Strategies to enhance linkages between care for HIV/AIDS in jail and community settings.

The policies of mass incarceration and the expansion of the criminal justice system in the USA over the last 40 years have weighed heavily on individuals and communities impacted by drug use and HIV disease. Though less than ideal, jails provide a unique opportunity to diagnose, treat and implement effective interventions. The role of jails in HIV detection, treatment, and continuity of care, however, has yet to be systematically examined. This paper reviews the service strategies and contexts for 10 demonstration sites funded to develop innovative methods for providing care and treatment to HIV-infected individuals in jail settings who are returning to their communities. The sites have implemented varied intervention strategies; each set in unique policy and service system contexts. Collaboration among agencies and between systems to implement these interventions is viewed as particularly challenging undertakings. We anticipate the sites will collectively serve 700-1000 individuals across the duration of the initiative. In this paper, we review the service contexts and strategies developed by the 10 sites. The individual and multi-site evaluations aim to provide new data on testing, treatment, and community linkages from jails that will further develop our knowledge base on effective intervention strategies in these settings.

HIV/AIDS in correctional settings: a salient priority for the CDC and HRSA.

Correctional facilities constitute an excellent opportunity to provide treatment, care, and prevention services for a population that may not otherwise access these services. The Centers for Disease Control and Prevention (CDC) and the Health Resources and Services Administration (HRSA) recognize the public health importance of correctional settings and have begun to develop formal strategies to address the HIV/AIDS-relevant needs of incarcerated individuals. The Centers for Disease Control and Prevention and HRSA have implemented policies, activities, and strategic plans to reduce the HIV/AIDS disease burden among the high-risk populations that pass through the nation's prisons and jails. They have also collaborated to address the HIV/AIDS needs of incarcerated populations and have initiated processes for expanding collaboration on these issues to include other federal agencies and prevention partners.

Development and implementation of the cross-site evaluation of the CDC/HRSA corrections demonstration project.

U.S. prisons and jails have the nation's highest concentration of individuals infected with and at risk for HIV infection. Many correctional institutions offer 1-HIV care, but advances are oftentimes lost when individuals with a lack of health insurance and access to care are released into the community. In 1999 the Centers for Disease Control and Prevention and the Health Resources and Services Administration jointly funded seven health departments to address this need. These projects target soon-to-be-released inmates of jails, prisons, and juvenile facilities and offer enhanced discharge planning, case management, HIV prevention, disease screening, and staff training. The Evaluation and Program Support Center (EPSC) at Emory University and Abt Associates was funded to oversee a cross-site evaluation of these demonstration projects. This paper describes the process of developing a cross-site evaluation, the implementation of this evaluation, and lessons learned by the EPSC throughout this process.