Correctional Health Care is Community Health Care - article

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Capitol Ideas: July / August 2010

Nearly half of the inmates in New York’s prisons return to the community each year. New York was also one of three states that housed nearly half the 20,000 state prisoners across the country who had HIV or confirmed AIDS. Correctional health care is not only good for the health of inmates and correctional staff—it’s also about preventing the spread of infections to their families and communities when prisoners are released.

“The state prisons have about 60,000 inmates, and each year about 27,000 of them return to the community. Providing essential health care to this population is important to the well-being of them, their families, communities and the correctional staff,” said New York Assemblyman Richard N. Gottfried. He sponsored a bill in 2009 to improve medical care for HIV/AIDS and hepatitis C in the state’s prisons and jails by requiring oversight by the state Department of Health.

The issue is so important because people entering correctional facilities have much higher infection levels than the general population for everything from tuberculosis and hepatitis to sexually transmitted diseases, including HIV/AIDS, according to the Centers for Disease Control and Prevention. And when the inmates are released to their communities without connections to adequate medical care, infections can continue to spread in their communities.

In New York, where more than 300,000 people pass through jails and prisons each year, the quality of care available to inmates varied widely among facilities. New York Assembly Bill 903 and companion Senate Bill 3842 aim for high quality medical care for all HIV/AIDS and hepatitis C infected inmates through a facility review and inspection process. The bill authorizes reviews of similar services in local correctional facilities to begin in two years.

Incarceration provides the state with a public health opportunity to test, treat and educate the inmates who have not had sufficient access to health care prior to incarceration, and have high incidence of chronic and infectious diseases, mental illness and substance abuse problems, according to the bill’s purpose statement.

According to public health experts, inmates often have no access to medical care outside correctional facilities, and are more likely to be drug offenders, homeless or mentally ill. They disproportionately come from racial and ethnic minority populations, or families of low socioeconomic status. Their lives are more likely affected by drug and alcohol abuse, lack of education, a history of physical abuse, unemployment and participation in unsafe sex practices.

As more states use community supervision to reduce prison populations, community-based programs that work with public and correctional health are more important than ever to help inmates overcome these conditions, to prevent infection and reduce health disparities.

Rhode Island’s Project Bridge, sponsored by the state departments of health and corrections, along with medical providers, connects inmates with physicians during incarceration that continues after release.

Georgia departments of corrections and parole refer inmates to STAND Inc., whose innovative approach includes individualized medical case management including sexually transmitted infection prevention and substance abuse treatment, as well as assistance with housing, job readiness skills and personal development.

The state-supported AIDS Foundation of Chicago is conducting cross-training of community and corrections health program staff, as well as education and counseling programs for inmates’ partners and family members.

Higher Rates of HIV, STIs in Prisons
New York, Florida and Texas together house nearly half the 20,000 state prisoners across the  country who had HIV or confirmed AIDS, according to the Bureau of Justice Statistics’ January 2010 Bulletin, “HIV in Prisons, 2007–2008.”

People in state and federal prisons have rates of HIV  infection and AIDS more than two times higher than the general population. Prisoners in these and  10 other northeastern and southern states had above average rates of HIV infections and AIDS,  according to BJS. In addition to HIV/AIDS, other sexually transmitted infections are more common among inmates, including gonorrhea and chlamydia, according to the CDC. These other infections can make people more susceptible to HIV infection if exposed.

While the prison population is falling in some states, according to the Pew Center on the States, one in 100 adults was incarcerated in U.S. prisons and jails in 2008. Nationally, this represents nearly 2.3 million Americans, and the highest incarceration rates were among young African-American and Hispanic men.

Communities are responding, and support for the New York bill focused on the disproportionate impact of HIV and hepatitis C infection in black and Latino communities, and the need to protect communities by addressing the epidemics both during and after incarceration. By starting  treatment and education for inmates while they are incarcerated, community supporters anticipate inmates will be more likely to continue treatment after release, encourage family and friends to seek testing and care, and will be less likely to pass infections on to loved ones or seek costly emergency services after incarceration.

In addition, since women in New York’s prisons are twice as likely as male inmates to have HIV and 80 times more likely than in the general population, there was support for making quality medical care available to all female inmates.

The financial costs of the New York program are expected to be offset by savings from initiating early treatment and decreasing the incidence of HIV and other sexually transmitted infections among inmates. The average cost of caring for a person with early HIV disease is approximately $14,000 a year, while the cost of caring for a person with advanced HIV disease is approximately $34,000 per year.

“If this bill reduces the spread of HIV/AIDS or hepatitis C, or prevents advance of the disease to a stage where the patient is more infectious and more difficult and expensive to treat, even in a small fraction of cases, it will pay for itself many times over,” Gottfried said. “This is an important first step across the boundary between public health and the prison system.”