I read with interest the recent article by Craven and coworkers [1] regarding patients claiming undocumented human immunodeficiency virus (HIV)-positive status. As the medical director at a county jail, I had the opportunity to evaluate several such patients during the past 6 years. All announced their serologic status on registration at the jail, before any medical evaluation. All were reluctant to reveal details of their history, and none would submit to confirmatory testing at our facility.

Several common factors were identified. First, each patient demanded a private cell. Second, each demanded narcotic medications. Third, each insisted on being managed at a local university medical center (creating a need to leave the jail, as well as potentially causing a conflict between the specialist and jail physician regarding treatment). All made threats of legal action if the recommendations of consultants were not followed without question.

We drew the following conclusions: Inmates in this population believed that special treatment, such as better housing, care by noncorrectional physicians, and access to desired medications, was associated with HIV-positive status.

I suggest that any patient claiming to be HIV positive without documentation be screened carefully for evidence of malingering, especially in a high-risk population such as incarcerated persons.