PROVIDENCE, R.I. -- It takes a community to help HIV-positive women released from prison.
A prison-release program for HIV-positive women successfully links clients with medical care and substance-abuse treatment on release from prison, resulting in a more than 50-percent decrease in the recidivism rate, say Brown University medical personnel, reporting in the American Journal of Public Health. They say the program could serve as a model for other states to meet the need for community follow-up for HIV-positive women released from prison.
During the first year of the program, 41 HIV-positive women were released from prison. Among them, 34 followed up with medical care, and 34 of 39 women received aid from either general public assistance or Social Security disability. Twenty-one of 31 women entered into a substance abuse treatment program after release. Of the 14 women who had no place to live, 8 were placed in an apartment or group home.
Women in the prison release program's first year had recidivism rates of 12 percent within six months and 17 percent within 12 months. For comparison, a randomly selected group of 41 HIV-positive women at the state prison who were not in the program had recidivism rates of 27 percent within six months and 39 percent within one year. Forty-one HIV-negative women who had release dates and charges that matched those of participants in the prison release program had recidivism rates of 22 percent within six months and 37 percent within 12 months.
Prisons are key sites to provide initial HIV-related care and links to community follow-up. Between 1989 and 1993, for example, 39 percent of all HIV-infected women in Rhode Island were first diagnosed with the virus in the state prison.
Upon release from prison, HIV-positive women frequently lack primary medical and gynecological care, substance abuse treatment and psychological and social support. The Brown University AIDS program, with the Rhode Island departments of health and corrections, designed the prison release program. It relies on a seven-member team of four doctors, two nurses and a social worker to assist the women. The program also supports a prison-based, half-time registered nurse.
In the program, team members meet with each woman, three to six months prior to her release, and up to five times depending on need, to discuss and design after-release plans. This pre-release counseling focuses on medical care, housing, substance abuse treatment and family support. Team members also conduct follow-up on all participants three and six months after release from prison.
"The first 24 hours after the women are out determines whether they will be back," said Timothy Flanigan, M.D., associate professor of medicine and one of the program's leaders. "The program's intervention tries to establish a medical relationship with women in prison and maintain that bond. The doctors who see the women in prison also see them in the community. Each woman's discharge plan is carefully crafted before she leaves prison and is reinforced by the doctor and other team members."
All but two of the 41 women in the program were incarcerated for drug or prostitution charges or both. Thirty-three of the women had been jailed more than twice.
"Success in the program is measured in changed behavior, which is reflected by the reduced recidivism rates," said Kevin Vigilante, M.D., clinical associate professor of medicine, and the program's other leader. "If the women are changing their behaviors by not returning to prison, they may also be reducing the behaviors that lead to drug use and prostitution."
Vigilante also operates a storefront clinic that provides medical care and substance-abuse treatment to HIV-negative women at high risk of contracting the virus. He and Flanigan run a program that helps children of incarcerated women and substance abusers attend parochial or private schools. Vigilante and Flanigan are physicians in the Brown University School of Medicine based at The Miriam Hospital.