Jails Address HIV-Positive Inmates’ Medical Needs Through ‘Linkage’ Programs

The most recent issue of Positive Populations, a quarterly newsletter examining infectious disease policies and program management within correctional settings, focuses on the problems jails face in treating HIV/AIDS inmates, and how some jails have overcome these challenges. In "many places," Positive Populations reports, the "needed linkages" between jails and communities do not exist. Unlike prisons, jails house inmates for a "relatively short period of time" -- usually a year or less. The quick turnover rate in jails causes "disruptions in treatment regimens while undermining the continuity of care." John Miles, special projects manager for corrections at the CDC, said, "A jail could do all the right things and three days later the person is gone and there is no mechanism established to follow that individual." One analyst added, "Many people spend a few days to a week in jail -- just long enough for patients with HIV to develop a resistance to their medications if they are unable to take their medications or if they are not given their therapies on time. They are then released back into the community with viral resistance -- it is a huge problem." Moreover, there is a high prevalence of HIV/AIDS among offenders, and many jails are "ill-equipped" to deal with this problem. Marmie Schuster-Walker, nursing supervisor for the Virginia-based Prince William-Manassas Regional Adult Detention Center's medical department, said, "The inmate population is getting to be a sicker population. We were not designed to be a hospital, and we were not designed to be a hospice but over the years, we have had to care for inmates who are sicker and sicker with very few resources."

Jail Release Linkage Program
The Ft. Lauderdale, Fla.-based Jail Release Linkage Project, an initiative that provides HIV-positive offenders with services inside and outside the facility, has attempted to overcome these challenges by working with other community organizations. The program, a collaboration between the Broward County Health Department, the Broward County Sheriff's Office and Emergency Medical Service Associates, has linked more than 80% of the jail's HIV-positive inmates to care and treatment. Todd Schwartz, correctional health care manager for the Broward County Sheriff's Office, explained, "The common goal for the community is to have a safe community and healthy citizens. The jail's mission is to make sure detainees are safe, secure and treated properly when they get out so that they can be better citizens." The first step of the program involves identifying inmates with HIV and informing them about the linkage project. To do so, inmates either self-identify as HIV-positive or take a voluntary HIV test as part of a routine physical exam within 14 days of their arrival. If the HIV-positive inmate expresses interest in the linkage project, health department officials meet with the inmate to find out necessary information, such as "if the inmate is going to prison or if the inmate has a trial or release date." Then, based on the "needs of the detainee," the linkage project refers inmates to one or more of the 26 community-based organizations that have agreed to participate in the program. Ellisa Scott, the health department's HIV/AIDS coordinator, said, "This person might have a housing issue, a medications issue or may need housing. Whatever their needs are, I can make sure they get help from the appropriate agency." Scott emphasizes that the program takes a "team approach" and requires "ongoing effort." The Broward County Health Department received $75,000 earlier this year from the CDC to "promote and conduct additional testing of HIV and other STDs among the county's jail population."

Boston's Suffolk County Jail
Boston-based Suffolk County Jail serves as an example of how jails "are in an ideal position to provide disease education, prevention, detection and surveillance for a captive population that tends to cycle in and out of their facilities," Positive Populations reports. Since 1996, the jail has included HIV/AIDS education as part of its orientation program for new arrivals. A video series and case managers provide HIV/AIDS education and prevention messages, and detainees also are encouraged to take an HIV test within 24 hours of their arrival. The program's goal is to "dispel a lot of false information about HIV disease." Timothy Burke, deputy superintendent for program services at the jail, said, "We want them to have correct and accurate information. We want them out there promoting AIDS education. They have to buy into the program and have some knowledge so they know what they are talking about." The jail also launched a peer education program in October 1999 that teaches inmates to educate fellow detainees about HIV/AIDS. The program, according to Burke, has been "very successful," prompting "dramatic" increases in HIV tests among inmates. Peer educators also are able to provide information to their peers about the disease in a "language and at a level that other detainees can easily understand," Burke said, adding, "They use terminology that (detainees) use outside of the facility, in their communities and neighborhoods. They also hold a question-and-answer period that is very frank and direct." In addition, case managers monitor HIV-positive detainees with follow-up tests to "confirm the HIV diagnosis and ... gauge viral load levels and CD4 counts," and also help detainees seek outside assistance. Burke said, "Our goal is to get our numbers up as far as testing is concerned, to identify people who are positive and to get them medical assistance" (Positive Populations, 2000). To obtain a free copy of Positive Populations, call 202-518-7768 or e-mail MMSJCA@aol.com.