New York Times - For Inmates, H.I.V. Testing Should Make an Impact

New York Times
By James Warren
Published June 25, 2010

Cook County Jail is a reminder of how we tend to be prisoners of our prisons.

We warehouse people in dungeons, throw away the key and rarely take seriously even the vaguest notions of rehabilitation. Reports of overcrowding and guard brutality surface, prompting lawsuits and court orders. We let inmates out and, like Claude Rains in "Casablanca," tend to be shocked, shocked, that they return to what country singers once called the Crossbar Motel.

And that's just with the adults.

The juveniles have it worse, with the juvenile correctional center a testament to incompetence and administrative deceit, all of which forced a federal judge to step in as a monitor.

When it comes to physical and mental health, our prisons have been notoriously insufficient. If there were decent mental health services, the county jail might be deemed the state's biggest mental health facility. Then there's the problem of AIDS and other sexually transmitted diseases, like gonorrhea and syphilis.

You remember the AIDS plague, don't you? Some may assume that AIDS is vanquished, certainly in the United States although not in distant regions, notably Africa, where they have been far less successful in treating the disease. Well, it's still a problem here, which is why one might offer tentative plaudits to the odious county jail, which is at least trying to address the problem.

H.I.V.-AIDS may generally be out of the news, except for the occasional foray to Africa by Bono and other compassionate celebrities. But there is still a crisis: an estimated 1.2 million Americans have H.I.V., and perhaps 20 percent of them are living with the disease unknowingly. About 17,000 die from it each year.

In Illinois, an estimated 45,000 people are H.I.V.-positive, with 3,000 newly infected each year, said David Munar, vice president of the AIDS Foundation of Chicago. The Illinois cases are disproportionately in Cook County, where gay men and women of color are hit hardest, and where the highest concentrations are in poor neighborhoods. While the advent of new treatments in the mid-1990s has made the disease less deadly, and thus increases the group living with it, it remains incurable, as Mr. Munar, who has it, can attest.

According to a just-released report from the federal Centers for Disease Control and Prevention, the prevalence of H.I.V. infection is four times greater among incarcerated people than among the rest of the population (1.5 percent vs. 0.4 percent).

Cook County Jail's anti-H.I.V. efforts have been alternately high-minded, inconsistent and litigation-filled. There have been periods of bona fide concern, but budget restrictions have dismantled most testing. Litigation brought settlement in a case alleging that many inmates were given invasive tests without their permission. Voluntary screening dates to 1996, but in recent years, routine offers of such testing stopped because of budgetary and space issues.

Voluntary testing will now return as part of what's intended to be a more sensitive and expanded intake process at the jail, financed with money found by the Cook County Board, led by Bridget Gainer, a commissioner.

The disease control centers in 2006 urged H.I.V. testing in correctional facilities as part of routine medical evaluations. Rhode Island was cited for scrupulously studying this topic and finding that the large majority of the state's prison inmates accepted an offer of testing, with the tests accounting for 15 percent of H.I.V.-positive results statewide.

At Cook County Jail, women are tested for syphilis, given the high rates among women and the impact on newborns, said Dr. Michael Puisis, the chief operating officer of Cermak Health Center at the jail. There is also screening for possible mental-health issues.

Now both men and women will be offered the full range of tests, including for H.I.V. "It's a big change, no doubt," Dr. Puisis said. "There's no question this will impact citywide rates."

The jail struggles with testing the 100,000 or so who pass through its intake each year. A new facility and 900 beds are scheduled to be completed within three years.

"It will be 1,000 percent better than what we have," Dr. Puisis said. Those testing positive will be treated at Cermak Health Center and, upon release, at the county's Ruth Rothstein CORE Center or a community clinic, with actual testing done at the Stroger Hospital lab.

While we await construction of the new facility, a very bad situation morphs into the tolerable. For government these days, that's not bad.