HIV and Inmates: Are Jails Failing to Educate?

HIV positive inmates in local jails and prisons are not a group that correctional facilities can continue to ignore.  According to Centers for Disease Control reported that for the years from 1999 to 2006, the prevalence of confirmed AIDS among the prison population was between 2.7 and 4.8 times higher than in the general U.S. population. No small number of inmates across the United States enter a correctional facilities knowing that they are HIV positive (while others are wholly unaware).  While many facilities account for this possibility and request whether or not a detainee or inmate is HIV positive on a various jail/prison intake forms or medical questionnaires, the real question is what does the facility do with this information?  The ability of an inmate or detainee to request testing to determine whether they are HIV positive is widespread but not without several states holding out.

Many in the general public may ask why would I care or how could this matter to me.  The reason it matters is that the reentry of detainees or inmates into our communities presents a danger of spreading HIV and other infectious diseases if those health issues are not adequately monitored and controlled.

So how are these correctional facilities failing to protect the inmates in their custody and in turn, the rest of us?  First, it starts with education.  The World Health Organization (WHO) has stated: “All inmates and correctional staff and officers should be provided with education concerning transmission, prevention, treatment, and management of HIV infection. For inmates, this information should be provided at intake and updated regularly thereafter.”

Educating facility staff and inmates on transmission of HIV and infectious disease seems patently obvious.  However, this training and education is not widespread.  However, educating staff and inmates on prevention is only part of the problem.  Managing those that enter a correctional setting already with HIV is just as crucial, if not more so.

For instance, educating the facility’s security or medical staff about the importance of timely providing the required antiretroviral therapy medication is essential.  Understanding the dosages needed and the frequency of administration helps all involved in providing medications by knowing when those life-sustaining dosages may run out.  Knowing the schedule and understanding when doses are low helps facility staff to communicate with each other and plan ahead so that the needed medications are not in a period where detainees or inmates adherence lapses.  Communication is important not just with the housing facility of the detainee or inmate but with other facilities in advance of a transfer which can help eliminate or reduce the number of missed doses.

A lapse in antiretroviral therapy has widespread ramifications.  It can increase the viral load and decrease the CD4 count in a prisoner.  It can create feelings of hopelessness and anxiety by not knowing when the next dosage will occur.  This psychological roller coaster can in turn create or excaberate further physical problems.  Eliminating the missed dosage is paramount in a jail or correctional setting.

While this short discussion deals primarily with educating staff regarding treatment plans, dosage, transmission and prevention, that is not the entirety of where a facilities duties start and stop.  However, we are finding that some of these rather obvious and small steps are not being implemented in local jail facilities or prisons.  It cannot be overlooked how education and communication operate to ensure the prisoner and staff have a plan to effectively manage treatment of HIV positive persons.