Transcript Incarceration and HIV Cathy Elliott-Olufs, M.A. Laura McTighe, MTS Correctional facilities are critical settings for the efficient delivery of prevention and treatment interventions for.

Incarceration and HIV
Cathy Elliott-Olufs, M.A.
Laura McTighe, MTS
Correctional facilities are critical settings for the
efficient delivery of prevention and treatment
interventions for infectious diseases. Such
interventions stand to benefit not only inmates,
their families, and partners, but also the public
health of the communities to which inmates
return.
—T. M. Hammett
American Journal of Public Health
Mission Statement
The Center for Health Justice empowers people affected by
incarceration and HIV to make healthier choices and advocates
for the elimination of disparities between prisoner health and
public health. To achieve our mission, we advocate for HIV+
prisoners and provide HIV/AIDS, STD and Hepatitis education
and treatment information to prisoners in California and
throughout the United States.
•
CHJ Services Areas
Policy and
Advocacy
Community Outreach
Legislative Involvement
Prevention Advocacy
Health Advocacy
Public Awareness
Condom Access
Custody Staff Training
Consulting
Public Speaking
In-Custody
Education
Services
HIV Classes
Individual Counseling
Hepatitis C Education
STD Education
Inmate Hotline
Women’s Programs
Pre-Release Planning
Treatment Education
Linkage to Care
Re-Entry
Support
Medical Referrals
Housing Referrals
Job Counseling
Skills-Building
Clothing Vouchers
Risk-Reduction Support
Hygiene Kits
Educational Referrals
Moral Support
Mission Statement
The Institute for Community Justice is a Philadelphia-based
national initiative committed to locally-rooted, national work to
reduce not only the number of people in prison living with HIV,
but also the lasting effects of mass imprisonment on communities
most affected. By centering the wisdom and experiences of
formerly imprisoned community leaders, we work to amplify
existing efforts to build safe and vibrant communities, push for
needed policy change, and realize our vision for community-led
transformative justice.
Our Core Projects
•Reentry Organizing Center – a community center
dedicated to helping people navigate the hurdles of self
care, recidivism prevention, and political engagement.
•TEACH Inside/TEACH Outside – an empowermentbased educational program on the intake housing units of
the Philadelphia jails and in the community
•Support Center for Prison Advocacy – a city-wide,
neighborhood-based prison reentry resource center
without walls in North, South and West Philly
•Prison Health News – the nation’s only health newsletter
written by and for people who are in prison
Overview of United States Correctional System
At end of year 2008
• The total number of inmates held in
federal or state adult correctional
authorities was 1,570,861—a 2.8%
increase over 2005 year-end total1
– The prison population grew at a
faster rate than the previous five
years
• The total number of inmates held in
local jails was 766,010—a 2.5%
increase over 20051
• 1 in every 133 US residents was in
prison or jail1
• Overall, the United States incarcerated
2,258,983 people—a 2.9% increase
over the 2005 year-end total—and the
most in the world2
1US
Dept of Justice, Bureau of Justice Statistics. Prisoners in 2006. NCJ publication 219416. http://www.ojp.usdoj.gov/bjs/pub/pdf/p06.pdf. Published December
2007. Accessed Jan 9, 2008.
2National Council on Crime and Delinquency. US Rates of Incarceration: A Global Perspective (FOCUS). http://www.nccdcrc.org/nccd/pubs/2006nov_factsheet_incarceration.pdf. Published November 2006. Accessed Jan 9, 2008.
US Incarcerated Population
1,600,000
Jails
Prisons
1,200,000
800,000
400,000
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US Dept of Justice, Bureau of Justice Statistics. Prisoners in 2006. NCJ publication 219416.
http://www.ojp.usdoj.gov/bjs/pub/pdf/p06.pdf. Published December 2007. Accessed Jan 9, 2008.
Jail
• Short-term facility
• Usually operated by a city, county, or local government
• Holds arrestees awaiting trial or sentencing and inmates convicted and
sentenced to less than 1 year
• Approximately 50% of arrestees are released within 48 hours1
• Public health interventions (eg, screening, testing, counseling, making
referrals) must happen QUICKLY or not at all
• Most jails do very little screening—usually only for tuberculosis,
sometimes for sexually transmitted diseases (STDs), sometimes for
pregnancy and HIV
• Mean expected time of jail stay is 9 months2
1CDC.
MMWR 1998;47:429-31.
Dept of Justice, Bureau of Justice Statistics. Profile of Jail Inmates, 2002. NCJ publication 201932.
http://www.ojp.usdoj.gov/bjs/pub/pdf/pji02.pdf. Published July 2004. Accessed Jan 15, 2008.
Adapted from: de Ravello L; CDC. Prisons and drug abuse: challenges to HIV perinatal prevention efforts.
http://www.cdc.gov/hiv/topics/perinatal/resources/meetings/2002/pdf/ps_prison.pdf. Published Feb. 13, 2002. Accessed Jan 9, 2008.
2US
Prison
• Longer-term facility
• Usually operated by the state or federal government
• Greater opportunity to implement long-term public health
interventions with follow-up
• Very comprehensive medical intake process, but the level and
quality of ongoing medical care varies
Adapted from: de Ravello L; CDC. Prisons and drug abuse: challenges to HIV perinatal prevention efforts.
http://www.cdc.gov/hiv/topics/perinatal/resources/meetings/2002/pdf/ps_prison.pdf. Published Feb. 13, 2002. Accessed Jan 9, 2008.
Top 10 HIV Seroprevalence Rates Among Incarcerated
Overall % HIV
Seroprevalence Rate
Female
Seroprevalence Rate
Male
Seroprevalence Rate
NY
7.0%
14.1
6.7
FL
3.9%
5.7
3.8
MD
3.0%
6.9
2.8
MS
2.7%
2.5
2.7
CT
2.6%
4.0
2.5
LA
2.5%
3.2
2.5
NJ
2.3%
6.8
2.1
SC
2.2%
2.5
2.2
GA
2.1%
3.2
2.1
MA
2.1%
3.3
2.0
State
US Dept of Justice, Bureau of Justice Statistics. HIV in Prisons, 2005; Appendix Tables 1 and 2. NCJ publication 218915.
http://www.ojp.gov/bjs/pub/pdf/hivp05.pdf. Published Sept. 2007. Accessed Jan 9, 2008.
US HIV-Positive Prison Population—2008
• 16.9% of all PLWHA in the US were in a correctional facility at some point
(2006).
•
On December 31, 2008, a reported 20,449 state prisoners and 1,538
federal prisoners were HIV positive or had confirmed AIDS
• 1 in 5 Black and Hispanic males released from corrections facility in US
are HIV-positive.
• The percentage of female inmates with HIV/AIDS decreased slightly from
2.1 percent to 1.9 percent.
1. US Dept of Justice, Bureau of Justice Statistics. HIV in Prisons, 2008;
2. 1Maruschak LM et.al. US Department of Justice, Bureau of Justice Statistics, Bulletin, April 2008.
3. Spaulding AC et.al. PLoS One, 2009
HIV Transmission in Correctional Settings
• The majority of HIV-positive people are infected before they enter
prison1
• HIV risk behaviors often continue inside the institution and include
injecting drug use, tattooing, body piercing, and consensual,
nonconsensual, and survival sexual activities2
• The scarcity of sterile drug paraphernalia leads to needle sharing
in prison3
• Needle sharing among soon-to-be released prisoners is high4
• Among IDUs in New Mexico, 37.6% of those with tattoos received
them in jail or prison5
– Tattoos received in prison were associated with increased risk for
HBV and HCV
1. CDC. MMWR. 2006;55(15):421-426.
2. Hammett TM. Am J Pub Health. 2006;96(6):974-978.
3. Davies R. Lancet. 2004:364:317-318.
4. Stephens TT et al. Am J Health Stud. 2005.
5. Samuel MC et al. Epidemiol Infect. 2001;127:475-484.
Incarceration is a Social Driver of HIV/AIDS
“We must remember… that incarceration itself
—not just inadequate prevention and care behind bars—
contributes substantially to the global burden of HIV,
particularly among drug users and sex workers.
In fact, we would argue that the
single most important strategy
in controlling HIV in prison is to
1
stem the rate of incarceration itself.”
1Duncan
Smith-Rohrberg Maru, Sanjay Basu, & Frederick L Altice. (2007) "HIV control efforts should directly address incarceration.”
The Lancet Infectious Diseases: Vol. 7 No. 9.
Understanding Community-Level Vulnerability
Financia
Lack of
l
Jobs
Loss of
Broken
Instabilit Caregivers
Family
y
Ties
Fractured
Fractured
Communities Arrest – Jail/Prison – Reentry Communities
Need for Services and Support
Relationshi
p Instability
Lack of
Social
Services
From Vulnerability to Community Health
Financial
Stability
Community
Wholeness
Ready
Employme
nt
Family
Support
Family
Reintegrati
Community
on
Wholeness
Arrest – Jail/Prison –
Reentry
Comprehensive Care and Support
Relationshi
p Stability
Access to
Social
Services
Working at the Intersection of HIV and Incarceration
• Testing
• Prevention
• Treatment and Care
• Treatment and Prevention Education
• Reentry Support
• Structural Interventions
Mandatory HIV Testing Policies by State
No testing
required
On entry
On release
On entry and
in custody
On entry and
on release
In custody and
on release
On entry,
in custody, and
on release
Not reported
US Dept of Justice, Bureau of Justice Statistics. HIV in Prisons, 2005;
Appendix, Table 5. NCJ publication 218915.
http://www.ojp.usdoj.gov/bjs/pub/pdf/p05.pdf. Published Sept. 2007.
Accessed Jan 9, 2008.
All states test upon inmate request
except NH, IA, AL, KY, UT, and NV
Condom in Prison Programs Nationwide
• County Jails
Los Angeles, San Francisco, Philadelphia, Washington,
D.C. and New York
• State Prisons
California, Mississippi and Vermont
CHJ’s Condom Distribution
Los Angeles County Jail
• Operated without incident for 7 years
• Distributed over 30,000 condoms
• Approximately 200-250 condoms per week
–
Limited to K-6G Unit (ie. gay unit)
–
One condom per week per inmate
(now expanded)
–
In conjunction with brief educational
session
San Francisco County Jail
• Collaboration with Forensic AIDS Project
Program
• Since 1987
• Previously in one-on-one in health educator
sessions
• Now offered via a condom dispensing
machine in the gym (free)
• Several small evaluations have been conducted.
Solano State Prison
• Findings indicate that condoms are being used
• Pilot program implemented Aug/Sep. 2008
and ongoing research is underway to determine
whether high-risk sexual activity is reduced by
access to condoms
• Under order from the Governor of California
to determine feasibility of prisoner access to
condoms
• Center for Health Justice selected to
implement a condom machine and
educational program
• Evaluation underway
HIV Treatment and Care in Prison
HIV-infected inmates are more likely to be
offered antiretroviral therapy in prison
Prisoners
offered ART in
prison (only)
ART offered in
64%
another setting
36%
Only 3% of HIV+
prisoners are on ART
at time of
incarceration
Study data collected from the Connecticut Department of Corrections (DOC)
Altice F et al. J Acquir Immune Defic Syndr. 2001;28:47-58.
HIV and Hepatitis Prevention and Treatment Education
Train-the-Trainer Program for State Prison Settings
TEACH Outside (people living with HIV coming out of jail/prison)
TEACH Inside/TEACH Outside (all people passing through the Philly jails)
Reentry Support Programs
Who in the room??
Thinking About Structural Interventions
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In Communities:
At Reentry:
Sentencing
reform
In Jail/Prison:
Civic
participation
Community
policing
Harm reduction
programs
Community-led
mentoring
Prison budget
reinvestment
Treatment
education and
advocacy
Job creation and
retention
Youth
empowerment
Good time
earned time
Housing
expansion
Research Advocacy Directions
• Lack of connection among those of us doing this work
• Lack of dissemination of programs we know work
• Lack of programming to reach jail-based populations
and those on parole
• Lack of research on incarceration as a social driver of
HIV in the US
• Lack of models for effective structural interventions
Thank You!
Cathy Elliott-Olufs
Laura McTighe
Center for Health Justice
Institute for Community Justice
Cell: 323-646-4575
Phone: 215-525-0460 x402
Email: [email protected]
Email: [email protected]
Web: www.healthjustice.net
Web: www.community-justice.org