The provision of HIV-related services for inmates should be regarded as an area of public health concern. The HIV seropositivity rate is 10-fold to 100-fold higher among inmates than in the general population; the rate among female inmates is usually higher than the rate among male inmates in the same correctional system. In 1994, HIV testing was mandatory in 16 States and the Federal Bureau of Prisons and was provided to some inmates on a voluntary basis in 34 State systems. Information on access to HIV care is extremely difficult to obtain, because most prison systems do not regularly publish information on HIV care protocols. Excellent models of discharge planning exist; however, HIV-infected inmates encounter many difficulties obtaining medical care and social services on release into the community. In addition, fewer correctional systems are offering instructor-led HIV education sessions for inmates in 1994 than in 1992. Recent treatment advances have made much clearer the rationale for early identification of HIV infection and enrollment of inmates in an HIV clinic setting. However, prison officials and the companies providing inmate health care will probably not experience the benefits of early intervention. Constraining these inmates' health services will both adversely affect their health and almost certainly lead to greater public health expenditures in the near future. In contrast, improved access to HIV care and prevention inside prisons will save money and may save lives as well. Figures, table, and 38 references