Last week I was called by a TV reporter with a video revealing the use of “cell extractions” against HIV positive prisoners in a California county jail. A cell extraction is where a goon squad of heavily armed guards rushes a prisoner who won’t voluntarily leave his or her cell, hogties the inmate and forcibly, with the likelihood of injury, yanks that person through the cell door. In recent months, California media have carried reports of guards beating to death an HIV positive prisoner in another county jail, and of the suicide of an HIV positive lifer at a state prison.

Ten years ago, loud, angry demonstrations would have been called. Today, I wonder who will be moved to protest.

The crisis of AIDS continues almost unabated behind bars. The advent of triple combination therapy held forth a promise to inmates that has barely been realized. Almost every prisoner who has started on combination therapy (a battle in itself) has suffered some disruption in care. Letters from prisoners in California document frequent “drug holidays” caused by the inability of prison pharmacies to refill medications on time. The recent prison trend toward directly observed therapy has also caused crises for HIV positive inmates.

Women with HIV at the Central California Women’s Facility now have to stand on line three times a day, exposed to the raw Central Valley weather, to get their medicines. This new “hot med” policy, as dehumanizing as it is unnecessary, replaced a system in which inmates received a monthly supply, allowing them to dose privately in their cells. At a time when treatments should spell hope, three women have died here in the past three weeks.

Advocates once fought hard for HIV in prison to be treated the same way as it is outside. But the surging growth of the nation’s prison system and the spiraling incarceration of a disenfranchised population of drug addicts—mostly poor African-Americans and Latinos—has laid the groundwork for inmates with HIV to be demonized. Mandatory testing, the return of HIV segregation and increased charges of assault with a deadly weapon for biting or spitting remind us that our work is far from done. Unfortunately, the reluctance of mainstream AIDS agencies to embrace this population has only deepened.

I was heartened to hear that some New York City AIDS organizations held a news conference in February to demand access to condoms in that state’s prison system. Today only two of our nation’s state prison systems and four county jails offer condoms (not dental dams) to inmates. With vulnerable populations being locked up for ever longer sentences, the denial of harm-reduction tools is criminal—especially with infection rates six times higher inside than out.

HIV positive inmates have no illusions about the “end”—or even the slowing—of the AIDS epidemic. The prisoner at Corcoran who committed suicide in December, Michael van Straaten, wrote a note before he died—a final request that his death be used to expose the cruelty of the prison system toward people with HIV. I hope Michael’s death was not in vain.