In 1999, 2.3 percent of State prison inmates, 0.9 percent of Federal prison inmates, and 1.7 percent of jail inmates were infected with HIV. Since the mid-1990's, medical treatment for HIV/AIDS has gotten significantly better due to new therapies. These new drugs are widely available in prisons and jails. During the early 1990's, about two-thirds of the deaths among New York State prison inmates were AIDS-related. Intense efforts were made to improve care in New York’s 70 State prisons, which led to a dramatic decline in AIDS deaths in 1996 through 1998. To achieve this success, the New York corrections systems made major changes in the medical care provided to inmates living with HIV, which included ensuring that antiretroviral medications were available to inmates. In addition, inmates with HIV often have other medical and psychosocial problems, including drug addiction and mental illness. As a consequence, a growing number of prisons are incorporating new therapies into a continuum of care. This care includes screening to identify medical as well as psychosocial problems, substance abuse treatment, and discharge planning. While inmate health care is necessary, achieving a balance between the facility’s security and the inmates need for privacy can be problematic. Escorting inmates to get medication and visit the doctor is a security concern that may strain correctional staff resources. The complexity of HIV care and the nature of inmate patients also present a challenge. Inmates may be reluctant to seek treatment and testing because of fear, denial, or mistrust. In addition, the competence of correctional medical staff may be uneven. A number of prisons and jails across the country are working to improve the care they give to HIV-infected inmates. These programs include: Hampden County Correctional Center in Massachusetts, Empowerment Through HIV/AIDS Information, Community and Services (ETHICS) in New York, and AIDS Counseling and Trust Program in the Avoyelles Correctional Center in Louisiana.