Improving the Care for HIV-Infected Prisoners: An Integrated Prison-Release Health Model

  • Sandra A. Springer
  • Frederick L. Altice

Highly active antiretroviral therapy (HAART) has remarkably transformed HIV disease into a chronic condition such that when patients completely suppress viral replication, they can expect to live a normal life expectancy. Unfortunately, many of those who might benefit most from HAART (e.g., illicit drug users, the mentally ill, and the socially and medically marginalized) are less likely to receive it, and when they do, less likely to adhere to treatment. Many of these individuals do not interface consistently with health care institutions in the community setting, yet when incarcerated, have an important opportunity not only to be identified as being HIV-infected, but also to initiate HAART if medically indicated. The prevalence of HIV infection among prisoners is five to seven times greater among incarcerated persons compared to the general population (Crosland, Poshkus, & Rich, 2002; Spaulding et al., 2002). Prisons and jails house individuals with HIV who have not traditionally benefited from access to HIV care and antiretroviral therapy in community settings. Specifically, prisons are comprised of HIV-infected individuals with comorbid medical conditions such as substance use disorder and serious psychiatric illnesses and are socially marginalized through relapsing homelessness, poverty, and unstable living circumstances. HIV care has resulted in impressive reductions in mortality in the New York prison system (CDC, 1999) and HIV/AIDS is no longer the leading cause of prison-related mortality nationally (Linder, Enders, Craig, Richardson, & Meyers, 2002). In nearby Connecticut where 98% of prescribed HAART regimens were within the Department of Health and Human Services guidelines, impressive increases in CD4 count and reductions in HIV-1 RNA levels were observed. Indeed, 59% of these prisoners achieved a viral load below the level of detection prior to release. Despite these successes, the one-quarter of subjects who were reincarcerated lost the viral load and CD4 benefits within 3 months after release to the community (Springer et al., 2004).


Viral Load Substance Abuse Treatment Methadone Maintenance Treatment Correctional Facility Case Management Service 
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Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Sandra A. Springer
    • 1
  • Frederick L. Altice
    • 2
  1. 1.Yale AIDS Program, Section of Infectious DiseasesYale School of MedicineNew HavenUSA
  2. 2.Yale University AIDS ProgramNew HavenUSA

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