Sexually transmitted diseases (STDs) constitute an important source of morbidity in incarcerated patients. In addition, the presence of an STD is a clear sign of HIV risk behavior.
Strange, but true -- in America, only the incarcerated have a legal right to healthcare. This right stems from early recognition by the courts that, "the public be required to care for the prisoner, who cannot by reason of the deprivation of his liberty, care for himself."
HIV in correctional settings is beginning to infiltrate our nation's political theater. In response to this new development, the National Commission on Correctional Health chose prominent political leader Reverend Jesse Jackson Sr. to open this year's National Conference on Correctional Healthcare (NCCHC), held September 9-13 in St Louis, Missouri.
Only a few short years ago, viral load (HIV-1 RNA) testing was introduced as a new tool for HIV management. Many physicians, inside corrections as well as outside, delayed implementing the test. Though most of the arguments against its use included lack of standardization, inability to process specimens and shortage of specialists to interpret and utilize results in HIV management, the major unspoken obstacle was cost.
Reflecting the unique role prisons and jails play in the HIV pandemic, an entire conference symposium, entitled 'HIV Behind Bars', was convened. Oral and poster presentations at this symposium provided a glimpse of life behind prison walls - from rural sub-Saharan African jails to Latin American penitentiaries, and painted a fuller picture of HIV in the nation with the greatest per capita prison population, the US.
The hepatitis C virus (HCV) is responsible for 60-70% of chronic hepatitis and 30% of cirrhosis, end stage liver disease, and liver cancer in the United States. Approximately 1.8% or close to 4.5 million Americans are infected with HCV, and HCV causes an estimated 8,000-10,000 deaths each year in this country.
Telemedicine was introduced in the U.S. in the late 1950s when the Bureau of Indian Affairs used telephone and video programs to train paramedics who resided on indian reservations. Despite technological advances that have greatly expanded the potential applications of telecommunication, telemedicine has developed slowly in the U.S. where issues such as physician acceptance, federal regulation of Medicare/Medicaid reimbursement, other third party reimbursement, and state regulation of medical licensure have impeded widespread adoption. Two recent reviews of the use of telemedicine in the U.S. suggest that only 50 - 80 telemedicine programs conduct interactive consultation. Radiology, Cardiology, Dermatology, and Psychiatry are the specialties that have used telemedicine most extensively.
Even though women are less likely to be incarcerated than men (one in 10 inmates in US prisons and jails is a woman), incarcerated women are three times more likely to be HIV infected than incarcerated men. The proportion of inmates with HIV (US prisons: 2.3% of men and 3.5% of women) is much higher than the proportion of HIV infected persons in the general population (US free population: 0.6% of men, 0.1% of women). This difference is amplified in the Northeast, where HIV prevalence among incarcerated men is 7% and 13% among incarcerated women.
The following procedures should be used for the initial screening of inmates, depending on their length of stay in the facility and the type of facility. According to the Essential Standard P-32 of the National Commission on Correctional Health Care Prison Standards, symptom screening should be done during intake for all new inmates, regardless of anticipated length of sentence.
Existing HIV treatment guidelines are updated every two years by the International AIDS Society and published in the Journal of the American Medical Association. Consensus from the Kaiser Foundation and Health and Human Services on new agents are inserted on the Guidelines Website as they become available (www.hivaits.org; last update 5/99).
At long last, politicians, public health officials and the lay public are recognizing that the correctional health unit, as Bureau of Prisons Medical Director, Dr. Newton Kendig puts it, lies "at the nexus of public health." (Full speech from the National Conference on Correctional Health Care located on page 4.) Why are our care decisions public health decisions? Simply put: corrections is the setting where our nation's most at-risk persons access organized health care.
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This information is designed to support, not replace, the relationship that exists between you and your doctor.