Rhode Island leads the nation in HIV care for prisoners

William K. Harter

Federal health experts claim Rhode Island’s human immunodeficiency virus (HIV) practices and care for our prisoners and released inmates are the best in the USA. 95% of released inmates accepting help at the Miriam Hospital get their medical care during the 1 1/2 year enrolled in the Project Bridge Program, a program designed to be a ‘bridge’ between incarceration and release. 46% got housing, 71% joined mental health care, and 51% joined addiction help. 97% of those individuals released with HIV had addiction problems and 34% were on medication for mental problems while in prison. Of those on this program, only 1/2 as many reoffended during that time period compared to those not in the program.

As A. T. Wall, the Director of Department of Corrections said a few years ago: “Someone that has an infectious disease and that we release to the community without giving them support is going to cause harm out there in the community as surely as if they had committed a crime.”

Dr. Charles Carpenter started working with women HIV prisoners in 1980. This has expanded to become the Center for Prisoner Health and Human Rights. Dr. Josiah D. Rich of the Miriam Hospital and Professor of Medicine and Community Health at Brown Medical School founded this organization along with Dr. Scott Allen, and he is still active in treating inmates and released prisoners who have HIV.

In 1996, The Miriam Hospital was funded by a grant through the Ryan White CARE (Comprehensive AIDS Recourse Emergency) Act for developing plans to reduce fears of prisoners seeking treatment when released. Called Project Bridge, it provides help and counseling for prisoners nearing release, plus follow-up after release. Its main purpose is to increase continuity of medical care upon release. A social work team continues treatment for 18 months after release. This program is currently funded by the R.I. Department of Health.
Upon release, one’s prime concern is NOT treatment. Safety of oneself and family, housing, transportation, money, jobs, family and establishing oneself back in the community are priorities. As in the general population, medicine budgets suffer when money is low. Two thirds of offenders released who have HIV have no insurance.

Release from prison is a very stressful time; so much has to be done during the first week and month. There are so many changes that took place in the outside world to which one must adjust. The chance of dying in the first two weeks is 12 times the normal rate due to drug overdose (your system is not used to the drugs anymore), heart problems and suicide. Almost two weeks without medication can be critical to one’s health, even leading to hospitalization.

Twenty five percent of people with AIDS do not know they have AIDS. About 2% of the prisoners have HIV. This is four times the general population figure. Many only learn they have AIDS when admitted to prison.

Many prisoners, including HIV positive inmates, have a background of mental disorders, homelessness & substance abuse or childhood abuse. Anyone on medication or counseling in prison needs to continue upon release. Project Bridge deals with HIV positive people in prison and for 18 months upon release.

HIV positive inmates are referred to Project Bridge by the prison’s health services up to three months before release. A team of doctors, nurses, case workers & social workers work to achieve treatment for these people upon release. Many of these inmates have mental health issues, including depression. Normally, there would be a high failure rate due to failure of mental health treatment and untreated addiction. The goal is to keep these people in treatment upon release.

Since many offenders have a history of not trusting people, the project tries to build confidence while in prison so that upon release they will be more willing to discuss and meet with medical and social staff on the outside who can help them continue treatment without dealing with the stigma attached to their problems.

While in prison, inmates get their medication. They meet with Infectious Disease Consultants twice a week. Inmates have one-on-one meeting with a doctor. These consultations are not based on theory, but discussions of mental health issues, medication, coverage, and social issues, among other topics.

Upon release, most are referred to the team at Miriam Hospital in Providence. Seventy five percent attend. (Miriam Hospital has 1,200 people in HIV treatment.) The team keeps contact for 1 1/2 years. Inmates often meet the same doctor and case worker as seen in prison for follow-up. This familiarity eases the fear of starting over and being stigmatized and ensures that former inmates don’t have to expose themselves to strangers.

Staff members check on diagnosis and prescriptions regularly, and patients typically are seen every three months for blood work and counseling. This is a safe place to ask questions and discuss issues and fears.

The first outside contact for continuing treatment upon release usually occurs during the first week of release, then weekly for 3 months. After that, meetings occur monthly for the next 15 months. Team conferences, sometimes with the client present, are held. Transportation can be provided. A case manager can go with the client to appointments and outreach workers follow up if an appointment is missed. Social workers help with housing, nutrition and community programs.

After 18 months, one gets transferred to less intense programs, but one is still monitored.

(When I read that RI has the best plan for HIV released inmates, I thought, “We did something right in RI?” I contacted Dr. Josiah D. Rich, MD, MPH, and Professor of Medicine & Community Health, Brown Medical School and Attending Physician, Dept. of Medicine, Division of Infectious Diseases at the Miriam Hospital. I want to express my appreciation for him spending two hours with me for an interview and for giving me six articles from various journals pertaining to the work done by Project Bridge.)

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