Despite the Federal Bureau of Prisons recommendation that all sentenced, imprisoned people be offered HIV testing, only five of the 104 Louisiana parish (county) jails offer formal HIV testing to every inmate, according to a recent Human Rights Watch report and video. Jail officials, such as Sheila Wright, the nursing director at Caddo Parish Correctional Center in Shreveport, LA, contend that they do not offer HIV testing because their budgets do not allow for treating every inmate who tests positive.
Louisiana has one of the higher rates of new HIV infections in the U.S., as well as an above-average rate of incarceration, the report says. As of year-end 2015, 49.3% of the 36,377 inmates in Louisiana correctional facilities were held in local jails, according to the Louisiana Department of Public Safety and Corrections. The situation is exacerbated by the fact that the Louisiana State University hospitals with HIV clinics that used to treat inmates have been partially privatized. As a result, they no longer offer subsidized treatment to inmates, as well as poor or uninsured patients, Human Rights Watch explains.
Why don't we do routine HIV testing? We cannot afford to treat someone who was identified as HIV-positive. It sounds cold, I know, but that is the reality.
-- S. Wright, nursing director, Caddo Parish Correctional Center, Shreveport, Louisiana,April 8, 2015, in Human Rights Watch's report Paying the Price: Failure to Deliver HIV Services in Louisiana Parish Jails
Even those who know their HIV status when entering jail are often left without access to their own antiretroviral medications. Joyce Tosten, for example, did not have access to her medications for three days, then was told to call her mother to bring her antiretrovirals to the jail. However, in a video accompanying the report, she notes that she was not permitted phone privileges, so she was unable to make that call. Another former inmate, Marvin Aguillard, had to wait for 44 days before receiving his first HIV medication. During that time he developed resistance to that antiretroviral, resulting in severe diarrhea and vomiting. Even then he was unable to access medical care, seeing a doctor only upon his release seven months after his initial incarceration.
Case managers, such as Darren Stanley from the Philadelphia Center in Shreveport, LA, struggle to find their clients once they enter the correctional system, let alone to ensure that they receive their medications. "It's almost impossible to communicate with the jails while the client is incarcerated or when they are getting out," he says. HIV service providers are left to hope that clients will return once they are released, but that is often not the case -- one in three people living with HIV in Louisiana drops out of care, according to Human Rights Watch.
"It is imperative that Louisiana parish jails implement a routine HIV testing program for inmates and make sure that they have a system for connecting that person, if they test positive, to care in the community," concludes the report's author, Megan McLemore.