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Automatic HIV-AIDS Testing and Health Care Services for Inmates

Monday, October 23, 2006

Testimony of Devon Brown, Director

Committee on Health of the Council of the District of Columbia
David Catania, Chairman

John A. Wilson Building
1350 Pennsylvania Avenue, NW
Washington, DC 20004

Good Morning, Chairman Catania and Members of the Committee on Health.

I am Devon Brown, Director of the DC Department of Corrections

Joining me are my Deputy Director, Patricia Britton, and Health Services Administrator, Dr. Henry Lesansky.

I appreciate this opportunity to appear before you today to provide an overview of the healthcare services that the Department of Corrections provides to individuals in its custody, most specifically as it relates to HIV/AIDS.

I first want to commend you, Chairman Catania, on the commitment, leadership, and support that you have demonstrated in confronting the HIV/AIDS crisis in the District. Your outstanding efforts have greatly contributed toward advancing the quality of health and healthcare services for all of our residents.

As you well know, HIV is a serious health crisis in the District of Columbia, with the city reportedly having one of the highest infection rates in the country. The Department of Corrections, like all of our city agencies, is gravely concerned that this escalating epidemic is permeating each segment of our communities to varying degrees. We recognize that HIV is just as much a public safety crisis as it is a public health crisis. The Department also recognizes that like other correctional systems in this nation, it has become a major provider of basic human services. Statistics show that more than one fourth of all individuals with HIV in this nation pass through correctional systems each year. Acknowledging the woeful presence of HIV/AIDS after 25 years and its continuing destruction, the DC Department of Corrections has not remained at the sidelines and let others address this growing public concern.

Even before the District announced its city-wide initiative to test all persons 14 to 84 years of age for the HIV virus, the Department had made plans to integrate an automatic HIV testing program into its routine medical intake procedures for inmates. The Department of Corrections’ approach to addressing the HIV issue is pioneering among correctional systems. The Department’s automatic HIV testing at the front and back end of incarceration is a first among detention systems nationally. Most correctional systems do not test inmates for HIV unless inmates volunteer for the procedure and even then do so under limited conditions.   

HIV testing is conducted automatically at the Central Detention Facility, the District’s primary correctional institution for pretrial detainees and sentenced misdemeanants. The Central Detention Facility, also known as the DC Jail, also serves as the point of entry for everyone who has been arraigned and committed for incarceration by the Superior Court of the District of Columbia, and the US District Court, including detainment by the authority of the United States Marshals Service. Approximately 20,000 individuals are processed through the DC Jail each year. Many of these individuals enter and exit the system with a host of communicable and contagious illnesses. If they are unaware that they possess these disorders or the illness are not treated before their return to the community, a serious public impact is created.  Our last month’s statistics reflect one active tuberculosis case; 121 STD cases (syphilis, gonorrhea, chlamydia, and genital herpes); 34 Hepatitis C cases; and 102 inmates who are currently on HIV medication (October 20).  While inmates were previously screened for HIV on a voluntary basis, they are now being automatically tested.  However, they can still elect not to be tested and will not be subjected to any disciplinary action as a result.

The automatic HIV testing was launched in June in collaboration with the city’s Department of Health’s Administration for HIV Policy and Programs. Inmates entering the Central Detention complex are screened for the virus by the Orasure test. Testing is conducted again before they are released to the community, thus helping to determine the prevalence of HIV and provide the appropriate services, from information to treatment, based on testing results. Irrespective of the results, the goal is to promote healthy living and a more constructive lifestyle.

Over a four-month period (June 1 to September 30) 4,753 inmates were tested for HIV at intake. This represents among the largest organized testing effort not only in the city, but in the country within a four-month period. Of those tested, four percent were confirmed positive via blood serology. Of this four percent positive rate, one percent reflects newly identified cases, three percent were previously identified or self-reported cases.

Unlike many other jurisdictions, the Department provides counseling, treatment, including medications, and peer education to all inmates identified as being HIV positive or who has active AIDS. Upon HIV identification, it is Department policy to immediately begin treatment, which is the responsibility of our healthcare provider.

The automatic HIV testing program has received national acclaim with detention centers throughout the country expressing interest in replicating our program.

The Department of Corrections anticipates becoming a demonstration site of a US Department of Health and Human Services, Health Resources and Services Administration funded project that targets HIV infected individuals in jail settings. Applications are expected to be available in January of the upcoming year.

The automatic HIV testing program served as an introduction to the Department’s enhanced healthcare efforts. The automatic HIV testing in June, followed by the community-oriented healthcare model for inmates that became effective October 1, are substantial contributions to the city’s overall efforts to identify treat and reduce the incidents of HIV and ultimately, build healthier, safer neighborhoods.

Under the community-oriented healthcare model, there is a contractual requirement that the healthcare provider develop a tracking and reporting system to monitor the continuity of care (e.g. medical appointments, medications, mental health services) post incarceration.

The Department is pleased to partner with Unity Health Care in managing the full healthcare continuum for District inmates. As a result of joint planning started more than a year ago through collaboration between the Mayor’s Office, Office of the City Administrator, Center for Innovation and Reform and the Department of Corrections, the Robert Wood Johnson Foundation awarded a grant in February 2006 to provide intensive technical assistance to the District to implement our community-oriented correctional healthcare services model. Although the technical assistance is based upon a model of care established in Hampden County, Massachusetts, which has been the recipient of national awards, the District is the first jurisdiction to benefit from this grant and to implement the model in an urban setting.

Unity Health Care—the largest federally qualified health center in the District—provides comprehensive health care services as the Department’s new medical contractor under a three-year contract (with up to three additional option years) at the Central Detention Facility, Correctional Treatment Facility, and the four community correctional centers which have all been designated as Unity health centers.

We are pleased to have entered into this partnership and look forward to positive outcomes.

Thank you again for the opportunity to testify before you today. I would be pleased to answer any questions that you may have at this time.