HIV in Corrections

Every year since 1991, the rate of confirmed AIDS cases among U. S. prison inmates has been higher than in the general population. At year end 2006, 1.6% of male inmates and 2.4% of female inmates in state and federal prisons were known to be HIV positive or to have confirmed AIDS. The overall rate of confirmed AIDS cases in state and federal prisons (0.46%) was more than 2.5 times higher than in the total U.S. population (0.17%). In California, there are over 1,600 prisoners or parolees identified as HIV infected; approximately half are diagnosed with AIDS. Current California law does not require mandatory testing to identify all HIV+ inmates, and the actual number of HIV+ prisoners is thought to be much higher, in the range of 5,000 – 8,000.

Clinicians in correctional settings face extraordinary challenges in caring for HIV-infected patients, and often lack specialized training in HIV therapeutics and care. Medical care staff in correctional facilities frequently interact with HIV+ patients who may not have previously accessed care. In addition to HIV/AIDS, incarcerated populations are also disproportionately affected by higher rates of other communicable and chronic diseases such as tuberculosis and hepatitis. Prison conditions can undermine adherence efforts essential to effective antiretroviral therapy, and gaps in treatment are common due to frequent transfers of inmates among correctional facilities. Transitional care planning for HIV+ parolees is also challenging because of inconsistent access to care before, during and after incarceration. Because many inmates with HIV infection eventually return to the community, how correctional health care providers deal with HIV treatment within their institutions has important implications to the overall care of HIV-infected people in the community.

The UCSF San Francisco Area AETC (SFAETC) offers HIV clinical education and training to assist correctional health care providers with developing the HIV knowledge base and clinical skills necessary to provide care and treatment to a challenging population. HIV/AIDS Training for Correctional Health Care Providers training programs and other educational activities are designed to meet the requirements for funding under the Minority AIDS Initiative (MAI) by addressing the HIV training needs of a specific population of health care providers (correctional health professionals) caring for minority patients. In California, minority populations are over-represented in the prison system as a whole, as well as among HIV+ inmates and parolees.

Our goals are to:

• Train correctional institution clinicians on the current status of prevention, diagnosis and treatment strategies for HIV/AIDS and related co-morbidities.
• Improve linkage to and continuity of care for recently released inmates with HIV/AIDS.