Treating HIV-positive individuals in a prison environment presents several unique challenges: prison medical staff cannot refuse to treat patients, the quality of medical treatment must be commensurate with national community standards, and staff must deal with the fears and interpersonal tensions related to AIDS that result from the closed nature of the prison setting. The most controversial aspects of the correctional system's HIV policy are testing and confidentiality. The Bureau tests new commitment and follow-up cohorts as well as inmates who request the HIV-antibody test or who exhibit signs or symptoms suggestive of HIV infection. In addition, all inmates being released on unescorted furloughs, parole, or mandatory release are tested. The Bureau has instituted an aggressive HIV counseling and education program. While the Bureau maintains strict confidentiality regarding HIV-antibody test results, its policies stress adherence to universal precautions against contact with blood and body fluids. Symptomatic treatment of HIV-infected inmates, including administration of AZT, is available at many Bureau of Prison institutions. Most HIV-positive inmates are mainstreamed into the general prison population; inmates who are promiscuous or predatory are segregated after a due process hearing. Bureau policies also cover issues related to staff members.