HIV prison population could grow just by changing a question

The Illinois Department of Corrections has offered inmates entering its prisons the chance to be screened for HIV for years now. Prisoners coming into the system are asked if they want to take the test, but faced with the choice many decline.

Legislation that advanced through the General Assembly this spring would automatically sign inmates up for the test. They'd only get out of it if they made the effort to refuse it. House Bill 1748 authorizes the corrections department, or IDOC, to include HIV as part of the cohort of diseases inmates must specifically refuse, rather than specifically elect, to take.

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In other states, opt-out testing for HIV has seen success. Between May 2008 and June 2009, researchers in North Carolina found
that around 90 percent of inmates who entered the state's corrections facilities under an opt-out, but still voluntary, testing regime were tested for HIV, as compared to just more than 61 percent who entered then system under an opt-in system. "With opt-out testing an additional 22 HIV infections that would not have been be detected with testing alone were revealed in 2009," the study's authors wrote (PDF).

Sponsored by a broad group of Illinois legislators mostly hailing from the Chicago area, the bill sailed through the State House and Senate in unanimous votes on March 31 and May 17, respectively.

Jeremy Young, an assistant professor of infectious diseases at the University of Illinois at Chicago, said shifting to "opt-out" HIV testing in IDOC would likely boost the percentage of inmates screened. And the number of HIV-positive IDOC prisoners could ultimately double from the approximately 500 known to be infected today, Young said.

"I think we are missing people," he said, under the current system.

Elman said in the 2010 fiscal year, 28,500
inmates were offered the test; more declined the test that year -- about 15,000 -- than the 13,500 who agreed to take it.

Better data about HIV's incidence among the state's prison population would give health authorities more information about staunching the spread of the disease, particularly in the communities -- often minority and low-income -- many offenders return to upon their release from jail. Officialls hope it will also help informed inmates and ex-inmates treat their illness.

State Rep. Camille Lilly, whose district includes parts of Chicago's Austin neighborhood and several west suburban communities, was a chief co-sponsor of HB 1748.

"What is happening over and over again is there's a number of inmates who do not know their status," she told the Reporter. "When they are released back into the community they still
don't know, which causes a risk factor for themselves and the community."

Young, part of a team at UIC using a $7 million grant to increase HIV testing of inmates at Cook County Jail and treat those infected, said switching to an opt-out system has particular resonance now, given the number of people in jail with drug problems, a risk factor for HIV.

A spokesperson for Gov. Quinn said the governor is reviewing HB 1748.

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-- Micah Maidenberg

Filed under: Criminal Justice, Health

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