Dr. Bob Fullilove

                                                     photo by The New York Times




        In three steps, I will combat AIDS within the New York State Correctional facilities. I will prevent the spread of AIDS, educate reduction factors, and initiate forms of care outside of the prison. My solutions are modeled from pre-cursing programs that were successful in many other states. I arrive at my solutions based upon the fact that HIV has a higher prevalence in prison that is 7 times more than that of the general population [7].

            The first step is to prevent the spreading of HIV. To effectively prevent HIV from spreading within prison, we must first identify inmates with HIV. The majority of inmates enter prison without knowing they are positive for HIV [9]. Studies have shown that 94% of facilities in N.Y. do not have mandatory testing for HIV and that 17% of prisoners who entered prison in the year of 2001 were HIV positive. Among them 42%, were not providing on-going health services [9]. Mandatory testing for HIV will not only identify which prisoners are infected, but also which prisoners are in position to receive beneficial treatment. Using the 1976 case, Estelle v. Gamble which states a prisoner is entitled to medical care. Making HIV testing mandatory becomes a device for providing medical care for those prisoners in need. Providing testing accommodation to every facility it will take recruiting physicians who are most times intimidated by dangerous criminals, or will not participate because of the lack of salary. The National Health Service Corp is a program used in the South, in which it made physicians in prisoners, member of the governmental workforce. By doing so it improved salary scales, provided time for further education, and numerous healthcare benefits. Inducing such programs would make employment in the prisons attractive to physicians [9]. Now that we have staff and mandatory testing, we move to make prevention factors eminent.        

            Prisoners have expressed in studies that making condoms available would be a great help. In a survey of more than 300 inmates and 100 correctional officers, it was found that condom distribution programs were acceptable and not only addressed transmission from inmate to inmate but also to partners in the outside world [5, 11]. Correctional officers should carry condoms around to have readily available during the nightly hours, and also in large common areas condoms should be dispensed in large quantities. Areas such as the shower and common rooms, places where inmates gather daily. Medical centers within the prison should also carry condoms for prisoners who wish to keep their actions secretive. Next, drug treatment should be given to prisoners who identify themselves as substance users. In 2001, a study found that 35% of prisoners had used needles to inject drugs at sometime in their life [5]. In 2003 a syringe exchange program took place in southern prisons. Prisoners used syringes as weapons in which 11 deaths over an 18 month period resulted [10]. Instead I suggest to run a treatment program. In another study, 42% of former prisoners expressed a concern that they never received drug treatment within the prison system, and returned to the same lifestyle shortly after release [4].

            The second step is to educate prisoners. In Massachusetts, the Hampden County Correctional Center introduced their own program for AIDS prevention. In their program, the HCCC offered extensive inmate health education by peers, and forms of disease management/self-care [12]. I believe using this same program will work in Oneida County and N.Y. prisons because the parallel number in prisoner educational desire. In N.Y., 42% were interested in HIV prevention compared to 45% in Mass., 39% in N.Y. compared to 42% in Mass. were interested in disease management [6, 12]. Introducing peer education programs combines cooperation amongst the inmates and a desire to prevent HIV from spreading, resulting in a higher result of AIDS cases declining. Peer educating prisoners addresses the need for culturally sensitive information [1]. Meaning that minority groups feel most comfortable when information is given in native tongue, and find it easy to digest the information. Studies have shown that appealing to groups by culture creates a sense of security, upon which trust is built and the information is passed better [14]. Peer educators will be responsible for learning causes of AIDS and the best ways to combat HIV. Training will be conducted by HIV/AIDS counselors for of 3 weeks. Classes should run once in the morning and once in the afternoon, during free time, peer educators should be available for additional questions.   

            Initiating discharge plans and follow-up procedures are keys to success in promoting continuity of care [12]. By contracting with local community health centers prisons can deliver services to prisoners who need them, before and after release from prison. This practice of contracting leads to results in securing healthcare. What is meant is that inmates receiving medical care from a facility within prison feel more comfortable obtaining the same treatment from the same provider outside the prison [11]. Discharge planning involves referral to appropriate community resources, advocacy for clients, and scheduling initial appointment post-release.

            You cannot put a cost on health, but to run this program effectively additional funds will be needed. I estimate that about 1 million dollars over a 8 month period will be sufficient to run this program. The most expensive part of the program is adequate salary for medical staff. AIDS is an opportunistic disease and by not combining all resources and helping to prevent AIDS in every group we risk our own lives. As a community, every member becomes an important factor in solving the AIDS epidemic. New York State’s lack of providing healthcare for the incarcerated population has caused tremendous rise in HIV/AIDS in many communities not just Oneida County. By starting in Oneida County prisons, and expanding into the Department of Corrections I intend to limit infectious diseases, virtually lowering AIDS rates in every community.