Study Shows Care for HIV-Positive Prisoners Poor after Release, Worse for Those Re-Incarcerated
by Scott Grammer
A study published by the Public Library of Science on October 18, 2018 found that prisoners with HIV tend not to retain their level of care after being released, and that those who are re-incarcerated fare even worse. The study reported that during a three-year post-release evaluation period, retention in care “diminished significantly over time, but was associated with HIV care during incarceration, health insurance, case management services, and early linkage to care post-release.”
The report “merged statewide databases from the Connecticut Department of Correction and Connecticut Department of Public Health on all people living with HIV who were released from prisons or jails in Connecticut ... between 2007 and 2011.” Each individual in this group was followed for three years after release to track retention in care and viral suppression (an indicator that the HIV infection has been so weakened through treatment that it cannot be detected in the blood).
Most participants in the study were unmarried men who were either black or Hispanic, who had acquired HIV though intravenous drug use. The report found that those who retained care following their release from prison or jail did well, but only 67.2% maintained their level of care for one year, 51.3% for two years and 42.5% for three years after release. Those who were re-incarcerated were more likely to retain medical care, but less likely to show viral suppression.
Dr. Frederick Altice, director of Yale’s HIV and Prisons program and the study’s co-author, said that in some states, prisoners are re-enrolled in Medicaid before release, but in other states it can take longer. Altice, who has been treating HIV patients since the early ‘80’s, said, “[HIV] is a chronic disease. People don’t need services six weeks after release. They need them immediately.”
Dr. Cato T. Laurencin, a professor at the University of Connecticut and founding editor of the Journal of Racial and Ethnic Health Disparities, noted the post-release period may be key in the fight to eliminate new transmissions of HIV. “We are now talking about the fact that we believe that we can end new cases of HIV in our lifetime,” he said. “We need to see changes in this setting. And if we’re not, that tells us we’re not on course.”
The study found that former prisoners who had health insurance were more than twice as likely to reach viral suppression, and those who received intensive case management were twice as likely to show viral suppression at the end of the three-year study period.
A 2009 report by the Public Library of Science revealed that at any given time, 1/6 of all HIV patients are incarcerated.
Sources: npr.org, journals.plos.org