Anyone who has spent time in a U.S. prison (including some 25 percent of all HIV-positive Americans) already knows: HIV rates behind the wall are twice what they are on the outside—and decent health care inside is sadly lacking.

Now we have backup. These health discrepancies and others are documented in a report in the April American Journal of Public Health. The journal predicted the problem 14 years ago. “Politicians vie to allocate more money to build prisons,” Alan Berkman, MD, wrote in 1995, “but [not] more money for prison health care. Less is spent each year to care for [more] sick prisoners. The public health implications are obvious.”

Among those implications: “Most prisoners [many in the United States are serving short sentences for minor offenses] will return to their communities,” says Andrew Wilper, MD, lead author of the new report. “They bring with them the consequences of substandard health care behind bars—for example, increasing the burden of HIV/AIDS for their communities.”

Jacqueline Walker, of the ACLU National Prison Project, adds that viewing prisoners as unworthy of health care undermines community values. “These are our brothers and sisters,” she says. “They don’t deserve to be mistreated and die.”