HRSA’s Ryan White HIV/AIDS Program Discusses Engaging the Criminal Legal System to End the HIV Epidemic

The Health Resources and Services Administration (HRSA) HIV/AIDS Bureau (HAB), which oversees the Ryan White HIV/AIDS Program (RWHAP), convened a Technical Expert Panel (TEP) earlier this year to identify barriers and facilitators in providing HIV services to people who are incarcerated. Participants in the panel identified issues related to provision of HIV care in correctional settings and others specific to re-entry. The panel also identified several general issues to consider in improving HIV treatment and care for people who are incarcerated. Some of the considerations include addressing HIV and incarceration-related stigma, providing patient-centered care, addressing co-morbidities, and valuing lived-experience of people who have been incarcerated. This week, HRSA HAB published an executive summary of the panel.

HRSA’s Ryan White HIV/AIDS Program has a critical role in the Ending the HIV Epidemic: A Plan for America (EHE) initiative, which aims to reduce new HIV infections in the United States by 90 percent by 2030. HRSA understands that ending the HIV epidemic will require building or enhancing relationships with non-traditional stakeholders. Institutions of the criminal legal system, like jails and prisons, are important partners to ensure people with HIV receive needed care and treatment – both in the correctional facility and upon returning to the community after incarceration.

The most recent Bureau of Justice Statistics HIV in Prisons report indicates HIV prevalence is 1.3 percent among state and federal prisoners; more than three times that of the general population. One study found one in five people with HIV are incarcerated in a jail or prison each year.  Many of the HIV-related disparities in health outcomes are mirrored in the disparities we see among people who are incarcerated or otherwise engaged in the criminal legal system.  In many instances people who are incarcerated, in prisons in particular, are receiving their HIV treatment and, as a result, are virally suppressed. However, upon release these same people can face multiple challenges to continuity of care, including challenges with being connected to a community-based healthcare provider and establishing ongoing access to medications, which can lead to viral load increases and poor health outcomes. Not surprisingly, one systematic review found that the HIV care cascade among the incarcerated and recently released population is dynamic, with large increases during and even larger declines after incarceration, resulting in a net negative effect on HIV outcomes.

Collaborative relationships with prisons and jails present important opportunities for providers of HIV services to improve HIV outcomes for justice involved individuals and thereby help meet the goals of the EHE initiative.

In 2018, HRSA provided policy guidance to Ryan White HIV/AIDS Program (RWHAP) recipients on how they may provide services to RWHAP-eligible people who are incarcerated.  While RWHAP recipients may provide HIV services to people who are incarcerated, building the necessary relationships with correctional facilities is challenging.

To read the findings of the technical expert panel, “Addressing the HIV Care Needs of People with HIV in State Prisons and Local Jails,” visit the HIV/AIDS Bureau website.