Hard Return Prisoners with HIV, fresh out of jail, find they have many more walls to overcome

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In October 2009, after 12 years behind bars, Beverly “Chopper” Henry was released from the Central California Women’s Facility (CCWF)—with $200 and some bus tokens. Living with HIV (and hepatitis C) in prison had been difficult, and getting out offered joy and relief. But Henry’s newfound freedom also presented a range of challenges.

In prison, Henry, now 60, had been among those prisoners who pushed for better care and treatment for their HIV and helped improve prison health care. Because of them, many of the 21,980 HIV-positive prisoners in U.S. jails and prisons now have access to HIV meds and can control their virus while locked up. Unfortunately, research shows that the health of many positive prisoners takes a nosedive once they’re released. A study published online in PLoS ONE in September found that only 15 percent of positive prisoners released from the San Francisco County jail system continuously took antiretroviral meds after release. In other words, the majority of former prisoners stopped taking their meds or took them only intermittently—which raised their viral loads and derailed their HIV treatment.

Why, when given a new (re)lease on life, would prisoners neglect their health? It’s simple: Most released prisoners have no medical benefits and scant prison discharge planning help. That deprives them of the services and support they need to secure housing, find a job, get health care benefits and enter drug treatment (if needed)—making it nearly impossible to stay on top of HIV care.

“In prison you have a roof over your head and three meals a day,” says Frederick Altice, MD, of Yale University and an expert on HIV/AIDS care in prison. “Then all of a sudden you’re out and in survival mode, and those basic needs have to be met. So health care and medication go by the wayside.” Add to the mix drug use (rampant in the shelters where many ex-prisoners are forced to reside), and HIV management disappears.

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