Prison Health Crisis -- What You Can Do

by Laura McTighe

Summary: Some basics on informing oneself and helping others, in prison or after release.

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The last 30 years have seen an increased emphasis on punishment over rehabilitation. At present, over 2 million people are incarcerated in the county, state, and federal correctional institutions in the US. Two-thirds of prisoners are incarcerated for nonviolent crimes, mostly drug-related, as a result of the War on Drugs. The War on Drugs has targeted the populations most at risk for HIV, including injection drug users and commercial sex workers. It is now estimated that 1 in 4 people with HIV pass through a correctional facility each year. For many people living with HIV, the prisons' Infectious Disease specialists have become their primary care providers.

Correctional systems are facing a health care crisis. Lapses in HIV medication are common, access to emergency medical care is poor, and many prisoners are actually charged for medical visits and prescriptions. Moreover, there is little regard given to prisoners' confidentiality. Correctional officers often know protected health care information like someone's HIV status, and prisoners frequently have their HIV meds called out by name in medication lines. Many prisoners with HIV do not seek treatment for fear of the discrimination they would face from other prisoners.

When released, HIV-positive ex-offenders are often sicker than when they entered prison, and have no referrals for medical care, housing, or drug treatment. Delay in receiving HIV medications can mean a swift deterioration in the immune system; lack of housing means living in a shelter or on the streets; and lack of drug treatment leads to high rates of relapse, and can hasten the road back to prison. According to a June 2002 study by the US Department of Justice, as many as two-thirds of prisoners will be rearrested within three years of their release. Nearly 30% of inmates with a history of addiction reported that their substance use was a "very important factor" in their re-arrest.

If You Are Incarcerated

Educate yourself. It is possible to live a healthy, normal life with HIV. And there is a lot of information available to help you learn how to best take care of yourself. Check out the resources section below for organizations that send free information to people in prison. Read as much as you can, and write to organizations with your specific questions.

Start planning now. There are many things to think about when you are coming home-medical care, housing, benefits, employment, parole. Start writing to AIDS Service Organizations (ASOs) now, so that you have a plan in place for when you get out. If you don't hear back, write again, and again. If you need help finding organizations in your area, write to one of the information resources in the resource section below.

If You Just Came Home

Seek support. You are dealing with a lot just getting out of prison -- you may have found out your HIV status while incarcerated, you might not have much knowledge about HIV, and you might not know where to turn for help. You are not in this alone. Reach out to the ASOs in your area, and take advantage of the services they have to offer. Look out for other former prisoners who have been home for a while and can give you advice on how they pulled through.

Be persistent. No matter how much planning you do while you are incarcerated, the transition home is always hard. You may feel overwhelmed by all the things you need to deal with, but remember that there are a lot of services out there for you. If you don't have one already, get an HIV case manager to help you navigate the HIV service system. When working with your case manager, pick your biggest issue and get that resolved before tackling the next one. If you can stay with your sister for a few weeks, then work on getting your medical care in order first. If you are on the street, finding housing (even if it's temporary) is more important than finding a job. When things are taking a long time be persistent, but be pleasant.

If You Work at an ASO

Reach out. If your ASO does not currently offer services for prisoners, there are a lot of things you can do without raising additional funds. Host a former prisoner support group; invite your community legal aid organization to do a legal clinic on getting benefits with a record; build connections with the job training programs in your area; or hold trainings for your case managers on benefits/services restrictions for people with criminal records. But before starting any new programs, hold a client focus group to make sure that you are addressing the biggest challenges people are facing when coming home.

Reach in. A lot of people with HIV in prison will write to ASOs before they get out, but many more people won't do anything about their HIV while incarcerated because of stigma. There is an urgent need for organizations to reach into prisons through letter writing, informational sessions and official visitor programs. The prison hierarchies can often be frustrating to navigate, but not impossible. You may have a sympathetic Infectious Disease doctor, there may be a volunteer program at your prison, or you may have an active peer education group run by prisoners. However you make your inroads, it is essential that people in prison know where to turn for help when they get out.

Resources

Here are a few of a longer list we hope to put together.

ACLU National Prison Project, Attn: Ms. Jackie Walker
915 15th Street, NW, Washington, DC 20005
202-393-4930, http://www.aclu.org
*referrals to HIV and legal services

Project Inform National HIV/AIDS Treatment Infoline
Monday-Thursday 9am to 4pm
Tuesdays 9am to 7pm (Pacific Time)
800-822-7422 or 415-558-9051 (collect calls accepted)
*questions about HIV treatment

Prison Health News
1233 Locust Street, 5th Floor, Philadelphia, PA 19107
http://www.fight.org/subsection.php?cat=2&sec=29&sub=7
*free quarterly newsletter on health issues

California Prison Focus, 2940 16th Street #B-5
San Francisco, CA 94103, http://www.prisons.org/
*quarterly newsletter on health, rights ($5 for prisoners)

National HCV in Prison Coalition
Hepatitis C Awareness Project
PO Box 41803, Eugene, OR 97404
http://www.hcvinprison.org/
*free quarterly newsletter, information packet on hepatitis C

AIDS Treatment Activists Coalition:
Access to Health Care for the Incarcerated Working Group
http://www.atac-usa.org/default.asp?id=105
*links to information, resources and statistics

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