Sunday, March 01, 2009

What strategies work to keep HIV+ ex-prisoners on their meds?

From the abstract to an article in the Journal of the American Medical Association, we get a bit more information about the shockingly high rates of HIV positive inmates who stop receiving anti-retroviral drugs when they leave prison. Researchers fear such inmates could become the source of drug-resistant HIV strains, which would be a grave outcome indeed.

Reuters reported that just 5.4% of former HIV+ inmates filled their prescriptions after ten days. Only 17.7% had done so within 30 days, and 30.0% after 60 days - still a strikingly low figure with 70% still off their antiretroviral medication two months after they leave prison.

There's a practical, public safety aspect to this that can't be ignored: The creation of drug-resistant HIV would be a very, very bad thing.

On the bright side, the study identified two variables that improve the chances HIV+ ex-prisoners get back on their meds after leaving confinement.

First, according to the abstract "Inmates released on parole were more likely to fill a prescription within 30 days ... and 60 days" by significant margins.

Even higher compliance rates, though, came because: "Inmates who received assistance completing a Texas AIDS Drug Assistance Program application were more likely to fill a prescription within 10 days," 30 days and 60 days. (See "Results" at the bottom of this page for the statistical details.)

In other words, HIV+ inmates on parole were slightly more likely to get their medication, presumably because they're under supervision, but they were much more likely to do so, especially in the short-term, if they're told where they can get help paying for the (quite expensive) drugs.

That makes a lot of sense, and it points to possible legislative solutions.

Perhaps there's some way to leverage stimulus funds designated for law enforcement or health services to go into the (already strapped) AIDS Drug Assistance Program, designating additional money to pay for indigent ex-prisoners to get that compliance rate somewhere closer to 100%? We're talking about a relatively small number of folks - an average of 700 or so people per year; that's a small price to pay for TDCJ to avoid becoming the source of some terrible, new medical scourge.

Once TDCJ has started an HIV+ prisoner on antiretroviral medications, making sure they're signed up to get their meds on the outside seems like as important a public safety function as locking prisoners up in the first place. The same could be said for mentally ill prisoners, for whom I'd like to see a similar study performed. More attention should be paid to that transition.

This is one of those moments when "an ounce of prevention is worth a pound of cure." I could make that argument for quite a few other reentry services, but in this instance it's particularly true.


Soronel Haetir said...

I tried leaving a comment similar to this of the previous thread with this topic but there was an issue with the verification system that prevented it, so here goes again.

Given that HIV is non-communicable without engaging in risky behavior (ignoring doctors not practicing proper sterilization techniques and other such sources which my understanding is are miniscule in the US), I fail to see how a highly drug resistant form of HIV is a significant issue. This is a major difference from diseases such as TB which can be transmitted easily.

Eventually we shall either develop a vaccine, a strain of resistant people will grow to dominat the population and life will go on, or humanity will be killed off. I don't see any of these as undeserved fates for the human race.

So let the HIV positive go forth and be a plauge upon the stupid and unwary, just don't ask society to pay for it.

PirateFriedman said...

...sure they're signed up to get their meds on the outside seems like as important a public safety function as locking prisoners up in the first place

Wow, this is a strange statement. According to Grits, rewarding an ex prisoner with health care is as important as punishing them incarceration.

And of course, Soronel and some of the other posters are right, this is not a serious worry for those who don't engage in risky behavior.

Anonymous said...

Soronel's comment shows what happens when mean meets dumb. Passion and Lore shows what happens when they mate.

Just because you wingnuts are too ignorant to understand why drug-resistant HIV would be a problem doesn't mean it's not a serious thing.

Gritsforbreakfast said...

Passion, I didn't say anything about "rewarding" anyone, I said it's important not to create "drug-resistant HIV strains." We can't have a real discussion if all of your comments only debate straw men and not what I actually wrote.

Soronel's arguments ignore how much AIDS treatment cost taxpayers before they came out with the cocktail ARV therapies. The lesson from the '80s and 90s on HIV economics was that it is cheaper to pay for prevention than to wait around and do nothing then pay to treat much sicker people in the future. Those are the only two options for those of us who live in the real world where the government can't just say "We don't give a crap, let 'em waste away in the streets."

Anonymous said...

After watching a documentary on the pandemic aids crisis in parts of Africa, wiping out villigas and generations of Africans, it shows the importance of dealing with this disease effectively. Oddly enough, one of the elements that caused many Africans to shun available treatments, was there fear of being socially ostrasized from their community if it was discovered that they were HIV positive, even in light of the fact that 80% plus of the population was known to have the disease in some stage. Pride goeth before a great fall is indeed true and sad. We must educate the general population to the real danger of this disease and treat it as a public safety issue instead of something that "happens to those people". Until the legislature sees the potential public safety issue lying within this public health threat, ex-offenders and other high risk HIV positive populations will not have the financial and medical support they need. The question is how do you educate people? We are spending money to advertise about the potential flu pandemic. That would be a good model to follow for HIV as well!

Anonymous said...

Evidently none of you with the exception of Mr. Henson has any idea regarding the disease process and how to prevent medication resistant diseases. I would suggest you not use your wrong information in print to make a bigger fool of yourselves.

How do you think MRSA and ORSA got started? Not by not taking medications, but by stopping the medications or not receiving them long enough to clear the disease process. The very samething could happen if HIV infected persons do not continue their medications. You CAN get HIV from other ways than sexual contact and dirty needles. HIV has been proven to be in salavia as well as all body fluids of an infected person.

Lay off and stop judging those who have a disease that they may not have gotten through a means that is unacceptable to you and your opinions of them. Every person alive deserves medical care so, back off. Unitl you can come up with the medical proof don't put your fingers to the key board.

I am a medical person with two degrees and not a desk medical person, I actually work with people and love every minute of it.

Anonymous said...

The mentally ill are referred for follow up mental health services thru the texas correctional office on offenders with medical or mental impairments. They also refer them for HIV services before they are released.