- Associated Press - Sunday, June 29, 2014

NEW YORK (AP) - Several times each month, a white bus picks up newly released ex-inmates at New York’s Rikers Island jail complex and drives them to Harlem, where helping hands await at a transition program run by a nonprofit called the Fortune Society.

As they readjust to freedom, these new arrivals face the myriad challenges confronting anyone leaving jail or prison - and a daunting additional one. They have HIV.

While infection and incarceration represent a double challenge, this can be a health-care opportunity, says JoAnne Page, the Fortune Society’s president. “You don’t want to see people locked up - but if you’re trying to reach people who are HIV-positive, that’s the place to be.”

Each year, according to federal estimates, one out of seven Americans with HIV passes through a correctional facility. Thousands are released every year - transitioning to the uncertainties and temptations of the outside world from a regimented environment where, in most cases, HIV medication is provided without charge.

Health professionals view imprisonment as a potentially vital chance to offer HIV testing and connect HIV-positive people to health care perhaps better than they’ve ever had before. Yet these experts worry about what happens post-release, when freedom can lead to disruption of the ex-inmates’ medication, worsening their own health and raising the risk they’ll infect others.

“In prison, they’re a captive audience - the medical care is relatively straightforward,” said Dr. Josiah Rich, a professor at Brown University’s medical school and co-director of the Center for Prisoner Health and Human Rights.

“But when they’re out, it can be hard to track them down,” he said. “Often they’re stopping treatment at exactly the point they’re starting new sexual relationships. It’s the perfect storm - exactly what we don’t want from a public health standpoint.”

Rich co-authored a study published in 2010 that set off alarm bells in the HIV-prevention field. It examined 1,750 HIV-infected inmates who’d been released from Texas prisons, and found that only 28 percent enrolled in an HIV clinic within 90 days of release.

That intensified efforts to ensure post-release continuity of care, and drew attention to agencies such as New York City’s health department, which had an ambitious transitional care program in place for HIV-positive people exiting jail. At the core of the program are individual discharge plans, addressing each ex-inmate’s need for housing, food, clothing, health care and other supports.

It’s a massive operation, complicated by unpredictable length of stays for many of the inmates. Alison Jordan, who oversees the program, said her team draws up about 2,500 discharge plans per year, and more than 70 percent of the released HIV-positive inmates are linked to primary health care in their community.

Jordan and several colleagues, in an article two years ago, depicted New York city’s jails as the epicenter of the national HIV and AIDS epidemic. The article gauged the HIV prevalence rate in the jail population at 5.2 percent - far higher than the 1.25 percent HIV rate in the nation’s prison system or the 0.4 percent rate for the general population.

Jordan views the New York program as a model for jurisdictions elsewhere and has helped develop a curriculum and training manual in response to requests for assistance.

“It sounds so challenging, but on the front line, it’s really simple,” Jordan said. “It’s caring about people, being sure their basic needs are met, and helping them get to the doctor.”

The Fortune Society is among the city’s partners in trying to meet these goals, sending its own staff into Rikers to help with the discharge planning and then offering newly released ex-inmates services ranging from mental health counseling to residential accommodation at its Harlem facility.

Without such support, says Page, many newly released people become disconnected from care.

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