One axiom is that voluntary inmate behavior is often difficult to distinguish from involuntary behavior. This bears upon the second axiom: an inmate's refusal of health care is often difficult to distinguish from a denial of health care. Inmates' voluntary behaviors are often difficult to distinguish from their involuntary behaviors because most behaviors and many choices are constrained and determined by prison rules and regulations, peer pressure, and fear of retribution. Where peer review is largely absent, services scarce, barriers to communication substantial, and motives suspect, it may be impossible to distinguish between an inmate who voluntarily refuses care and one who has been involuntarily denied needed care. A supposed refusal of care by an AIDS patient may be suspect, depending on how the offer of care was made, the humiliation associated with the care offered, and the despair which infuses the care system. The third axiom is that it is impossible to ensure the confidentiality of information in a prison or jail. Health information can be used for intimidation, may spur rivalries, and may create dangers, especially when the information pertains to AIDS infection. 2 references.