HIV-seropositive detainees in jail: service needs and standards of care.

Abstract

Brief communication 141 HIV-SEROPOSITIVE DETAINEES IN JAIL: SERVICE NEEDS AND STANDARDS OF CARE The United States incarcerates more people per capita than any other country in the world that keeps records of such events. The point prevalence seen midyear 1997 (1.7 million adults) represents only those incarcerated in county jails, state prisons, and federal institutions/ It does not include those on parole, work release programs, or under community supervision. Twothirds are incarcerated in county jails (1.1 million adults). Of those, up to 24,200 ± 100 in jail on any given day are estimated to be HIV seropositive.** Nationally, the rate in jails is more than seven times that seen across the country in the communities. The prevalence of HIV within any particular county jail reflects primarily the rate of IV drug use and the prevalence of the sextrade industry (prostitution).1"3 However, the institutional-based prevalence for county jails across the United States varies from 0.0 percent (Ohio County Corrections) to 22.4 percent (New York [County] Correctional System).4,5 Both health care providers and administration consistently estimate that 1 to 5 percent of the approximately 2,100 daily jail detainees at the King County Correctional Facility (KCCF) in Seattle, Washington, are HIV seropositive. The estimated range for HIV prevalence in the surrounding (King) county is 6,000 to 9,000 individuals from an encatchment area of approximately 1.5 million people.6 The comparative estimate for the HTV prevalence rate in the surrounding community (0.4-0.6 percent) reinforces the view of an urban jail as temporary "collection and containment centers" for HIV-seropositive individuals. An individual who is HTV seropositive and a jail detainee presents numerous challenges. For clinicians and program/agency evaluators: Do incarcerated individuals know their CD4 counts (T-cells) and viral loads? For policy formation: What is a reasonable standard of care within the jails that can be supported? Where should future efforts be directed? And for the clinician/ provider: What should you be advocating for? * Jails are pretrial facilities for any individual incarcerated while awaiting trial on either minor (misdemeanor) charge(s) or major (felony) charges. In addition, those sentenced to (typically) "12 months less a day" for misdemeanant offences are incarcerated in county jails. Prisons hold those found (or plead) guilty of a felony offense and were sentenced to more than 12 months. Federal institutions hold those (generally) convicted of a federal offense. ** (2.3 percent HIV seropositive by Bureau of Justice [BJJ interviews) (1.1 million) = 24,200. Reported 95 percent confidence interval (CI) by BJ=0.33 percent. Total interviewed = 289,991. Therefore , estimate = 24,200 ± 100. Journal of Health Care for the Poor and UnderserOed · Vol. 12, No. 2 · 2001 142 HTV-Seropositive Detainees in Jail CD4 counts and viral loads, as physiologic markers for immune function and viral infectivity, respectively are both required for biologic therapy against HIV.7"9 That the incarcerated population is marginalized, disenfranchised , and often subject to substandard care is well recognized. This study examined how care received by those incarcerated in a county jail compared with HTV-seropositive individuals in the surrounding community . A fundamental issue is equity in medical care. Answers to some of the issues, in part, resulted from evaluation and treatment of HTV-seropositive individuals at the KCCF. Nonincarcerated HTV-seropositive residents of the same county (King County, Washington) provided a comparison group for "community standards." Method Setting. KCCF is classified as a medium-sized county jail,3 with 1,723 beds and an average daily population of approximately 2,100. Located in downtown Seattle, Washington, the jail serves as the criminal justice center for 31 municipal jurisdictions. Adults who are detained by the Port of Seattle, the University of Washington Police, the U.S. Marshals, the Washington State Patrol, the King County Police, or the Washington State Department of Corrections are incarcerated in the KCCF. In addition, juveniles who have been remanded to the adult criminal justice system within King County are also held in the KCCF. There are approximately 61,000 bookings per year at the facility. Located within the facility is the third largest psychiatric unit in the state, with 90...