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110th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 110-342
STOP AIDS IN PRISON ACT OF 2007
September 24, 2007.--Committed to the Committee of the Whole House on
the State of the Union and ordered to be printed
Mr. Conyers, from the Committee on the Judiciary, submitted the
R E P O R T
[To accompany H.R. 1943]
[Including cost estimate of the Congressional Budget Office]
The Committee on the Judiciary, to whom was referred the bill
(H.R. 1943) to provide for an effective HIV/AIDS program in
Federal prisons, having considered the same, reports favorably
thereon without amendment and recommends that the bill do pass.
Purpose and Summary.............................................. 1
Background and Need for the Legislation.......................... 2
Committee Consideration.......................................... 2
Committee Votes.................................................. 3
Committee Oversight Findings..................................... 3
New Budget Authority and Tax Expenditures........................ 3
Congressional Budget Office Cost Estimate........................ 3
Performance Goals and Objectives................................. 5
Constitutional Authority Statement............................... 6
Advisory on Earmarks............................................. 6
Section-by-Section Analysis...................................... 6
Changes in Existing Law Made by the Bill, as Reported............ 7
Purpose and Summary
H.R. 1943 directs the Bureau of Prisons (BOP) to develop a
comprehensive policy to provide HIV testing, treatment, and
prevention for inmates during incarceration in Federal prisons
and immediately before reentry into the community, while
protecting confidentiality of prisoners and allowing them to
refuse routine HIV testing.
Background and Need for the Legislation
HIV/AIDS in prison poses a threat not only to prison
inmates and prison employees, but ultimately to the community
at large. Prisoners who are unaware of their condition or who
do not know how to keep others safe from the infection can
unwittingly infect fellow prisoners. Prison workers, including
corrections officers, healthcare workers, and administrators,
are also at risk from exposure incidents resulting from close
interaction with the prison population. The threat to the
community at large comes from infected prisoners being released
without having had the proper screening, education, and
treatment, thereby exposing friends and loved ones to the
The Stop AIDS in Prison Act would require initial testing
and counseling of inmates upon entry into the prison system,
and then make ongoing testing available up to once a year upon
the request of the inmate, or sooner if an inmate is exposed to
the HIV/AIDS virus or becomes pregnant. The bill requires that
the BOP make HIV/AIDS counseling and treatment available to
prisoners, and give testing and treatment referrals to
prisoners prior to their reentering the outside community.
The bill may have a particularly beneficial effect on
minority communities. According to the Centers for Disease
Control and Prevention, racial minorities comprise 69% of all
new HIV/AIDS cases in the nation. Since African Americans are
disproportionately represented in the inmate population--41
percent of all inmates in the prison system at the end of 2004,
according to the Bureau of Justice Statistics--the risks
associated with contracting HIV/AIDS in prison are one factor
putting minority communities at higher risk of exposure. The
Stop AIDS in Prison Act is therefore one way to begin reversing
the high incidence of HIV/AIDS in minority communities.
The Committee's Subcommittee on Crime, Terrorism, and
Homeland Security held 1 day of hearings on May 22, 2007.
Testimony was received and heard from Mr. Devon Brown, Director
of the Department of Corrections for the District of Columbia;
Mr. Vincent Jones, Executive Director of the Center for Health
Justice in West Hollywood California; Mr. Philip Fornaci,
Director of the D.C. Prisoner's Project for the Washington
Lawyer's Committee for Civil Rights and Urban Affairs; RADM
Newton E. Kendig, M.D. the Assistant Director of the Health
Services Division for the Federal Bureau of Prisons; and Mr.
Willie Mitchell, Chairman of the Board for San Antonio Fighting
On July 24, 2007, the Subcommittee on Crime, Terrorism and
Homeland Security met in open session and ordered the bill
H.R.1943 favorably reported by voice vote without amendment, a
quorum being present. On July 25, 2007, the Committee met in
open session and ordered the bill H.R. 1943 favorably reported
without amendment by voice vote, a quorum being present.
In compliance with clause 3(b) of rule XIII of the Rules of
the House of Representatives, the Committee advises that there
were no recorded votes during the Committee's consideration of
Committee Oversight Findings
In compliance with clause 3(c)(1) of rule XIII of the Rules
of the House of Representatives, the Committee advises that the
findings and recommendations of the Committee, based on
oversight activities under clause 2(b)(1) of rule X of the
Rules of the House of Representatives, are incorporated in the
descriptive portions of this report.
New Budget Authority and Tax Expenditures
Clause 3(c)(2) of rule XIII of the Rules of the House of
Representatives is inapplicable because this legislation does
not provide new budgetary authority or increased tax
Congressional Budget Office Cost Estimate
In compliance with clause 3(c)(3) of rule XIII of the Rules
of the House of Representatives, the Committee sets forth, with
respect to the bill, H.R. 1943, the following estimate and
comparison prepared by the Director of the Congressional Budget
Office under section 402 of the Congressional Budget Act of
Congressional Budget Office,
Washington, DC, September 7, 2007.
Hon. John Conyers, Jr., Chairman,
Committee on the Judiciary,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for H.R. 1943, the Stop
AIDS in Prison Act of 2007.
If you wish further details on this estimate, we will be
pleased to provide them. The CBO staff contact is Leigh Angres,
who can be reached at 226-2860.
Peter R. Orszag,
Honorable Lamar S. Smith.
H.R. 1943--Stop AIDS in Prison Act of 2007.
H.R. 1943 would amend current law to require the Bureau of
Prisons (BOP) to test all incoming and outgoing inmates for the
human immunodeficiency virus (HIV). The legislation would offer
an opt-out provision to most inmates. Presently, BOP performs
HIV testing on those inmates who are sentenced to six months or
more in prison if they are determined to be at risk for HIV.
CBO estimates that implementing H.R. 1943 would cost about $3
million in fiscal year 2008 and $12 million over the 2008-2012
period, assuming appropriation of the necessary funds. Enacting
H.R. 1943 would not affect direct spending or revenues.
H.R. 1943 contains no intergovernmental or private-sector
mandates as defined in the Unfunded Mandates Reform Act (UMRA)
and would impose no costs on State, local, or tribal
ESTIMATED COST TO THE FEDERAL GOVERNMENT
The estimated budgetary impact of H.R. 1943 is shown in the
following table. The costs of this legislation fall within
budget function 750 (administration of justice).
By Fiscal Year, in Millions of Dollars
2008 2009 2010 2011 2012
CHANGES IN SPENDING SUBJECT TO APPROPRIATION
HIV Testing and Services for BOP
Estimated Authorization Level 3 2 2 2 2
Estimated Outlays 3 2 2 2 2
Estimated Authorization Level * 1 * * *
Estimated Outlays * 1 * * *
Estimated Authorization Level 3 3 2 2 2
Estimated Outlays 3 3 2 2 2
Note: HIV = Human Immunodeficiency Virus; BOP = Bureau of Prisons; * =
less than $500,000.
BASIS OF ESTIMATE
For this estimate, CBO assumes that H.R. 1943 will be
enacted near the start of fiscal year 2008 and that the amounts
estimated to be necessary will be appropriated for each fiscal
Current HIV Testing Procedures in Bureau of Prisons' Facilities
Under current law, BOP performs HIV testing on those
inmates sentenced to six months or more in prison who are
determined to be at risk for HIV--about 25,000 tests a year.
Inmates can also request an HIV test once a year or when an
inmate believes that he or she has been exposed to the virus.
BOP also has the right to mandate testing for any inmate that
it believes has intentionally or unintentionally transmitted
the virus. For those who receive a test, BOP provides pre- and
post-testing counseling, regardless of the diagnosis. Inmates
who test positive for the virus--about 1 percent of the nearly
200,000 incarcerated by BOP a year--also receive treatment
during their incarceration and a 30-day supply of medication
upon their release.
New Testing Procedures under H.R. 1943
CBO estimates that implementing the expanded testing,
medical treatment, and associated services under H.R. 1943
would cost $11 million over the 2008-2012 period, subject to
appropriation of the necessary amounts. H.R. 1943 would require
BOP to test all incoming and outgoing inmates but would allow
inmates to opt out of such testing. As under current law, if
BOP believes that an inmate intentionally or unintentionally
transmitted the virus, the inmate would be subject to mandatory
testing. For inmates admitted prior to the effective date of
the new policy, a test would be required within six months.
Based on information from BOP, CBO expects that
comprehensive HIV testing would likely be incorporated into the
current medical examination system at an average cost of $10
per inmate. We estimate that the cost of additional HIV testing
on about 200,000 additional inmates in fiscal year 2008 under
H.R. 1943 would be about $2 million, subject to the
availability of appropriated funds. That first-year total would
include tests for all inmates admitted prior to implementation
of the new policy near the middle of fiscal year 2008. We
anticipate that for years after 2008, BOP would conduct about
110,000 additional tests a year (assuming that few inmates
would opt out of testing), at a cost of about $1 million
annually, also subject to the availability of appropriated
Testing of entering and exiting inmates may result in the
diagnosis of some new HIV cases. CBO estimates that the cost of
providing additional medical services for newly diagnosed
inmates would be nearly $1 million a year. We estimate that the
cost of HIV education and counseling programs would be less
CBO estimates that BOP would spend about $1 million over
the 2008-2012 period to prepare two reports required by the
bill, assuming the availability of appropriated funds. The
first report would delineate BOP procedures for testing,
treating, and preventing hepatitis and other infections
diseases. The second report would provide the Congress with
statistics on HIV test results.
INTERGOVERNMENTAL AND PRIVATE-SECTOR IMPACT
H.R. 1943 contains no intergovernmental or private-sector
mandates as defined in UMRA and would impose no costs on State,
local, or tribal governments.
ESTIMATE PREPARED BY:
Federal Costs: Leigh Angres (226-2860)
Impact on State, Local, and Tribal Governments: Melissa Merrell
Impact on the Private Sector: Paige Piper-Bach (226-2940)
ESTIMATE APPROVED BY:
Peter H. Fontaine
Assistant Director for Budget Analysis
Performance Goals and Objectives
The Committee states that pursuant to clause 3(c)(4) of
rule XIII of the Rules of the House of Representatives, H.R.
1943 will help stem the spread of HIV/AIDS in the prison inmate
population and in the community at large.
Constitutional Authority Statement
Pursuant to clause 3(d)(1) of rule XIII of the Rules of the
House of Representatives, the Committee finds the authority for
this legislation in Article I, Section 8 of the Constitution.
Advisory on Earmarks
In accordance with clause 9 of rule XXI of the Rules of the
House of Representatives, H.R. 1943 does not contain any
congressional earmarks, limited tax benefits, or limited tariff
benefits as defined in clause 9(d), 9(e), or 9(f) of Rule XXI.
SEC. 1. SHORT TITLE.
This section sets forth the short title of the bill as the
``Stop AIDS in Prison Act of 2007.''
SEC. 2. COMPREHENSIVE HIV/AIDS POLICY.
This section requires the Bureau of Prisons to develop a
comprehensive HIV testing, treatment and prevention policy to
stop the spread of HIV/AIDS among inmates, protect prison
guards, provide medical treatment to affected prisoners and to
provide comprehensive AIDS education, within 1 year of
enactment. All inmates who test positive shall be provided
confidential pre-release counseling and referrals to
appropriate health care providers, and a 30-day supply of
medications the prisoner is currently receiving
SEC. 3. REQUIREMENTS FOR POLICY.
This section requires the BOP to administer a routing HIV
test upon intake of all prisoners regardless of how long they
will be in prison. The BOP must administer the test within 6
months of the date of enactment to prisoners who are already
incarcerated. Prisoners shall be provided with pre-test and
post-test counseling. Prisoners have the right to ``opt out''
and choose not to be tested.
Besides the testing upon admission, prisoners may obtain
HIV tests upon request up to once a year. If a prisoner is
involved in an ``exposure incident,'' the BOP may perform
testing without the prisoners consent. Medical personnel shall
notify prisoners of the test results and all results shall be
SEC. 4. CHANGES IN EXISTING LAW.
This section amends existing law to incorporate HIV test
results from this Act including amending Title 18 sec 4014(d)
so that all test results from this Act will be inadmissible in
criminal or civil proceedings.
SEC. 5. REPORTING REQUIREMENTS.
This section requires the BOP to provide Congress a report
on the policies and procedures to provide testing, treatment
and prevention education programs for Hepatitis and other
diseases transmitted through sexual activity and intravenous
drug use with in a year of enactment. This section also
requires the BOP to report to Congress on the incidence of
diseases transmitted through sexual activity and intravenous
drug use within 2 years of enactment. The report will also
contain information about the incidence of HIV/AIDS in prison.
SECTION 6. APPROPRIATIONS.
This section authorizes the appropriation of such sums as
necessary to carry out this Act.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3(e) of rule XIII of the Rules of
the House of Representatives, changes in existing law made by
the bill, as reported, are shown as follows (existing law
proposed to be omitted is enclosed in black brackets, new
matter is printed in italics, existing law in which no change
is proposed is shown in roman):
TITLE 18, UNITED STATES CODE
* * * * * * *
PART III--PRISONS AND PRISONERS
* * * * * * *
CHAPTER 301--GENERAL PROVISIONS
* * * * * * *
Sec. 4014. Testing for human immunodeficiency virus
(a) The Attorney General shall cause each individual
convicted of a Federal offense who is sentenced to
incarceration [for a period of 6 months or more] to be tested
for the presence of the human immunodeficiency virus[, as
appropriate,] after the commencement of that incarceration, [if
such individual is determined to be at risk for infection with
such virus in accordance with the guidelines issued by the
Bureau of Prisons relating to infectious disease management]
unless the individual declines. The Attorney General shall also
cause such individual to be so tested before release unless the
* * * * * * *
(d) The results of a test under this section or under the
Stop AIDS in Prison Act of 2007 are inadmissible against the
person tested in any Federal or State civil or criminal case or
(e) Not later than 1 year after the date of the enactment
of this section, the Attorney General shall issue rules to
implement this section. Such rules shall require that the
results of any test are communicated only to the person tested,
and, if the results of the test indicate the presence of the
virus, to correctional facility personnel consistent with
guidelines issued by the Bureau of Prisons. Such rules shall
also provide for procedures designed to protect the privacy of
a person requesting that the test be performed and the privacy
of the person tested. Such rules shall also provide that the
initial test under this section be performed as part of the
routine health screening conducted at intake.