived more than 6 weeks ago; he said that at Krome they took his blood pressure every day. “They’ve only taken it twice here, and that’s only when I asked them to,” he stated. Jean showed Human Rights Watch a slip from the medical staff ordering a low sodium diet due to his hypertension, but none has been provided.

Jean did not feel that he had been discriminated against on the basis of his HIV status, but he expressed concern about the lack of confidentiality in the pill line. “The pill cart comes in, everyone crowds around it, there’s no privacy in getting your meds. Your pill order can be lying open on the cart.

Jean recounts that two days prior, approximately 100 detainees had refused to eat for one day because it had been two weeks since they received any soap or toothpaste and “we can’t afford to buy it from the commissary.” Soap and toothpaste were provided after the protest. The transfer to Alabama, he stated, interfered with his immigration case as it made it very difficult to contact his lawyer in Florida. “The phone card costs ten dollars for twenty minutes, and they use up a lot of the minutes telling you they are monitoring your phone call.”

Jean told Human Rights Watch that he is anxious, depressed and “tired of being locked up…I put in a request to see the psychologist but they just keep telling me I’m on the list.”

Independent Medical Review

In 2004 Mr. P. was detained at a non-ICE facility (Florida Department of Corrections). Medical records from that facility show that he was prescribed an inappropriate ART regimen. His viral load increased during this time, suggesting drug resistance. When resistance testing was finally ordered several months later, the results were incomplete.

Mr. P’s blood pressure was monitored and well-controlled while in ICE custody.

He was also referred to a hematologist when indicated.

The chart suggests some confusion regarding Mr. P’s left eye blindness, which was attributed to laser surgery, stroke, and CMV (cytomegalovirus) retinitis in different parts of the chart.⁶⁶  In 2003 (pre-ICE custody) Mr. P. was under the care of an ophthalmologist for CMV retinitis. If a patient’s CD4 counts improve on ART over a sustained period of time, it is acceptable to discontinue medication for CMV retinitis, as was done for Mr. P; however, such patients should continue to be regularly monitored by an ophthalmologist to evaluate for relapse.⁶⁷ However, the chart documents that Mr. P’s last eye exam was in 2003.  

Mr. P’s viral load increased in October 2006. Resistance testing was appropriately ordered, but not drawn until January 2007. As of February 2007, the results from this time-critical test were not available. Mr. P. was then transferred to another facility. It is unclear why there was a delay in obtaining these results, as well as whether the results were forwarded to or rechecked at the next facility.

Mr. P’s frequent transfers interrupted his continuity of care, particularly important for someone with a complicated medical history and lengthy detention.  At times, it appears that the medical records from each facility did not refer to his records from the previous detention, such as the confusion surrounding his blindness and apparent lack of awareness of his history of CMV retinitis.⁶⁸ 

Albert P.

They had no medical records for me when I was transferred here from across the street. After six weeks, I finally made copies for them from the records in my property. Now those are the only records they have.

—Albert P., a 48-year-old-man from Mexico detained at the San Pedro Service Processing Center in San Pedro, California.

Albert P.⁶⁹ is a 48-year-old man from Mexico detained at the San Pedro Service Processing Center in San Pedro, California. Albert served a two year sentence at the Federal Correctional Institution at San Pedro, a facility directly across the street from ICE’s San Pedro Service Processing Center (SPSPC). On May 17, 2007 Albert was transferred to ICE custody and taken across the street. According to Albert, his extensive medical file failed to accompany him. “They had no medical records for me when I was transferred here from across the street. After six weeks, I finally made copies for them from the records in my property. Now those are the only records they have.”  

Upon his arrival at SPSPC, Albert told the medical staff which anti-retroviral medications he had been taking. He saw them make a telephone call to verify this information, after which they prescribed these medications. No lab work has been done since his arrival more than three months ago. “They took me downstairs to draw blood three weeks ago, but the doctor looked at me and said ‘he doesn’t need blood drawn. He’s out of here.’…I don’t understand why that happened. I didn’t sign the consent to be deported. I’m going to a hearing because of my medical issues.”

Albert has received no HIV/AIDS education, counseling or information.

David E.

I told them I was HIV positive, but they did nothing. No tests or anything.

—David E., a 50-year-old man from Liberia, of his detention at the Dodge County Jail in Juneau, Wisconsin.

David E.⁷⁰ is a 50-year-old man from Liberia. David drove a taxi in New York City for more than 20 years. During that period he had a series of misdemeanor arrests. In 2006, David and his wife moved to the Chicago area. In August of that year he went to an ICE office in Chicago to check in for an interview regarding his green card. He was detained and transported to Dodge County Jail in Juneau, Wisconsin.

At the time of his detention, David was under the care of a physician for HIV/AIDS but had not started taking anti-retroviral medication. At Dodge County Jail, they did no physical examination. David said, “they didn’t even take my blood pressure,” even though he told them that he was taking high blood pressure medication at the time. As for his HIV status, the medical staff did not ask. “The only way they knew about it was (that) I told them.” There was no response during the four weeks of David’s detention. “I told them I was HIV positive, but they did nothing. No tests or anything.”

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