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April 01, 2010

Ex-Offenders' Right to Health: HIV/AIDS and Reentry

bt Natasha H. Williams

According to Lauren E. Glaze and Thomas P. Bonczar of the Bureau of Justice Statistics (Probation and Parole in the United States, 2008), in 2008 more than 7.3 million people were in prison, jail, on probation, or on parole. This number is equivalent to 1 in every 31 adults. Of those, more than 2.3 million men and women were incarcerated in local jails and state or federal prisons—the rough equivalent of 1 out of every 133 U.S. residents. William J. Sabol, Heather C. West, and Matthew Cooper, Prisoners in 2008. Furthermore, The Sentencing Project estimated that more than 700,000 individuals will be released each year from prisons (Criminal Justice Primer: Policy Priorities for the 111th Congress 2009) and The Urban Institute estimated that 230,000 will be released from jails each week. Amy L. Solomon et al., Life After Lockup: Improving Reentry from Jail to the Community (May 2008).

The prevalence of communicable and chronic diseases among prisoners during incarceration and upon release demonstrates the severity and extent of unmet health-care needs—especially for those with HIV/AIDS. The National Commission on Correctional Health Care reported that, of prisoners released in 1996, 155,000 had hepatitis B infection, 1.4 million were infected with hepatitis C, and 566,000 had latent tuberculosis infection. In addition, in 1995, 8.5 percent of inmates suffered from asthma, an estimated 5 percent from diabetes, and more than 18 percent from hypertension. The Health Status of Soon-To Be-Released Inmates: A report to Congress (March 2002).

According to the Bureau of Justice Statistics, in 2007 the overall rate of estimated confirmed AIDS cases among the state and federal prison population was “more than 2 times the rate in the general population.” Laura M. Maruschak, HIV in Prisons, 2007–08, 3 (Jan. 2010). In 2008, 21,987 people in state or federal prisons were known to be HIV-positive or had confirmed AIDS. This number includes 1.5 percent (20,075) of male inmates and 1.9 percent (1,912) of female inmates. During 2007, nearly three-quarters (73 percent) of state prisoners “who died of AIDS-related illness were ages 35 to 54.” Black non-Hispanic inmates accounted for nearly two-thirds (65 percent) of state inmates who died from AIDS-related causes.

Inside prisons, the risk behaviors for the transmission of HIV are unprotected sex, either consensually or by force, and the sharing of injecting, tattooing, and piercing equipment. It is imperative that inmates receive a continuum of care and counseling not only while they are incarcerated but also once they return home. Because many of those released do not have health insurance or Medicaid coverage (reinstitution of their benefits can take weeks to months—if they are eligible at all), they do not have medical care or medication. Pre-release planning to manage HIV/AIDS could ensure that networks for payment and facilitated access to services be in place before an individual’s return to the community.

Moreover, reentry programs can serve as essential linkages to community resources and a source of health care and counseling. Reentry program models that combine one-stop onsite health services with access to social services can provide one-on-one HIV counseling; access to health services where clients can pick up their medications and receive medical care; and assistance to address the contextual barriers that may impact HIV risk behaviors such as substance abuse, mental health, employment, and housing needs for those formerly incarcerated returning to the community.

Additional recommendations to stem the spread of HIV/AIDS within the correctional population while incarcerated and upon return to the community include:

• voluntary HIV screening followed with pre- and post-counseling and medical referrals for treatment;

• ensuring the confidentiality of HIV test results of prisoners;

• making condoms, bleaching kits, and sterile syringes available in correctional settings;

• initiating prevention education at onset of incarceration, during incarceration, at pre-release, and upon community reentry;

• pre-release and discharge planning;

• forming partnerships between department of corrections, public health departments, community-based organizations, commnity health providers and the community itself to ensure linkages to treatment and prevention services in the community; and

• developing prevention interventions that address the issues of housing, employment, health-care access, and education to address contextual factors that may impact HIV risk behaviors.

The social, economic, and health consequences of incarceration can no longer be ignored. The correctional population’s health and the public’s health are intimately intertwined. The men and women returning home to their families and our communities are our mothers, fathers, uncles, aunts, brothers, and sisters. Addressing the health needs of this vulnerable population is not only the right thing to do but also the necessary thing to do, because to do otherwise puts our viability as a society at stake. If we do not act earnestly, decisively, and compassionately, the public health crisis and health-care costs that will emerge will decimate our public health and health-care infrastructure and our communities, and will mortgage future generations.

Natasha H. Williams

Natasha H. Williams is an associate attorney at Bailey & Glasser, LLP in Washington, D.C.