Joseph Bick MD

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Joseph Bick MD Chief Medical Officer California
Medical Facility California Department Of
Corrections and Rehabilitation
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HIV-infected prisoners, U.S. HIV in Prisons,
2004 BOJ Statistics
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States with largest HIV-infected prisoner
populations 2004 BOJ Statistics
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HIV prevalence by gender 2004 BOJ Statistics
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of population with confirmed AIDS 2004 BOJ
Statistics
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AIDS-related deaths in state prisons 2004 BOJ
Statistics
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Deaths of state prisoners 2004 BOJ Statistics
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HIV testing of prisoners, U.S. 2004 BOJ
Statistics
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HIV testing of inmates 2004 BOJ Statistics
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California Department of Corrections

• 172,000 inmates
• 33 prisons
• HIV prevalence 1.5-2.5 (2500-4300)
• Identified HIV population at any given time
  1500-1800

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HIV prevalence, CDCR 1999Ruiz et al, DHS OOA
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CDCR 1758 HIV-infected inmates 5/07

• CMF 530
• CMC 400
• CIM 247
• COR 124
• CCWF 95
• NKSP 65
• SQ 49
• LAC 47
• RJD 46
• SAC 33

• WSP 33
• CCI 25
• CIW 22
• DVI 20
• CRC 8
• SOL 5
• SVSP 3
• ASP 2
• CTF 2
• FOL 1
• KVSP 1

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HIV testing of prisoners, California

• If clinically indicated
• Upon inmate request
• If exposure incident
• By court order

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The Effect of Various Counseling and Testing
Methods on the Rate of HIV Testing Among Male
Prisoners

• J. Baham, J. Gavin, S. Mittal,
• M. Kuniholm, D. Harriss, J. Ruiz, J. Bick
• California Department of Corrections, Department
  of Health Services Office of AIDS

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Purpose of Study

• Evaluate how the rate of voluntary HIV testing at
  one prison was effected by
• different counseling strategies
• offering different testing methodologies
• Evaluate how HIV risk factors, testing history,
  and testing attitudes influenced testing method
  preferences

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Results
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Choice of Testing Method

• 40 chose oral fluid testing
• Of those who reported fear of needles, 75 chose
  oral fluid
• 60 chose blood testing
• Some associated oral fluid testing with DNA
  collection
• No one chose urine testing
• Some associated urine testing with drug testing

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Interview results (n128)

• 23 had never tested for HIV before
• 30 said that they did not know where to get
  tested in free community
• 35 said that they had wanted to get tested in
  past but didnt

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Interview results

• 44 first tested at age gt30, in spite of the fact
  that
• 37 of testers gave history of IDU
• 57 of testers gave history of gt5 female sex
  partners over past ten years

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Conclusions

• 11 counseling of all new arrivals doubled rate
  of HIV testing
• There is a role for multiple testing modalities
  within corrections

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Assembly Bill 66 (Dymally)

• Amends penal code sections 7520 and 7521 and
  adds sections 7507 and 7507.5 relating to inmate
  HIV testing and disclosure
• Requires that HIV testing be offered to all
  inmates who will be incarcerated for a period of
  at least one year
• Testing to be routinely, universally offered
  twice within 30-60 days after entry, and at
  least 60 days prior to release
• Testing would require patient consent and could
  be declined (opt-out)

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AB 66 (HIV Testing)

• Requires HIV care and treatment plans, referral
  to HIV care and treatment services, and
  notification of parole officers
• Authorizes notification to spouse or domestic
  partner of potential HIV exposure
• States that HIV status shall not be used to deny
  eligibility for and access to programs that are
  otherwise available
• Requires the CDCR to report annually to the DHS
  and the Legislature on the prevalence HIV

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Impact of AB 66

• 12 reception centers HIV counseling and testing
  services for 70,000 new intakes per year
• All facilities counseling and testing for
  65,000 inmates in the months prior to their
  release
• Inmates inmates found to be HIV infected will
  require additional evaluation by clinical staff
• Lab studies, radiographic exams, immunizations,
  medications, and specialty referrals

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Impact of AB 66

• Most HIV infected inmates currently housed at a
  limited number of facilities
• Current housing matrix may need to be revised to
  accommodate an increased number of identified HIV
  infected prisoners

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Impacts of AB 66

• Will require additional clinicians who are
  knowledgeable in the treatment of HIV
• Geographic isolation of prisons often makes it
  difficult to have an HIV specialist on-site
• ? increased use of telemedicine
• All primary providers and nursing personnel will
  require continuing education re medication side
  effects, drug-drug interactions, opportunistic
  infections and other issues related to HIV
  infection

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Impacts of AB 66

• Increased pharmaceutical expenditures
• Antiretroviral agents will be needed at all
  facilities where HIV testing takes place
• Will need to be able to dispense antiretroviral
  agents at all facilities at the time of release

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Linkage to care at release

• Uncertainty of the release date or precipitous
  release by the courts can challenge effective
  discharge planning
• AB 66 will lead to the identification of a
  significant number of HIV infected inmates
  shortly before their scheduled release.
• ADAP, SSA, Medicaid applications

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Linkage to the Community

• CDCR currently contracts with community based
  organizations to provide HIV associated discharge
  planning (Transitional Case Management Program,
  TCMP)
• TCMP establishes linkages to medical care, and
  other re-entry needs such as housing, food,
  employment, mental health and substance abuse
  treatment and childcare
• Will require a significant expansion of the
  current TCMP

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Harm Reduction

• Soon after release to the general community,
  HIV-infected inmates have a high rate of unsafe
  sex practices, especially with their regular
  partners
• Pre-release risk reduction interventions as part
  of transitional care have been found to decrease
  high risk behaviors in the months post release
  and increase linkage to community resources.

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Impacts of AB 66

• Increased need for mental health services
• Partner counseling and referral services
• HIV/AIDS Case reporting requirements
• Rapid vs. routine testing oral fluid, serum,
  urine

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Contact information

• Joseph Bick
• joseph.bick_at_cdcr.ca.gov