Inmates' rights advocates, alarmed by the rising death toll from AIDS, are pressing the D.C. Department of Corrections to improve medical care, distribute condoms and release terminally ill prisoners.

A recent corrections department report found there were 20 AIDS-related deaths among inmates last year, 12 more than in 1989.

Those deaths outstrip the 13 AIDS-related fatalities in Maryland prisons in 1990, and the 10 in Virginia.

D.C. officials said the increase reflects the harsh toll the AIDS epidemic is exacting in the city, which has one of the highest rates of AIDS virus infection in the country.

Advocates for inmates contend that the department's beleaguered medical treatment system may be to blame.

"For a prisoner, finding out he is HIV-positive is like getting a death sentence," said Judy Greenspan, a lawyer for the American Civil Liberties Union, which provides AIDS information and legal help to inmates.

She said the financially strapped corrections department lacks a comprehensive AIDS program to help inmates avoid contracting the virus from intravenous drug use and sexual contact. For her and others, the 50 fatalities since 1985 -- which make AIDS the leading cause of death in D.C. prisons -- are a grim indication that medical staff shortages and other problems are hampering efforts to diagnose HIV-infected inmates in time to provide care that might keep them alive.

"The department often waits until the illness is in its final stages before administering treatment. Generally, by the time they get to {D.C. General Hospital}, they are ready to die," Greenspan said.

Mary Campbell, health services educator for D.C. prisons, said the department conducts about 30 AIDS education workshops a year, and she disputed claims that inmates are not receiving adequate care. "Our patients receive the standard treatment" set by the Centers for Disease Control, she said.

Campbell said most inmates who are HIV-positive "contracted the virus on the outside of the facility."

The rising number of AIDS-related deaths has drawn D.C. corrections officials into the national debate over ways to stem the spread of AIDS in prisons, where there are concentrations of drug abusers and others considered at risk.

Acquired immune deficiency syndrome is caused by infection with human immunodeficiency virus, or HIV, which destroys the body's natural defense against illness.

In recent years, local, state and federal institutions have tried several measures to control the spread of AIDS, but so far they have been frustrated by conficting moral, policy and legal issues.

"It's been very difficult from a policy perspective to strike a balance," said Walter B. Ridley, director of corrections for the D.C. Jail and the seven facilities at the Lorton complex in Fairfax County. "When I talk with my counterparts around the country about the issues that are confronting them, along with overcrowding and budget deficits, the AIDS situation is up there on the list of major problems.

"I tend to believe right now we have a fairly good AIDS program in place, but there's always room for a lot more, and that's one of our targets for the coming year."

Ridley said he has directed his staff to review the ideas of inmates' rights advocates and recommend ways to improve AIDS education and care.

Some institutions have quarantined HIV-positive inmates. That policy sparked lawsuits in New York, Connecticuit and Alabama. In 1989, officials at the Maryland State Penitentiary in Jessup began placing HIV-positive inmates in a special 10-cell ward. They stopped that practice later after 12 inmates alleged in a lawsuit that they were isolated from prison life.

Campbell said HIV-positive inmates are not segregated in D.C. facilities because "AIDS is not spread through casual contact."

Still, officials said they need ways to identify HIV-positive inmates so they can treat the virus before it reaches advanced stages.

Of the nearly 10,000 inmates in the D.C. corrections system, 119 are being treated for AIDS-related problems. Maryland officials said 245 of the state's 17,523 inmates are HIV positive. Virginia officials said they don't know how many of the state's 14,748 inmates are infected.

Those officials acknowledge there may be more people infected than records show, and they concede they can't find out because AIDS testing is voluntary.

Despite policies ensuring confidentiality, some HIV-positive inmates are afraid to seek help. In remarks before a committee of D.C. Mayor Sharon Pratt Dixon's transition team in December, Grace Lopes, executive director of the D.C. Prisoners' Legal Services Project, said inmates who come forward often are singled out for "discriminatory treatment by other inmates and correctional staff."

Some corrections officials believe the best method of detection is mandatory screening. In 1986, only three federal and state institutions screened inmate populations. Now, 17 institutions require mandatory screening, according to a report by the National Institute of Justice.

Campbell said D.C. inmates are not tested for AIDS unless they show signs of infection.

The screening issue also underscores clashing interests among prisoners. While HIV-positive inmates want to remain in the mainstream of prison populations, those not infected want protection from those who are. Some Maryland inmates filed an unsuccessful lawsuit recently seeking mandatory AIDS testing of prisoners to determine whether they and others are at risk.

As another protective measure, prison officials in six states have begun issuing condoms to inmates, even though sex in prison is prohibited.

Campbell said the District has not adopted that policy because "under District government {law}, sodomy is considered illegal. If we were to pass out condoms, then we would be going contrary to our own governing body."

"Whether the system sanctions it or not, the fact is that prisoners are having sex," Greenspan said. Condoms "have saved lives on the outside, so they definitely can save lives on the inside."

The Rev. Stanley R. King, executive director of Liberation of Ex-Offenders Through Employment Opportunities, said there is intravenous drug use within the prison system as well.

"I've had inmates tell me that they lined up to share a needle," he said.

The D.C. corrections department was sued several years ago by inmates who alleged that crowding and other conditions were unsafe and unhealthy.

In a 1989 report designed to determine whether the corrections department had improved medical services after the lawsuit, a doctor cited at least 14 areas where deficiencies remained. Robert Cohen, medical director of the AIDS Center at St. Vincent's Hospital in New York City, said problems included the use of unlicensed medical personnel and technicians for clinical services; shortages of nurses and doctors; and lack of access to emergency care. Cohen also said inadequate care was given to patients with HIV-related diseases.

Art Graves, associate director for operations, said the corrections department intends to hire more medical personnel this year.