Discharge Planning for People Living With HIV in Correctional Institutions

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People living with HIV may have received antiretroviral treatment while imprisoned. However, that treatment can easily be interrupted when they re-enter the community without sufficient resources or support. A number of community organizations provide discharge planning and link people to medical care. This not only helps individuals, but also prevents the spread of HIV within the community, because people with undetectable viral loads are unlikely to transmit the virus.

Almost 44% of the more than 1.6 million people imprisoned in U.S. state and federal prisons in 2010 were released that year, according to the U.S. Bureau of Justice Statistics. Assuming a similar release rate for the more than 20,000 people living with HIV who were held in state and federal prisons in 2010, over 8,800 people living with HIV may have found themselves back in their communities. A much larger number of people are in local jails for relatively short periods; about nine million of them are released each year, the Council of State Governments estimates.

In many states, prisoners about to be released are supposed to be signed up for Medicaid, but that often does not happen. In Maryland, for example, fewer than 10% of those leaving prison each year are enrolled in Medicaid prior to their release, the Baltimore Sun reported earlier this year. According to that article, prison medical director Sharon Baucom, M.D., blamed a lack of resources for the decision to enroll only the sickest in the federal health insurance program.

But health care is only one of the things people need when they leave a correctional facility. A place to stay and food are just as important, which means the supportive structures needed for maintaining HIV treatment may actually be better in prison than on the outside, said David Wohl, M.D., of the North Carolina Department of Corrections in a 2014 North Carolina Health News article: "It's this three-hots-and-a-cot phenomenon."

Planning for a person's needs after their return to the community can avoid interruptions in HIV treatment. Barry Zack, M.P.H., described some discharge planning programs that address these needs in a recent webinar on continuity of HIV care for those leaving prison or jail. Project START, for example, includes three one-on-one sessions prior to release and four sessions thereafter. While still in prison, the client and counselor develop a plan to reduce the risk of acquiring or transmitting HIV, hepatitis or other sexually transmitted infections, as well as a plan for the resources and services the client needs for reentry into the community. During the post-release sessions, the client's needs are reviewed and plans adjusted as necessary. Referrals to community resources are also provided.

The U.S. Ryan White HIV/AIDS Program publishes materials for organizations that are linking the estimated 85% of the imprisoned population that is housed in local jails to HIV prevention, care and services. The curriculum, manual and webinars stress the importance of housing, nutrition, transportation and post-release follow-up, in addition to medication and linkage to health care services. Other groups that help organizations working with people who are imprisoned or recently released and affected by HIV include The Bridging Group and pilot projects by AIDS United.