Rhode Island’s programs for prisoner health figure prominently in an article in today’s New England Journal of Medicine.

Public health experts rate Rhode Island’s medical care for prisoners, and particularly HIV counseling and testing services, “among the best in the country,” according to the article by Dr. Susan Okie, a contributing editor at the journal. The state prison offers routine HIV testing, and 90 percent of inmates get tested. Rhode Island also provides other services, such as education about avoiding HIV transmission and referrals to HIV care providers upon release, Okie writes in “Sex, Drugs, Prisons and HIV.”

In her discussion of how prison policies on sex, drug use, addiction treatment and HIV testing affect infection rates, Okie also gets at the darker side of life at the ACI. The article begins with the perspective of an inmate she interviewed, given the pseudonym “Mr. M.” The inmate, who is HIV positive but healthy thanks to anti-retroviral drugs, describes how sex and drug use take place inside the ACI, even though the activities are prohibited, and how inmates make condoms — also prohibited — from latex gloves or sandwich bags.

Okie goes on to quote an ACI correctional officer, Gerald Ducharme, saying that giving inmates condoms would send a message that “sex, whether consensual or not, is OK.”

The article discusses the work of Dr. Josiah D. Rich, a physician at Miriam Hospital and Brown Medical School who visits the ACI each week to give medical care to inmates. Rich is studying the effects of giving methadone to inmates with a history of opiate addiction, starting a month before the inmates’ release. The hypothesis is that treating inmates with methadone, a synthetic drug used to quell cravings for heroin, will help them stay off drugs after their release. That, in turn, would keep them from landing back in prison.

In an interview yesterday, Rich lauded A.T. Wall, who heads the state Department of Corrections, for being “tremendously open” to ideas from the medical community.

Today’s issue of the medical journal features other articles on the theme of health in prisons, including one on dialysis in prisons and one on a study in Washington state that found inmates run a very high risk of dying of a drug overdose during the first two weeks after they’re released.

And it includes a letter to the editor written by Rich and Dr. Scott A. Allen, Rich’s colleague at Miriam and Brown, and the former medical director for the Department of Corrections.

Rich and Allen urge their fellow physicians to take a stand on sentencing laws and other policies and practices that affect public health.

“We believe that physicians have an often unrecognized responsibility to advocate for the reform of systems that are harmful to their patients,” the doctors wrote.

Rich and Allen co-founded the Center for Prisoner Health and Human Rights, based at Miriam, last year, and Rich was at the State House on Tuesday testifying on the need to make substance-abuse treatment available to prisoners. Their letter also focused on that issue.

“In U.S. prisons, rehabilitation has been largely abandoned in favor of punishment,” they wrote.

They say a more supportive approach could help break the chronic cycle of addiction, crime, illness and high-risk behavior that Okie’s article describes.

Nationally, the incidence of HIV infection among prison inmates is more than four times the incidence among the general population.

Rich said he supports efforts to diminish the spread of HIV within prisons. But the majority of new HIV infections in Rhode Island result from needle use, rather than sexual contact, and most HIV-positive prisoners here contracted the virus before being incarcerated, Allen said. The physicians believe the high incidence of HIV among prisoners correlates with the high percentage of prisoners who have used injected drugs, and does not indicate the virus is being transmitted within the ACI, at least not on a large scale.

While Rhode Island may do well when it comes to HIV-positive prisoners, there’s room for improvement when it comes to treating substance abuse, the physicians said.

Doctors who treat prisoners “have an obligation to speak up when we see a system-wide problem that needs to be addressed,” Rich said.