Inmate advocates work to close lapse in HIV treatment after discharge Posted Saturday, Jun. 11, 2011 By Alex Branch abranch@star-telegram.com

Diana Harris remembers the fear and shame she felt in a Texas prison when a blood test revealed she was HIV-positive.

She also recalls clearly the day she was discharged, deposited at a bus station with a 10-day supply of the antiviral medication and, she says, little idea how to get more medicine.

So Harris, who had served a sentence for forgery, went two years without medication.

"I didn't want to tell my family I had [HIV], so I couldn't ask them for help," said Harris, who lives in Tarrant County. "I was on my own and didn't really know where I should go to keep myself healthy."

More than a decade has passed, and Harris is now a peer advocate at the AIDS Outreach Center in Fort Worth. But studies show that HIV-positive prison inmates still regularly experience dangerous lapses in treatment after discharge.

Only 20 percent of inmates enrolled in an HIV clinic within 30 days of their release, and only 28 percent did so within 90 days.

It's a problem with consequences beyond the personal health of the offenders. Interruptions in medication increase the risk of transmission, can lead to medication-resistant strains of HIV and often require more costly treatment later.

Health officials have launched initiatives to end the lapses, including using telemedicine to connect HIV-positive prisoners with local AIDS organizations that can assist them when they return to their communities.

But success depends on the personal responsibility of the former inmate, one official said.

"Once they leave prison, we no longer have any control over what they do," said Owen Murray, vice president for offender health services at the University of Texas Medical Branch at Galveston, which provides healthcare to about 80 percent of Texas prison inmates. "We can't drive to their houses and make sure they go the clinic. I really think the state is doing everything it can do."

Former prisoners report several obstacles to getting medication, AIDS outreach workers say. Many are unsure where they will live after discharge, lacking homes and families to which they can return.

Some don't even complete the bus trip home, using the $50 they are given at discharge to fall into previous bad behaviors, they say.

Those who have been incarcerated for a long time have little experience making doctor's appointments, filling prescriptions and understanding bureaucracies, said Shannon Hilgart, associate executive director at the AIDS Outreach Center.

"Navigating a hospital system is daunting if you have been incarcerated since 19 and never had to deal with it," she said. "Getting to a clinic, getting through the paperwork. ... It's a whole new learning process."

Outpatient care

Dr. Jacques Baillargeon of UTMB headed a study on HIV clinic enrollment that reviewed the cases of 1,750 HIV-infected inmates released from prison between January 2004 and December 2007.

It concluded that "a large proportion" the inmates failed to establish outpatient care.

The findings reinforced an earlier study that found that only 18 percent of inmates filled prescriptions for HIV medications within 30 days of their release.

The study's authors noted that HIV rates among prisoners are three times higher than that of the general population. In Texas, about 2,500 of the state's 151,000 incarcerated offenders have tested HIV-positive, Murray said. About 1,800 of them are on medication while the remaining 700 have viral loads that do not require medication.

The number of HIV-positive prisoners has remained relatively flat in recent years, he added.

State officials held a summit to discuss the issue and agreed on several strategies to link services offenders received in prison with those provided by organizations in communities, said Janina Daves, re-entry coordinator for the Texas HIV Medication Program, which spends $90 million annually supplying HIV medication to low-income Texans.

Prison officials are using medical discharge planners to help inmates complete applications for treatment programs before they're released, she said. Inmates are told how to contact the AIDS service organizations and given phone numbers to call if they run into difficulties.

"Prisoners receive such good [medicine] regimens in prison that most are released with undetectable viral loads," Daves said. "If they lapse, that is such a waste of what was expensive medication."

More efficient system

Offenders returning to Tarrant County are often referred to the AIDS Outreach Center. Caseworkers there see two to three such clients a month, said Brenda Herndon Johnston, a care and treatment manager.

Since the state made changes, the agency has had more success in getting ex-offenders to continue medical regimens, officials said. Case managers, mental health counselors and nutritionists help clients set up medical appointments and live healthy lifestyles.

UTMB has usually sent the offender's paperwork before they arrive, Herndon Johnston said. One worker at the HIV medication program in Austin is assigned to specifically handle applications for ex-offenders.

"We can get same-day approval," she said. "They have it working without delays so, when the client comes in, we get the process rolling as quickly as possible."

Harris, now 59, said the system works far more efficiently than when she was got out of prison. She has now taken her medications for years and has an undetectable viral load and is married.

She said she often meets clients fresh out of incarceration and uncertain about their futures.

"I tell them, 'I know just how you feel,'" Harris said. "But the most important thing is to keep taking your medications and keep yourself and your loved ones healthy. That's where you start."

Alex Branch, 817-390-7689

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