H. Denman Scott

Infection with the human immunodeficiency virus in prisoners: Meeting the health care challenge

The magnitude and the scope of health care problems posed by human prison inmates seropositive for the human immunodeficiency virus (HIV) are enormous. Prisoners represent a substantial proportion of HIV-infected individuals in North America. A high proportion of prisoners are intravenous drug users who often have not received appropriate health care or HIV-directed services prior to incarceration. Health care of HIV-seropositive prisoners and follow-up medical care after prison release has often been less than optimal. Among inmates at the prison facility in Rhode Island, 4% of the men and 12% of the women are HIV seropositive. The Brown University medical community, in conjunction with the Rhode Island Department of Health and Corrections, has developed an effective program for the health care of such prisoners, both during incarceration and after release from prison. Academic medical centers are uniquely poised to assume the leading role in meeting this obligation. We believe that this general approach, with region-specific modifications, may be effectively applied in many correctional institutions in North America.

The future of public health: a survey of the states.

A survey of state health agencies was conducted to determine agreement and disagreement of state health officers with the recommendations contained in The Future of Public Health issued by the Institute of Medicine in 1988. The survey also measured the extent to which the IOM recommendations were judged currently in place or in the process of being implemented in the states.The survey showed almost unanimous consensus among the nations state health officers for the vast majority of the recommendations. There was less consensus concerning the appropriateness of locating substance abuse, Medicaid, mental health, and regulation of health professions within state departments of health. However, a significant proportion of health officers favored a health agency location for these responsibilities (72 %, 52 %, 48 %, and 38 % respectively).