Discharge Planning for Inmates with HIV/AIDS: Can It Help Increase Adherence to Medical Treatment and Lower Recidivism?
Devereux, Paul G., Whitley, Richard, Corrections Today
Authors' Note: This research was supported by a grant from the Centers for Disease Control and Prevention. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of CDC.
In 1997, the Centers for Disease Control and Prevention reported that the confirmed AIDS case rate for inmates is five times the U.S. rate. (1) While in prison, people living with HIV/AIDS have access to medical services; however, this is not true once they leave the correctional setting. (2) According to the Archives of Family Medicine article, "Human Immunodeficiency Virus Infection Care Is Unavailable to Inmates on Release From Jail," offenders with HIV/AIDS admitted that they may seek rearrest to obtain medical services, (3) thus, making medical services easily accessible to released offenders is essential.
To increase the probability that inmates with HIV/AIDS will access medical care outside the prison system, certain steps must be taken while they are in the correctional setting. One effective way is to link them to community services as part of a discharge planning program. In March 1999, the Nevada State Health Division instituted a discharge planning program to increase adherence to medical treatment outside the prison community.
As part of the process, the discharge planning program brought the community to the correctional setting. In the month prior to their release date, inmates with HIV/AIDS met with a community nurse from a medical clinic to discuss treatment needs and medical services that would be available to them outside of prison. In addition, an appointment at an AIDS clinic was made within the month following their release. At the time of their release, inmates also received a one-month supply of medication provided by the AIDS Drug Assistance Program (ADAP), which supplies HIV/AIDS-related medications to low-income individuals who do not have private insurance or Medicaid. ADAP is authorized under Title II of the Ryan White Comprehensive AIDS Resources Emergency Act and provides assistance to individuals living with HIV/AIDS in the 50 states, the District of Columbia, Puerto Rico, Guam and the U.S. Virgin Islands. An individual whose income is below 400 percent of the Federal Poverty Level and who has less than $4,000 in assets (car and residence not counted) is eligible for ADAP.
During the initial meeting at the community clinic following release, offenders provide their complete psychosocial histories to identify service needs and potential treatment obstacles, such as housing, employment and substance abuse issues. As a result, any potential barriers to medical treatment are addressed. For example, it has been shown that recidivism rates are lower and adherence to treatment is more likely if an individual has stable housing and employment, and is receiving treatment for other conditions, such as mental illness or substance use. (4)
The Nevada State Health Division's objective was to evaluate the impact this program had on recidivism and adherence to medical treatment for HIV-positive inmates exiting the prison system. Recidivism rates and adherence to medical treatment were examined and measured by receipt of HIV medication in the ADAP records. The study followed the offenders for up to 21 months after their release.
Fifty-four inmates received discharge planning from March 1999 through December 2000. The gender, race and age for each person is presented in Table 1, as well as identified substance abuse problems and/or mental health issues.
The percentage of program participants who received medication in the months following release is presented in Table 2. In the first month of release, 31 percent of the sample picked up their medication. The percentage of participants who received medication at least once increased from 63 percent in the first three months to 69. …