Nina T. Harawa, MPH, PhDIOM Panel:

HIV Screening & Access to Care

To identify laws, policies, and procedures that may• influence the willingness of correctional

populations to consent to HIV testing.• impede the logistic feasibility of routine HIV

testing in correctional settings. To identify strategies for increasing

HIV testing uptake in these settings.

1. Many state laws result in criminalization of non-criminal acts if they are engaged in by HIV- positive people who are aware of their HIV status.

2. A positive HIV diagnosis can increase the sentence or severity attached to specific crimes.

3. Existing laws reduce the confidentiality protections for inmates if they are known to have HIV. (or for people living with HIV if they are incarcerated.)

1. CriminalizationHSC 120291: states that if an individual is

known to be HIV infected and engages in unprotected sex or needle sharing, he/she can be charged with a felony

2. Increased sentence/severityPC 647: elevates any subsequent prostitution

conviction among those known to be HIV infected from a misdemeanor to a felony.

3. Lack of confidentialityPC 7520: directs correctional officials that they

must notify parole and probation officers when an HIV infected inmate is released.

HSC 121070: requires medical personnel to disclose the HIV status of all inmates to the “officer in charge” of the detention facility. This officer in charge is then required to notify all employees and volunteers who may have direct contact with the inmate of the inmate’s HIV status.

Housing Work opportunities Response to violence Confidentiality Costs/benefits

Housing• Official and “de facto” segregation of HIV-

infected inmates.• Segregation of HIV-positive inmates

continues in a number of states.• In order to address their medical needs,

inmates with HIV may be housed in a limited number of facilities.

Work opportunities• May be limited through official or “de facto”

policies.• Implications for sentence length, work

release, and halfway house placement.

Response to violence• Positive HIV status may lead to increased

punishment for infractions. Confidentiality

• Very difficult to maintain in correctional settings. Pill call, special diets, visits to specific service

providers• Inmates lack the same HIPAA protections

provided to the general population.

• Challenges to implementing universal HIV testing at jail or prison intake:1. Large numbers of inmates may be

processed at once.2. Some may enter while still high or drunk.3. Classification process has not yet

occurred, increasing the probability of security breeches.

4. Lack of trained personnel.5. Lack of sufficient/appropriate space.

• Challenges to implementing universal HIV testing at jail or prison release.

1. Timing of releases.2. Release dates not always known in advance.3. Not all inmates released directly from

jail/prison.4. Security/safety issues.5. Dissemination of test result post release.

Costs of HIV testing• Largely borne by the correctional system• Benefits shared by correctional system and

society at large.• Possible model:

CDC Corrections Demonstrations Projects

A range of laws, policies, and procedures may limit the uptake of routine HIV testing by correctional facilities and populations.

These factors vary across systems and facilities.

Solutions requiring identifying and addressing them through creative strategies and partnerships.

Walker et al. CID 2004;40:319 Boutwell et al. CID 2004;40:320-1 Boutwell, Rich. CID 2004;38:1761-3 MacGowan et al. JCHC 2006; 12:203-

213 Shrestha et al. STDs 2007;34:No. 11. De Groot et al. Int’l J Prisoner Health

2006; 2: 173-191 www.leginfo.ca.gov/calaw.html Harawa et al. JCHC 2009;15:105-17