Jails in Unique Position to ID High-Risk Population: Cook County in Illinois Serves as Model

Through a grant from CDC, the Cook County, Ill., correctional system has developed an HIV prevention and testing program that has succeeded in identifying about 60 percent of HIV-positive inmates. James B. McCauley, M.D., M.P.H., of Rush-Presbyterian-St. Luke's Medical Center in Chicago, said a blinded study of the HIV rate among people in the Cook County jail in Chicago found that 2.5 percent of the 2,500 people tested had HIV, five times the HIV prevalence rate of the Chicago area. The rate, however, is lower than the HIV infection rate in New York prisons.

McCauley said treating HIV in jail makes public health sense because the majority of inmates are poor and disenfranchised and they will take their health problems back into the community. "These are people who don't have insurance and will ultimately end up in Cook County health care," McCauley said, "and they'll come in sicker and need more care, and it will end up costing you more to care for them than if you started to treat them in jail."

When inmates test positive for HIV, they are given treatment as quickly as possible, although many are incarcerated too briefly to receive the jail's antiretroviral formulary: The median length of stay in the jail is nine days. Also, Illinois law prohibits inmates from receiving AIDS Drug Assistance Program (ADAP) drugs.

If patients are to be released soon, officials refer them to a disease specialist team at Core Center, a public medicine provider for Cook County's uninsured poor. Cook County also provides case managers who work with inmates within the jail and after they've been released. The Cook County jail does not provide inmates with condoms, but once they're released, they can receive harm reduction services and condoms, McCauley said.

Although inmates may be transferred to another clinic or HIV team after a few visits to Core, the goal is to provide consistency in HIV treatment as they make the transition from jail back to the community. "Core is one of the largest HIV providers in the country with a patient census of [more than] 3,000," McCauley said, adding that about 60 percent of those eligible to follow-up with Core do so.

Back to other news for February 25, 2004