AIDS Action Weekly Update Special Edition

Advancing Prevention for All Populations

HIV and the Criminal Justice System

HIV has become intrinsically entwined with the U.S. prison and jail population. It has been estimated that as many as 17% of all HIV-positive people in the U.S. are processed through the criminal justice system each year. Moreover, the rate of HIV infection among state and local prison populations is approximately five times that of the general public. As a result, criminal justice and health programs have begun to respond with a renewed focus on working with HIV-positive inmates and former inmates throughout the U.S.

A workshop entitled Alabama Prison Initiative: Incarceration -- A New Beginning highlighted an Alabama Department of Health prevention program for HIV-positive inmates. In Alabama, the Department of Public Health-HIV/AIDS has created a special program working on both prevention and care issues for prison populations that extends into reentry into society. Despite this program, Alabama's prison system is often viewed as one of the toughest in the nation for HIV-positive inmates. Alabama's prison populations are tested upon entry into the Department of Corrections, and HIV-positive inmates are segregated and placed in separate dorms at two prison facilities. Eighteen HIV-positive women are currently housed at the Julia Tutwiler Prison for Women, and 235 men are housed at Limestone Prison for Men.

Under these circumstances, the Department of Health created a new Prison Initiative model designed to deliver prevention and direct care services to HIV-positive persons in the Alabama Department of Corrections. The Department of Corrections now views the program as more important than ever because of the lawsuit. Moreover, it was reported in the workshop that service delivery may be a little easier because the HIV inmates are segregated. The Department of Health sought to extend their resources by identifying gaps in services and filling those gaps during incarceration and during reentry. They created a Be Free Stay Free -- Life Enrichment Model Program to leverage the resources of community-based organizations (CBOs) to provide primary and secondary HIV education and education about HIV medications, treatment and therapies. The program also convenes classes on addiction, tuberculosis, cancer, social security benefits and more. In addition, they provide career vocational training classes and ensure a 30-day supply of medication upon reentry while the former inmate is given community resources and help in connecting to new sources of medication. Ultimately the goal is to empower the prison populations to do things for themselves.

Similarly, the Integrating HIV Prevention and Treatment into Drug Court Programs roundtable described how the Maryland AIDS Administration uses the Baltimore City Drug Treatment Court to make contact with individuals who are HIV positive or at risk of HIV Under a program financed by the Substance Abuse and Mental Health Services Administration (SAMHSA) the AIDS Administration works with judges, attorneys and probation agents to identify high risk probationers and bring them into community-based treatment, prevention and case management services. Probationers have incentives to join the program, such as food vouchers, coupons to local stores or restaurants or the provision of clothing. In addition to providing HIV education, prevention and movement into care, the program connects probationers with housing and other programs. Like the Alabama program, the AIDS Administration leverages services from CBOs in Baltimore which helps keep costs low.

Staff members of the AIDS Administration hope to be able to show diminished rates of HIV among drug court clients who participate in the program; however, it has been difficult to create a control group. Currently they are seeking ways of measuring this outcome via other measures and they hope to hire an individual solely concerned with tracking results from individuals at six and 12 month intervals. Staff members believe that this may be the only program in the nation that has specifically targeted a drug court for HIV outreach.

Back to the AIDS Action Weekly Update June 25, 2004 contents page.