AIDS

We got a new AIDS patient this week. The facility has about 50 or so of known HIV positive inmates who live out in population, take their meds, go to work, and lead normal incarcerated lives. I have three inmates who live in the infirmary because their counts are low, but they do not have any symptoms. They will remain in the infirmary until a medication is found that their diseases respond to. This process can easily take about a year.

I have only worked with one other inmate with full-blown AIDS. She came in straight from jail right around the time I started working at the pen. Like the new patient this week, she was newly diagnosed HIV positive. AIDS was ravaging her body while anger and denial ate up her mind. I worked with her in the infirmary form November of '04 till March of '05, when she went to population. When this first AIDS patient arrived she was so angry at the world that she would literally not speak to any of the nursing staff for about a month. Now when I see her in population going to school, tutoring, and getting ready for her release she looks so healthy.

This new one is going to be another really long road. She has all of the classic symptoms of AIDS, a certain kind of pneumonia, thrush (yeast infection in your mouth and throat), and a CD4 count of 6. Normal would be more like 500. Yet she refuses to consent to an HIV test to confirm diagnosis. Without a confirmed diagnosis she cannot be started on anti-retroviral therapy through MCV. These meds are expensive and the state pays for them out of a special budget, but to get into the program you must have a confirmed case. She keeps telling us to worry about the pneumonia and do one thing at a time. She swears that she can't have HIV.

She is needs to be on oxygen but is very non-compliant with this therapy as well. Whenever I go into her room to check her she has it off. We have tried masks, nasal cannulas, and switching between the two. Her fingernails will be blue. Last night she told me that she thought that there was carbon monoxide coming out of her oxygen condenser. "I knew someone who went to the hospital for that," she confided to me.

In nursing school they barely teach you anything about HIV and AIDS. We had a few lessons in Pathophysiology. Nothing in Medical Surgical classes, nothing in Pharmacology classes. Pretty much everything I know I have learned on the fly working with my patients at the prison. I have learned about different med combinations, med side effects, pneumonia, and wound healing in the HIV patient. I have worked with some really interesting wounds in HIV positive patients. I have worked with inmates who have been positive, taking medication for 10 years, and doing well. Think about it. Magic Johnson is still around. That is what I tell my new diagnosis patients. I tell them HIV is a disease that people are living with, not dying from immediately.

Learning about HIV and AIDS is one of the things that I like about working in the prison. I get to see them when they are well, when they are sick, and when they get well again. I like the prison because I get to see the big picture of the disease. Not just a little snap-shot on a highly specialized hospital floor.