Chicago Tribune - November 14, 2004
Johnathon E. Briggs, Tribune staff reporter

Armed with little more than a last known address, James Duffy searched high and low for ex-convicts. Canvassing Chicago neighborhoods in his Chevy Lumina, he was often mistaken for a cop--in truth, he was an AIDS bounty hunter of sorts.

Duffy was one of eight intensive case managers under an innovative AIDS-prevention program that sought to stop the spread of HIV by keeping recently released prisoners from infecting others.

The program is exactly what the Centers for Disease Control and Prevention has in mind as it shifts the focus of its AIDS strategy from healthy people at risk of becoming infected to infected people who might transmit the virus to others.

But today Duffy and his fellow bounty hunters are on the sidelines after federal funding for the Illinois Public Health Corrections and Community Initiative ended Sept 30.

With momentum lost, former program director Kendall Moore fears HIV transmission rates will spike in pockets of the city. "It's a powder keg waiting to explode," he said.

Studies suggest that prison is a primary source of HIV transmission, continually reintroducing the virus to society when prisoners return home.

Between 20 and 26 percent of Americans living with HIV/AIDS have spent time in the nation's correctional system, where the AIDS rate is six times higher than in the general population, according to a 2002 report by the National Commission on Correctional Health Care.

Inmates are at greater risk than the general population for contracting the virus through injection drug use, unprotected sex and tattooing that may occur during incarceration, the Center for AIDS Prevention Studies at the University of San Francisco found.

The Bureau of Justice Statistics estimates that 2 percent of the nation's inmates are HIV-positive. In Cook County, about 8,000 inmates were tested for HIV in 2001 and 3.5 percent tested positive, according to the AIDS Foundation of Chicago.

Started in 1999

Funded by the CDC and the Health Resources Service Administration, the ex-convict program launched in 1999 after the Chicago Department of Health was selected as one of seven health authorities in the country to expand HIV-related services to inmates.

It was the only one of its kind in the state and administrators say it was successful in connecting prisoners with HIV/AIDS to services after their release. But funding for the $1 million pilot program was limited to five years and CDC officials say local agencies must now foot the bill.

The city has managed to secure $250,000 from the state Health Department. But there's a catch: Since it's state money, the citywide program is being retooled to serve the entire state, with only a quarter of the original funding and a tiny staff.

It is an ambitious, if not impossible, goal, AIDS groups say, pointing out that even in the city, the program was overburdened.

"We always had to move clients [through the program]--keep them moving, moving, moving--because we didn't have space," said Rev. Doris J. Green, AIDS Foundation of Chicago manager of community outreach who coordinated case management for the program.

Meanwhile, Duffy and his colleagues wonder how their work could have ended as the number of AIDS cases climbs in city neighborhoods where large numbers of ex-convicts return.

The communities they often visited--West and East Garfield Park, North Lawndale, Woodlawn--have some of the highest AIDS rates in Chicago, city Health Department figures show.

"We don't understand that, you know?" said Dawud Abdul-Nur , 56, a case manager at the Alliance for Community Empowerment, an AIDS organization in Bronzeville, who worked for the program. "We're right in the middle of the battle and then, all of a sudden, we've been pushed aside."

The case managers were warned when they were hired that the program might end Sept. 30, the day federal funding expired. But back in February, Duffy had no idea he would take the news so hard.

"I told myself that it wouldn't bother me," said Duffy, an ex-convict and former drug addict who worked for the University of Illinois at Chicago HIV/AIDS Project, "but it's bothering the hell out of me."

Duffy said he remains troubled because the funding cut dismantled a close-knit group of dedicated outreach workers who often searched "under the rock"--in crack houses and junkie-filled shooting galleries--for HIV-infected ex-convicts.

Case manager Carl Jones-El, for example, said he used to change clothes "like Superman" in the back of his four-door Nissan, donning a baseball hat and pulling his shirt out of his khakis before getting out to ask the whereabouts of an ex-convict. It was his way of going undercover.

"It was easy to bond because we all were about the same thing: getting the best for client," said Duffy, 54. "It was just beautiful, man."

Inmates were offered HIV testing upon intake at Cook County Jail and, if positive, were assigned an internal case manager. Before their release, they were matched with an external case manager like Duffy who made sure they took their medicine, tried to avoid transmitting HIV and got linked to social services.

A network of 18 agencies provided services, from substance-abuse treatment and housing to food vouchers and employment assistance. When ex-convicts no longer required hands-on help, they were moved into a standard form of case management.

Between 2000 and 2004, the program helped 1,287 inmates. Seventy percent were men, 80 percent were African-American, and most were indigent.

Federal health officials say ex-convicts with HIV/AIDS need the extra attention.

"For people who are coming out of the justice system, there are often a lot of other needs that supersede, in their mind, their disease," said Hugh Potter, a public health adviser at the CDC's National Center for HIV, STD and TB Prevention. "It really is about helping people with their life situation oftentimes."

"We had a lot of success stories," said Jones-El , 55, a discharge planner at Cook County Jail. "We got 15 to 20 people who've been to prison [several times] and these people are living in society as productive citizens."

For several of the case managers it was more than a job, it was a calling. Some were ex-convicts or former addicts who empathized with their clients. Others, like Jones-El, whose brother, Jacquea, died of AIDS, had lost loved ones to the disease.

It was the 1989 death of Raymond Neely, a friend he used to get high with, that moved Duffy to AIDS outreach.

"I remember I used to carry him up and down the stairs and he'd just start crying because he was so weak. And I would tell him that he shouldn't cry, that the only time he should cry is when nobody's there to carry him, and I was there."

After Neely's death, Duffy vowed that if he had anything to do with it, no one would face HIV alone.

"We got people falling through the cracks now," Jones-El said.

Finding new funding

Program and city health officials tried to find new funding as early as two years ago, but encountered a tough funding environment.

The absence of the case managers is already being felt. Last month, within 48 hours after the program's end, Green received seven referrals and didn't know what to do.

Duffy said that a piece of him is missing as well.

"It was always more than a job to me," he said. "It had become such a part of me."

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