Dying Inside: The HIV/AIDS Ward at Limestone Prison. By Benjamin Fleury-Steiner & Carla Crowder. Ann Arbor, MI: University of Michigan Press, 2008. 238pp.


On first consideration, the idea of a special prison ward reserved for individuals diagnosed with HIV/AIDS might appear sensible, even first-rate. It could be imagined that such a ward could allow for specialized medical care and enhanced facilities to meet the unique medical needs of the individuals in the ward. However, in Dying Inside, Benjamin Fleury-Steiner and Carla Crower describe a very different reality. The authors describe the HIV/AIDS ward at Limestone prison in Alabama not as a state-of-the-art medical prison facility, but rather as an old, inhumane warehouse with backed-up plumbing, cold breezes, and rows of over-crowded, barrack-style beds. Fleury-Steiner and Crower’s book aims to reveal the appalling conditions of Limestone’s HIV/AIDS ward and to situate this description within a broader discussion of the larger social trends of mass incarceration, prison privatization, racism, and privatized healthcare in the United States. 

The first author, Fleury-Steiner, is an Associate Professor of Sociology and Criminal Justice at the University of Delaware. He has published numerous books and articles on topics of capital punishment, prisoner’s rights, and prison reform. Dying Inside is his most recent contribution to these areas of research. The second author, Carla Crowder, is a law student who, at the time of the project, was an investigative reporter for the Birmingham News. Together, the authors blend the rigours of academic scholarship with the insights gained through investigative inquiry. Dying Inside is a sophisticated, critical examination of a failing medical care system in American prisons and jails.

Between 1999 and 2003, 43 HIV positive prisoners at Limestone prison died. Investigations revealed that the deaths were not a direct result of HIV or AIDS. Instead, the deaths resulted from inhumane prison conditions and inadequate medical care. The authors describe the conditions in Limestone prison as “deadly” (15). These conditions include: massive overcrowding with beds lined up end to end and side to side; stagnant water from clogged shower drains; broken windows causing cold drafts; an outdoor pill line to receive medications; insect infestations; a prison layout that requires a full 20-30 minute walk to the prison medical center; and an understaffed and unqualified medical team.

The aim of the authors is not simply to reveal the inhumane conditions of what might be seen as “an isolated prison horror story” (13). Instead, the authors suggest that the Limestone ward is indicative of a larger prison catastrophe that exists across the United States. The authors link this catastrophe to several policies and trends, including: an unjust war on drugs; a tough-on-crime approach that has led to the mass incarceration of more people than any other country in the world; racial disproportion in mass incarceration as a systematic effort to continue to marginalize disadvantaged minority groups; as well as cost-cutting measures fuelled by increasingly privatized prison and medical care systems in the United States.

Dying Inside concludes with a discussion of prison reform possibilities. Fleury-Steiner and Crower propose that downsizing the prison population in the United States would be the most viable option. This approach, they argue, would free up much-needed resources for better prison health care and provide more public dollars to spend on mass education and healthcare instead of mass incarceration. This book should be of interest to prison reform activists, criminologists, sociologists, and anyone who is concerned with the conditions in American prisons.

Curtis Fogel
Department of Sociology and Anthropology
University of Guelph
Guelph, Ontario, Canada

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