AIDS Cases Surge in California Prisons

California prisons saw 246 additional AIDS/HIV cases between 2007 and 2008, the largest jump in cases of any prison system in the nation, according to a recently released federal report.

The number of inmates infected with the disease has climbed steadily in California over the past few years, from 1,155 in 2006 to 1,402 in 2008, although questions regarding prisoner tracking and follow-through upon their release may have influenced the data.

"Part of the underlying problem is that there's a concentration of HIV/AIDS among those who are the most disenfranchised," says Dr. George Lemp, director of the University of California's Universitywide AIDS Research Program.

"Those who are least likely to receive services and seek care are those persons who are more likely to find themselves in the prison system," he says. "As HIV becomes more concentrated in disenfranchised populations, I'd assume that this would be reflected in who is showing up in prison."

This growth in California cases, however, may reflect changes to prison health policy rather than an escalation in cases.

"There was no outbreak but merely increased effort to identify patients with HIV and get them into treatment," says Dr. Lori Kohler, a UCSF professor and the director of Correctional Medicine Consultation Network, which provides HIV services to California prisons.

"Patients with HIV are getting excellent care through a network of HIV providers in CPHCS and at UCSF," Dr. Kohler adds.

(As part of the ongoing federal oversight of prison medical care, the California Office of Inspector General will soon release a summary of its evaluations of prison medical facilities.)

Additionally, the percentage of inmates with the disease clocks in at only one-tenth of one percent, compared to nearly six percent of New York's HIV/AIDS-positive inmates. Nationwide, inmates are 2.5 times more likely to have the disease than the general public, the federal report notes.

"The subset of people who are HIV positive and who are incarcerated are the people who are least likely to be tested and more likely to have other significant health problems like hepatitis C or mental illnesses," says Dr. Josiah Rich, a professor at the Warren Alpert Medical School of Brown University. "This is a tremendous public health opportunity to find the hardest to reach people while they're incarcerated and get them access to health care."

Rich says that prisons "generally do a good job" providing health care for infected inmates, but "we fall flat on our face after people are released."

Rich co-authored a 2009 study that looked at 2,115 HIV-positive parolees in Texas and found that 90 percent did not refill their medications in time to safely continue treatment.

Another recent study tracked 512 HIV-positive repeat offenders from the San Francisco County Jail over nine years and found that only 15 percent continued medical treatment for the virus between incarceration and release.

"This population is at high risk for spreading the virus because they don't know they have it, they can be incarcerated for reasons related to mental illness or addiction, and they are not receiving treatment in the community," says Rich. "Connecting them to care when they are released is a public health argument. It's not a moral argument about whether they are more or less deserving of care."

Bernice Yeung wrote this story while participating in The California Endowment Health Journalism Fellowships at USC's Annenberg School for Communication & Journalism.