Continuing HIV Care for Formerly Incarcerated U.S. Citizens: Part One

Nilda Ricard
Nilda Ricard

Imagine being released from prison after serving a 20-year sentence. The world looks different to you. Many of your friends and family members have moved on. The privileges you once had are gone and people now look at you as a threat. Now add the fact that you're HIV positive, homeless, unemployed and have a history of drug addiction. That is the reality that faces many formerly incarcerated people when they are done serving their time.

According to a recent report from the National Minority AIDS Council and Housing Works, every year 150,000 people living with HIV in the U.S. are released from correctional facilities across the country. The Fortune Society is an organization that helps formerly incarcerated people successfully re-enter their communities while maintaining their health care. They have been helping former prisoners for more than 45 years and have recently received a grant from Kaiser Permanente for $250,000 to expand their services.

Nilda Ricard is the director of the Drop-In Center at Fortune in Queens, New York. In this interview with Ricard, explores the disconnection in HIV care and why it's important to reach out to individuals when they are released from prisons.

Let's begin with what the level of care is like while people are incarcerated. Describe what kind of care your clients receive when they are locked up.

Some believe that people in prison get really horrible medical care. I don't think that's necessarily the case. For a lot of our clients, when they are out drugging, health is not a priority. They don't see the doctor at all. Or they will see them when they are really sick. So when they wind up getting arrested, that's the first time they have gone back to care. It's not the best care but it's the first time they've seen a doctor in a while. So if you look at it that way I don't think the standard of care is low because they are now seeing a doctor when before they weren't.

When they are arrested they are asked if they are HIV positive. If they have a high recidivism rate and they tested positive once before it's already in their medical records. If they say no, they are automatically given an HIV antibody test. If they say yes, then they [the Corrections Department] will do their blood work. Then they will start treatment. It may not be the level of care you get in the community, but at least you're seeing a doctor.

When does Fortune get involved and how does it work?

The Department of Health will identify the clients who are HIV positive and in need of more follow up after release. They will ask the client if they are interested in receiving services form the Fortune Society. If they say yes then they will send a referral to me and I will assign a staff member to start working with them. We consider what's important to the client. His or her priorities may be elsewhere at that point in time. He or she may be homeless. They may have no identification. Their family may be a little sick and tired of dealing with him or her. If you're going to be released on April 20 but you don't have a place to sleep, giving you a referral for St. Vincent's Medical Care Center isn't going to do anything for you. But if I start the conversation with "we have a place for you to sleep" it's different. I wouldn't think about medications if I don't have a place to sleep either.

Now, they might decide [to say] yes to everything before they are released, but things may change when they are out. So we go pick them up when they are released from Rikers Island. The first stop is to a restaurant that we have an agreement with to buy them breakfast. A lot of them have to take medication and they are just plain hungry. Then we bring them back here to our office. We'll allow them to make phone calls, shave, brush their teeth, and clean up. It makes them feel human again. The ideal next step to get them to medical [treatment] within the first seven days, but that may not always be the priority, so we deal with that. We work on getting them a place to sleep. Then we work on getting their entitlements like public assistance, food stamps, Medicaid, SSI, SSD if they qualify, etc. Our work with them used to be for only 30 days, but now with this grant we can stay with our clients for six months.

In part two, we will look at the obstacles in maintaining HIV care, and what it's like for women prisoners.