Study Says Prisons, Jails Miss Opportunities for HIV Testing, Post-Release Treatment

Few prison systems or jails in the United States have comprehensive programs to provide critical services that link HIV-positive inmates to care after their release, according to a study published in the March issue of the journal Health Affairs.

People who are incarcerated are three to five times more likely than the general population to be infected by HIV, so correctional facilities play an important role in testing for HIV and linking infected people to post-release treatment services. Researchers surveyed medical directors from 50 state prison systems and 40 of the largest jails in the United States to create the first comprehensive look at how U.S. prison and jail programs screen for HIV and link people to HIV care in the community once they are released.

“While some progress has been made when it comes to providing HIV testing in jails and prisons, we are missing a major opportunity to provide comprehensive, ongoing HIV care to people once they leave a correctional facility,” says Dr. Liza Solomon, the study’s lead author and a principal associate with Abt Associates.

Only 19 percent of prison systems and 35 percent of jails provide opt-out HIV testing recommended by the Centers for Disease Control and Prevention (CDC), according to the survey. Less than 20 percent of prisons and jails follow the CDC’s guidelines for helping inmates once they transition back into the community. This includes services such as making an appointment with a community healthcare provider, assisting with enrollment in an entitlement program, such as Medicaid, and providing a copy of the medical record and a supply of HIV medications.

In spite of the extensive evidence on the importance of early diagnosis of HIV and ongoing treatment, many jails and prisons are failing to implement the CDC’s guidelines for HIV testing and getting former inmates into post-release care. The researchers note that Medicaid expansion under the Affordable Care Act “may create incentives for states to improve the HIV testing and discharge services offered in correctional settings.” They also recommend that programs link HIV-positive former inmates to comprehensive substance abuse and mental health treatment.

“By ensuring that individuals get the care they need while incarcerated and helping them remain in care once released, we will ensure that some of most vulnerable people will avoid a  life threatening illness and help meet the national goal of reducing health disparities,” Solomon says.

Study co-authors include Michael Costa of Abt Associates; Brian Montague, Curt Beckwith and Josiah Rich of Brown Medical School; Jacques Baillargeon of the University of Texas Medical Branch; Irene Kuo of the George Washington University; Ann Kurth of New York University; and Dora Dumont of the Miriam Hospital.

Source: Abt Associates