The state of HIV and hepatitis C care in NYS prisons, 2013
People in prison have some of the greatest chronic healthcare needs. Because low-income communities of color are disproportionately affected by incarceration, the health challenges faced by these populations are frequently shifted to the prison system.
Incarcerated patients have the highest rates of serious chronic illness, such as HIV and hepatitis C (HCV), and often have had limited access to community care. Providing appropriate care in the prisons is an opportunity to diagnose and treat conditions previously undetected or inadequately treated and is a critical public health intervention point.
As part of our prison monitoring efforts, we have visited 18 prisons since January 2011, which was the last time the state-operated AIDS Institute issued a report about HIV and HCV care in the prisons.
At each prison we visit, the Correctional Association collects specific data concerning HIV and HCV care, interviews medical staff about the prison’s healthcare system, and surveys the incarcerated population concerning their assessment of the care they are receiving at that prison.
In addition to information gathered on prison visits, we routinely collect system-wide data from the Department of Corrections and Community Supervision (DOCCS) about medical staffing, prevalence of HIV and HCV diagnoses, testing and monitoring, utilization of specialty care services and other information about the prison healthcare system. For purposes of this particular study, we obtained more in-depth surveys regarding HIV and HCV care from approximately 100 incarcerated people chronically infected with those diseases.
Unfortunately, DOCCS has difficulty identifying all those individuals in its custody who are infected with these illnesses and engaging these patients in care. Moreover, the quality of care seems to vary significantly throughout DOCCS. This is, in part, due to limited medical resources at some facilities and apparent limitations in the training, skill, and/or commitment of some medical staff to provide timely and effective care to every patient.
At some prisons, patients infected with HIV and/or HCV are closely monitored, are receiving timely and appropriate care, and seem to have few complaints about the care they are receiving. In contrast, at other facilities, there is less access to care due to under-staffing, patients have much more limited access to specialty care and other services, and patients express significant dissatisfaction with the quality of care they are receiving. Download facility-specific information about the HIV and HCV care at each prison we have visited
The Department of Health Oversight Law, which mandates that the DOH assess the quality of HIV and hepatitis C care in NYS prisons, presents an important opportunity both to improve healthcare inside our state prisons and to assist in the integration of the incarcerated population and those released from prison into the emerging community healthcare systems being developed through initiatives under the NYS Medicaid Redesign Team and the federal Affordable Care Act.
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