Advocates for Evidence-Based Health Policy Speakers
Law and Ointment
Overall HIV seroprevalence reported by the 50 state prison systems was 4.5 times as high as that for the general United States population. Correctional facilities indeed provide access to primary care and prevention services for a good number of persons otherwise without access. For this reason the CDC recommends HIV screening in correctional facilities as a part of the initial medical evaluation of detainees. This early testing not only allows for earlier diagnosis and treatment for sero-positive detainees, but also decreases chances of spread of the virus in the general community.
Source: miss_millions (Flickr/CC)
In 2007, 0.7 percent of the more than 106,000 tests performed in 16 health departments reporting prison or jail information were of newly identified HIV positive patients. These detainees were 2.3 times more likely to be women, 2.2 times more likely to be ages 40-49, 2.42 times more likely to be Black, 2.20 times more likely to have been tested in the South, 8.14 times more likely to be a male who has sex with men, and 5.44 times more likely to be an IV drug using male who has sex with men. Thirty percent of these newly identified HIV positive detainees were reported as having had low-risk heterosexual contact or no acknowledged risk at all.
One proposed intervention at many prison and jail systems is routine opt-out HIV testing under which the patient is notified that testing will be performed unless they decline. At facilities in Baltimore, Maryland, Philadelphia, Pennsylvania, and the District of Columbia, such testing was performed over time periods in 2008 and 2009, with multiple HIV cases newly identified. These detainees were given services while housed in the correctional facilities and were provided discharge planning services including medications upon release. Additional interventions were needed however to link these detainees to community HIV care upon release.
Commentary
At my own facility – Cook County Jail in Chicago, Illinois – which houses approximately 10,000 detainees a year, we have recently restarted our opt-out HIV and STD testing program. Stressing the importance of informed consent and appropriate follow-up after testing, our program has been successful in its pilot stages. Anecdotally, individual detainees are more likely to consent to opt-out testing that is provided wide-scale; it’s a less burdensome process and they are not otherwise being pulled aside for “special labwork” where they might be subjected to ridicule by other detainees. The emotional impact of discovering HIV-positivity while incarcerated is by no means optimal, but it indeed allows for a focused and attentive introduction to the health care system that is often otherwise not available. Overall HIV care throughout the entire facility is substantial, with a third of our medication expenses going towards HIV medical treatment. As our medical unit, Cermak Health Services, is a part of the county public health system, we have the fortune of having the ability to directly connect the patients to HIV care upon release. Our skilled HIV care team works diligently to assure that patients have access to follow-up. Other opt-out testing for gonorrhea, chlamydia and syphilis is also quite successful, and the treatment our facility provides will indeed make an impact throughout the community as we are decreasing the chances of subsequent HIV and other STD infection upon release.
by
Kameron L. Matthews, MD, Esq.
You must be logged in to post a comment.