Comprehensive Medical Care among HIV-Positive Incarcerated Women: The Rhode Island Experience

Abstract

Our objective was to characterize the clinical presentation of human immunodeficiency virus (HIV) infection among incarcerated women in a program that provides HIV testing and primary care to all state prisoners in Rhode Island. A retrospective medical chart review on all HIV-seropositive women who were incarcerated between 1989 and 1994 and had at least two medical visits with an HIV medical care provider was used. At the Rhode Island Adult Correctional Institution (ACI), under mandatory testing laws between 1989 and 1994, 28% (172 of 623) of all women were identified with HIV infection. Of the 172 women who tested seropositive in prison, 110 were included in the study. Of the 110 women followed, 84% reported injection drug use (IDU) as their primary risk factor, and 30% reported both IDU and sex work. The median CD4 count was 596/mm3, with 60% having a CD4 count >500 cells/mm3. The most common medical conditions were vaginal candidiasis, oral candidiasis, and bronchitis. Antiretroviral therapy was well accepted and followed community standards. Continuity of medical care after release was facilitated by the same physician caring for the patient in the community setting, with 83% of women following up for HIV care after release. The medical conditions noted reflect that these women are early in the course of their HIV disease when they are initially diagnosed. This comprehensive program in Rhode Island's state prison plays a central role in the diagnosis of HIV-seropositive women and provides counseling, primary medical and gynecological care, and linkage to community resources after release.

Recidivism in HIV-Infected Incarcerated Adults: Influence of the Lack of a High School Education

“…9 While these individuals frequently lead chaotic lives, they are also intensively case managed in some U.S. jails and have access to social and medical resources both in and out of the institution. [10][11][12][13][14][15][16] Health-related efforts in correctional facilities have mainly focused on short-term (G3 years) risk reduction and interventions to improve continuity of care after release, and even effective programs to improve HIV outcomes on the inside have shown reversal of gains made after release to the community. 17 Risk reduction interventions have demonstrated positive outcomes related to behaviors, 18 but the effect of such interventions on decreasing recidivism has often been inconclusive or not measured.…”

“…17 Risk reduction interventions have demonstrated positive outcomes related to behaviors, 18 but the effect of such interventions on decreasing recidivism has often been inconclusive or not measured. 10,11 Interventions to improve continuity of care and links to outside programs have demonstrated that high-risk individuals will access, utilize, and benefit from medical and social services provided by a regular network of providers, [12][13][14][15][16]19 but these have not been evaluated for their long-term effect on recidivism.…”

Correlates of HIV Infection Among Incarcerated Women: Implications for Improving Detection of HIV Infection

“…Because pretest counseling for HIV can be a barrier to expanded testing, the CDC initiative now promotes HIV testing that does not require pretest counseling. 2 Correctional systems represent important sites for the detection of HIV [3][4][5] ; they house the nation's highest concentration of HIV-infected individuals. 6 For example, in 2000, 2.2% of all inmates in US prisons and 5.2% of all inmates in the Northeast were HIV infected.…”

Educational Attainment but Not Literacy Is Associated with HIV Risk Behavior among Incarcerated Women

“…[19][20][21][22][23][23][24][25] Addictions to drugs and alcohol have been identified as key variables in the propagation of such risks, and an array of prison-based and postincarceration intervention models have been developed and are being evaluated. 19,[26][27][28] It is crucial to determine ways to reduce HIV risk behaviors among incarcerated women returning to the community. Lower educational attainment has been reported as a risk factor for higher rates of HIV risk behavior among female inmates, although evaluation of different educational factors has not been conducted.…”