As noted above, one quarter of HIV-positive people in the United States have spent time in the correctional system. Connecting released prisoners to community resources is a critical opportunity and responsibility for jails and prisons. Recognizing the potential for public health and educational interventions in prisons to reduce the disease’s devastation in the larger community, prisons and jails gradually are making efforts to assure continuity of care and follow-up of AIDS patients after their release from custody.

The transition for prisoners from custody to community often is chaotic and difficult, and health care concerns often take a lower priority than the search for jobs and housing, rebuilding personal relationships, and a myriad of other chores. Many policies exist on paper but not in practice. The planning that does occur ranges from giving inmates information about outside resources, to making appointments, to accompanying released inmates and assisting with enrollment for housing, health care, drug rehabilitation, financial benefits, HIV counseling, and psychosocial support. Several states provide case management services, establishing contact with prisoners and beginning to plan several months before scheduled release dates.

A review of women who had participated in Rhode Island’s intervention and discharge planning program found that their rate of return to prison was reduced by 26% a year after release, suggesting that these women had reduced the risk activities in the community that in the past had led to their incarceration.(64)

AIDS Research
The Nuremberg Code, developed after World War II as the result of hearings regarding Nazi treatment of prisoners, stated that “the voluntary consent of the human subject is absolutely essential” for medical research. Many countries subsequently outlawed all research on prisoners. The pharmaceutical industry regularly performed medical research involving prisoners in the United States until banned by federal prisons and several states in the 1970s.

Prisoners who participated often lived in separate and superior housing units, ate better food, earned more money than was available for other prison work, and were offered hope of parole. No pharmaceutical agents were being used in clinical trials in the U.S. state prison systems in 2005.(65)

The issue of medical experimentation and research on prisoners arose in a new context in the 1980s and 1990s, as HIV and related conditions were treated in the community with experimental drugs that the Food and Drug Administration had not yet approved and that generally were not available to prisoners. There is a clear distinction between experimental drug treatments used primarily for the benefit of the imprisoned HIV-infected patients and those used to test the hypotheses of drug developers or others.(66) In 1994, 15 of the 51 state or federal systems surveyed reported offering experimental therapies to inmates with HIV disease.(67) A Connecticut prison survey of 101 eligible inmates in 1996 found that 50% were willing to participate in clinical trials within the prison, whereas 66% were willing to do so “outside.”(68)

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Elizabeth Kantor, MD
University of California San Francisco

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Dr. Elizabeth Kantor MD practices geriatric medicine and internal medicine in San Francisco, California.

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REFERENCES

1. U.S. National Commission on AIDS. HIV Disease in Correctional Facilities. Washington: U.S. National Commission on AIDS; 1991.
2. Harrison P, Beck AJ. Prisoners in 2004. Washington: U.S. Department of Justice, Bureau of Justice Statistics; October 2005.
3. Maruschak L. HIV in Prisons, 2003. Washington: U.S. Department of Justice, Bureau of Justice Statistics; September 2005.
4. Maruschak L. HIV in Prisons and Jails, 2002. Washington: U.S. Department of Justice, Bureau of Justice Statistics; December 2004.
5. Hammett TM, Harmon P, Rhodes W. The Burden of Infectious Disease Among Inmates and Releasees from Correctional Facilities. In: The Health Status of Soon-to-Be-Released Inmates: A Report to Congress. Vol. 2. Chicago: National Commission on Correctional Health Care; March 2002.

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