Public health officials, hospital administrators, forensic directors, jail wardens, judges, prosecutors, and defense attorneys must confront the issue: how should cases of individuals with AIDS dementia be treated when they are found to be permanently incompetent to stand trial? Although charges are sometimes dismissed in advanced cases of dementia, the more common pattern involves placement of the defendant in a public facility while awaiting trial. The refusal of some state facilities to accept these patients raises a host of legal, moral, and medical questions that virtually every urban state's forensic system will have to consider in the near future.