CJDATS HIV SERVICES AND TREATMENT IMPLEMENTATION IN CORRECTIONS

1. CJDATS HIV SERVICES AND TREATMENT IMPLEMENTATION IN CORRECTIONS Barry Zack and Katie Kramer The Bridging Group

2. Goal of Training • To provide a baseline level of knowledge on HIV prevention programs and testing within correctional settings and linkages to care upon community release.

3. Training Objectives • Present an overview of best practices in HIV prevention programs and testing within correctional settings and linkages to care upon community reentry. • Provide an in-depth review on HIV linkages to care policies and practices within correctional settings. • Highlight the important role of prisons and jails in HIV linkages to care policies and practices.

4. Participant Introductions • Your Name • Agency and Position in Agency • Years Working in or with a Correctional Agency • Experience with HIV/AIDS • Testing, prevention, linkages to care • Expectations from Training • First Musical Concert and/or Event

5. HIV and Corrections 101

6. What is HIV and AIDS? H = Human Virus I = Immunodeficiency V = Virus A = Acquired I = Immune D = Deficiency S = Syndrome

7. Modes of HIV Transmission

12. United States Incarceration Rates More than 1 in 100 American adults were incarcerated at the start of 2008. One in every 31 American adults, or 7.3 million Americans, are in prison, on parole or probation. US has over 25% of all people incarcerated worldwide. Approximately one in every 18 men in the US is behind bars or being monitored. US Dept of Justice, Bureau of Justice Statistics. Prisoners in 2006. NCJ publication 219416.

13. Federal & State Prison Population 1980-2005

14. 14 Dual Epidemics

15. Health and Incarceration • HIV/AIDS - 2 ½ times the national rate • STIs, Hepatitis, TB - significantly higher • Mental Health - 45-64% • 10-17% SMI • Substance Use – 43-69% • 30% have co-occurring SMI • Chronic Conditions - significantly higher • Hypertension • Diabetes

16. Top 10 HIV Rates Among Incarcerated Populations 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.

17. HIV Transmission in Correctional Settings • 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 • Scarcity of sterile drug paraphernalia leads to needle sharing in prison3 • Needle sharing among soon-to-be released individuals is high4 • Among IDUs in New Mexico, 37.6% of those with tattoos received them in jail or prison5 1. CDC. MMWR. 2006;55(15):421-426. 4. Stephens TT et al. Am J Health Stud. 2005. 2. Hammett TM. Am J Pub Health. 2006;96(6):974-978. 5. Samuel MC et al. Epidemiol Infect. 2001;127:475-484 3. Davies R. Lancet. 2004:364:317-318.

18. HIV Prevalence Among Those Released From Prison/Jail in 2006 • Estimate of proportion of HIV+ persons in US who passed through a jail or prison in 2006 • 1 of 7 (14.1%) of all HIV+ in US were released from incarceration in 2006 • At least 22% of all HIV+ black men in US passed through a correctional facility during 2006 14.1 85.9 Incarcerated/released Not incarcerated Total US HIV population ~ 1.1 million Spaulding A, et al. PLoS One. 2010.

19. HCV/HIV Co-infection in Correctional Systems • Maryland Division of Correction and Baltimore City Detention Center (January-March 2002)[1] • 29.7% HCV+ • 6.6% HIV+ • 4% HCV/HIV co-infected • CDC Prison Study[2] • 8.2% of HCV+ inmates had HIV • 70% of HIV+ inmates had HCV • Entrants to 3 large city jails (Detroit, Chicago, San Francisco)[2] • 9.2% to 15.7% HCV+ • 1.8% to 2.6% HIV+ • ~ 1% HCV/HIV co-infected 1. Solomon L, et al. J Urban Health. 2004;81:25-37. 2. Weinbaum C, et al. AIDS 2005, 19 (suppl 3):S41–S46 .3. Weinberg C, et al. APHA Annual Meeting 2003. Abstract 5097.0.

20. Syphilis Rates in Correctional Systems

21. 21 Drug Abuse or Dependence and Mental Health Disorders – State Prison Belen, S.,  (2011). Treatment needs and treatment options for drug-involved inmates: Opportunities and challenges.  Yale University Law School Sentencing Workshop.

22. Behavioral Health Disorders by Offense Type 22 *p <. 001 Belen, S.,  (2011). Treatment needs and treatment options for drug-involved inmates: Opportunities and challenges.  Yale University Law School Sentencing Workshop. 22

23. Cycle of Incarceration Court Community Jail Prison

24. Relationships in the Community

25. 25 When Prison Enters the Picture

26. 26 Concurrent Relationships in the Community

27. 27 Focus: Past and Present • History of HIV Prevention in Correctional Settings • Testing in late 80’s/early 90’s to isolate • Move away from testing in mid 90’s – “have to treat” • Mid 2000’s – up swing in testing as treatment became cheaper and more available • Current Research Projects • NIDA: CJ-DATS * NIDA/NIMH: Seek, Test and Treat • CDC: Proof of Concept * SAMHSA: Criminal Justice Initiative • Recent US Supreme Court Decision • Overcrowding results in unconstitutional level of healthcare/140% of capacity

28. A Community at Risk • Reality Check: • It is estimated that each year, 14 - 25% of all HIV positive persons in the US spend time in prison or jail. • People come into facility with higher rates of infectious diseases • Most people (over 90%) in correctional facility will return to the community • Incarcerated does not occur in a vacuum. People move in and out of prisons and jails and likewise move in and out of communities and relationships. • Correctional medical care and health programs represent an opportunity to improve community health

29. A Unique Opportunity • High turnover of people in prisons and jails creates a flow of individuals who may have access to health care only when incarcerated. • The correctional setting may be the only place where people get care, treatment and support.

30. Issues to Consider • Disconnect between Corrections and Public Health • Different Cultural Identities • Security= Safety First • Operational Policies, Procedures and Relationships • Confidentiality • Ethical Considerations

31. The Disconnect Public Health Corrections • Mission = Public Health • Orientation toward Change • Humanitarian • Dress code is Informal • Prevention/Care/Dx • Client-Centered • Flexibility • Creative • Mission = Public Safety • Orientation toward Order • Para-Military • Dress code is Uniform • Punishment • Institution-Centered • Rules • Standard Operating Procedures

32. 32 Addressing HIV Supports the Mission of Corrections • Safety and security is the number one priority of every correctional facility. • Effective HIV testing, prevention and linkages to care programs can contribute to the safety and security mission of a correctional facility. “People, who are actively working to better themselves, are less likely to get into trouble on the inside. Thus, more programs make my prison safer.” - Former Warden, San Quentin State Prison

33. HIV Services Continuum Prevention Testing Linkages to Care

34. HIV Prevention • Provide HIV information, education and/or skills building about preventing the spread of HIV • Different types of programs include workshops, peer education programs, one-on-one outreach, health fairs, educational brochures, etc. • Models • Peer based • Educational Services • Medical services

35. HIV Testing • HIV and other disease screening • Confirmatory test • Models • Mandatory vs. voluntary • Timing (entry, during incarceration, at release) • Pre/post counseling • Tied in to other HIV prevention programs

36. HIV Linkages to Care • Linkages to HIV treatment providers in the community after release • Seamless medical care • Additional support services • case managers, benefits counselors • Access to other treatment providers • substance treatment, mental health, etc.

37. Gallery Walk Exercise

38. 38 Linkages to HIV Care in Inside & in the Community After Release

39. HIV Linkages to Care • Discharge planning • medications, benefits paperwork, medical records • Linkages to HIV treatment providers in the community after release • seamless medical care • Additional support services • case managers, benefits counselors • Access to other treatment providers • substance treatment, mental health, etc.

40. 40 The Journey Home

41. The Linkage Challenge Freedom Incarceration What are we doing? • Screening • Diagnosis • Infectious diseases (HIV, STI, TB, HCV, HBV) • Mental illness • Substance abuse • Treatment • Pre-release planning Making the transition work! • Linkage to care and services • Treatment • ID (HIV, HCV, STIs, HBV, etc.) • Chronic (hypertension, diabetes) • Substance Use & Mental Health • Adequate community resources • Addressing life’s competing priorities Reincarceration How to break the cycle? • Societal challenge (poverty, discrimination, etc.) • Policy (Sentencing, Drugs, Housing, Sex Offenders)

42. 42 Linkages to Care Spectrum • Inside Only Model • Planning begins near release with continuation of case management until release • Released Focused Model • Brief planning happens near release with continuation of case management after release • Inside/Out Model • Ongoing planning and case management occur inside and continues in the community after release

43. 43 NCCHC Position Statement on HIV Discharge Planning in Correctional Facilities • HIV-positive individuals need to receive prevention, education, and treatment that continues upon release. • It can be difficult for HIV-positive individuals to find health care services outside a correctional environment. • Individuals on treatment inside need to have continuity of care upon discharge from jail or prison. • Give sufficient supplies of medications at release (14-30 days). • Provide instruction on the importance of medication adherence.

44. Current Local Practices inLinkages to Care

45. 45 What’s happening out there: 4 Models of Linkages to Care • California DOC Transitional Case Management Program (TCMP) • NYC Enhancing Linkages Program • CDC Project START (HIV-positive adaption) • Hampden County Public Health Model of Care in Correctional Facilities

46. 46 California DOC (CDCR)Transitional Case Management Program (TCMP)

47. 47 TCMP Activities: Pre-Release • In-depth interview 90 days prior to release • Build relationship and confidence with client • Act as liaison between prison medical staff, community service providers, and parole officers • Conduct psychosocial needs assessment (immediate needs, id, housing, ADAP, SSI/medi-cal, substance abuse) • Develop care plan based on individual’s needs upon release • Care planning 60 days to release • Match needs with long-term community service provider • Meet with individual to discuss options from care plan • Provide individual with information and referrals

48. 48 TCMP Activities: Post-Release • Post-Release support/follow-up for 60 to 90 day • Meet with client within first 48 hours of release • Provide client with Parole Packet - i.e. condom, prevention telephone card, toiletry items, resource information • Encourage client to keep planned appointments • Encourage client to participate in community peer support group • Help client identify risky behaviors • Empower participant to begin to make choices • Discuss prison vs. free world obstacles

49. 49 NYC Enhancing Linkages Program

50. 50 Jail Discharges to NYC Communities by Zip Code and Socioeconomic Status 2004