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HIV Testing and Access to Treatment Hardly Universal in U.S. Correctional Facilities

September 21, 2016

The DMV Balenciaga House Meeting

Credit: Kareem Rizkhalla for iStock via Thinkstock

Despite the U.S. Centers for Disease Control and Prevention's recommendation that everyone passing through a prison or jail be tested for HIV unless they explicitly decline, a 2014 study estimated that only 19% of prison systems and 35% of local jails provide for such testing.

In the past, standard HIV testing procedures might have taken too long for those who spend only a short time in jail, but the advent of rapid HIV tests has removed that obstacle. Three model programs that implemented such tests in (Baltimore, Maryland; Philadelphia, Pennsylvania; and the District of Columbia) saw a six- to seven-fold increase in the number of detainees tested for HIV, despite a median stay in such facilities of less than 15 days, the American Journal of Public Health reports.

However, other issues remain. Preserving doctor-patient confidentiality can be difficult in a correctional setting, where corrections officers or other inmates may be within earshot when test results are disclosed. An HIV diagnosis while in prison is often treated simply as a medical issue, without any counseling or information about the medications prescribed. Having antiretroviral medications dispensed, potentially several times a day, can also involuntarily expose an inmate's HIV status, a study in HIV Therapy. It therefore recommends issuing "keep-on-person" medications that inmates can take on their own.


This, of course, is only an issue if the person is actually receiving antiretroviral therapy. The HIV Therapy article cited a study in Texan correctional facilities finding that only one-third of those who met Department of Health and Human Services criteria for starting HIV therapy were actually on antiretrovirals. Even if someone is receiving therapy, various events can cause treatment interruptions: medications taken prior to an arrest may not be available or considerably delayed after arrest; a transfer between facilities, court appearance or period of solitary confinement could also result in multiple missed doses.

When treatment is provided, medication adherence "in prison is facilitated by a highly structured environment and … can result in viral suppression during incarceration," the authors of a retrospective study in the Connecticut penal system published in JAMA Internal Medicine conclude. Such an outcome not only helps the individual living with HIV, but also can prevent transmission of the virus both within the facility and in the community after the person is released from incarceration. However, return to the community is often precisely when treatment is interrupted as the former inmate deals with competing life priorities such as housing. While the choice of antiretrovirals should generally be guided by the same principles whether prescribed in prison or in the community, the greater potential for treatment interruptions among this population must be taken into account to minimize the potential for developing drug resistance, the HIV Therapy article advises.

Barbara Jungwirth is a freelance writer and translator based in New York.

Follow Barbara on Twitter: @reliabletran.

Copyright © 2016 Remedy Health Media, LLC. All rights reserved.

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