State Initiatives Address HIV, STDs Among Prisoners - article

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As of 2008, about 450 state prisoners in Illinois were living with HIV.

Most of these inmates have one thing in common: They will eventually be released from prison. About 85 percent of those released will end up in the Chicago area, according to the Illinois Department of Public Health.

And if their experience is like so many other HIV-positive former inmates, they may have difficulty paying for their medications, finding a medical provider or securing stable housing.

That’s where organizations such as the AIDS Foundation of Chicago come in. The nonprofit organization is part of the state’s network designed to make sure people with HIV can manage their health and avoid spreading the disease to others.

The Illinois program is just one example of how state policymakers in this region are working to address the rate of HIV and sexually transmitted infections among prison inmates. HIV/AIDS affects federal and state inmates at nearly 2.5 times the rate of the general U.S. population.

Other sexually transmitted infections, such as gonorrhea and chlamydia, also occur more often among people entering jails and juvenile corrections facilities than in the general population.

State policymakers are looking to prevent the spread of these diseases in communities by testing and treating people with infections while they are incarcerated. When inmates are released, they have the potential to spread diseases to others — especially if they are unaware of their infection. And studies have shown that routinely testing and treating inmates for sexually transmitted diseases can reduce infections in the general community.

In all but four Midwestern states, inmates must be offered HIV testing when they arrive in prison. But prisoners can opt out of being screened — and how testing is offered can make a big difference in whether prisoners opt to be tested. When prisoners are tested in private rooms and as part of other routine medical care, and results are disclosed privately, they are more likely to consent.

Nationally, the U.S. Bureau of Justice Statistics reports that more than 20 percent of inmates in state and federal prisons were never tested for HIV or didn’t receive their test results. In jails, more than 80 percent were never tested for HIV.

Inaddition to testing and treatment, states are also focusing on prevention — by educating prisoners about high-risk behaviors such as unprotected sex as well as sharing syringes for intravenous drugs or materials used for tattooing.

Illinois initiatives
Illinois has the Midwest’s highest rate of HIV/AIDS in state prisons; 1 percent of inmates are infected.

One state public health program trains peer educators to teach HIV prevention to inmates in all 39 state prisons. Another provides funding for six local health departments to test high-risk populations for HIV in county jails.

The busiest of those six programs is run by the Chicago Department of Health. The department works extensively with the Cook County Jail, where more than 100,000 inmates are detained annually — many with stays of less than 72 hours.

“The inmates are 90 percent male, and the cost of testing men is not insignificant, but the impact on public health is enormous,” says Dr. William Wong, medical director of the department’s STD/HIV/AIDS division. For example, when the Cook County Jail discontinued gonorrhea and chlamydia testing of male inmates in 2004, the facility saw a nearly 80 percent decline in the number of infections reported.

“We know that the majority of undetected infections likely remained untreated and contributed to the additional spread of disease in the community,” Wong says.

Later this year, the jail will offer routine testing for HIV and other sexually transmitted infections. Using newer technology, test results will be available within 24 hours and treatment can be initiated before the detainee is released.

The state is also offering resources to inmates after their release through the HIV Care Connect (www.hivcareconnect.com), a statewide case management network that helps people living with the disease. As Illinois Department of Corrections discharge planners learn the release date of an HIV-positive inmate, they contact any of the HIV Care Connect regional programs. Each inmate is matched to a local case manager and medical provider to coordinate their care, says Mildred Williamson, chief of the HIV/AIDS section at the Illinois Department of Public Health.

The AIDS Foundation of Chicago is one of the local groups that helps provide case management.

Effective reentry support can not only reduce recidivism, but prevent new HIV infections as well, says the Rev. Doris Green, the AFC’s director of correctional health and community affairs. “We need to be sure that every inmate is offered testing so they know their status,” she says. “And for those who need treatment, we focus on integrating treatment on both sides of the wall.”

To provide more support for community organizations providing HIV/AIDS prevention, education and treatment, the Illinois legislature created an endowment in 2007 through a special lottery game. Through the Red Ribbon Bonus Bucks program, $1.4 million will be awarded later this year to 11 applicants serving the highest-risk individuals, including former inmates.

Rep. Karen Yarbrough, one of the sponsors of the 2007 legislation, now serves on the board that reviews the grant applications. “I was struck by the increasing numbers of African-American women who are impacted by this horrible disease,” says the Democrat. “The dollars raised through this mechanism will provide needed resources for prevention, intervention and treatment of HIV and AIDS, especially in African-American communities.”

Wisconsin seeks federal funds for HIV
Helping inmates obtain continuous medical treatment for their infections after release remains challenging for corrections and public health officials across the region. Common obstacles include obtaining proof of identity or residence and enrollment in Medicaid or Medicare. Some former inmates who were diagnosed with HIV while incarcerated may not be given copies of their medical records from prison, making it difficult to continue their previous course of treatment.

The Wisconsin Department of Corrections has several policies in place to make sure inmates know their HIV status and that they can continue treatment when they return to the community.

All inmates are offered voluntary testing at intake, and more than 90 percent agree to be screened. Inmates may also be tested, upon request, during incarceration or on release.

Since 2004, the department has had an agreement with the state Medicaid program that allows an inmate’s application for benefits to be accepted up to 23 days prior to his or her expected release date. And specialized HIV case management for inmates ensures that inmates are linked to community-based providers for continuous care when they are released into the community.

Wisconsin is also pursuing another approach: obtaining additional federal funds for patients with HIV, including inmates after release. SB 647, enacted in May, authorizes the Department of Health Services to apply for additional Medicaid funding to expand case management services for patients with HIV.

Using a patient-centered medical home model, each HIV patient’s care would be closely monitored, including compliance with prescribed medications, doctor’s visits, and inpatient, dental and mental health care. The initiative would also address other needs, such as stable housing.


CSG continues partnership with CDC
For more than five years, CSCSG has partnered with the U.S. Centers for Disease Control and Prevention to educate state leaders about disease-prevention policies. This article is part of a series of resources on preventing HIV and sexually transmitted infections; more information is available at http://knowledgecenter.csg.org/kc/view-policy-areas/125.