Linda Rose Frank

Prisons and Public Health: Emerging Issues in HIV Treatment Adherence

Correctional facilities in the United States are faced with challenges in providing appropriate and timely HIV treatment to incarcerated HIV-infected inmates. Prison and jails, due to their structure, operation, and staff, may present many barriers to HIV treatment and adherence to complicated and expensive HIV treatment regimens. Changes and modifications of prison health care delivery are required to accommodate the needs of HIV-infected inmates. Approaches to improving correctional HIV care and treatment include training health care personnel, prevention education for inmates, increasing access to voluntary HIV testing, comprehensive treatment planning, and continuity of care. Policy changes for correctional systems include adopting current HIV care standards and immediate evaluation for and access to HIV treatment upon entry into the institution. These changes can have a significant impact on the quality of care for inmates, ultimately improving their quality of life and reducing the morbidity and mortality of HIV disease for incarcerated populations.

Supporting the Integration of HIV Testing Into Primary Care Settings

OBJECTIVES We examined the efforts of the US network of AIDS Education and Training Centers (AETCs) to increase HIV testing capacity across a variety of clinical settings. METHODS We used quantitative process data from 8 regional AETCs for July 1, 2008, to June 30, 2009, and qualitative program descriptions to demonstrate how AETC education helped providers integrate HIV testing into routine clinical care with the goals of early diagnosis and treatment. RESULTS Compared with other AETC training, HIV testing training was longer and used a broader variety of strategies to educate more providers per training. During education, providers were able to understand their primary care responsibility to address public health concerns through HIV testing. CONCLUSIONS AETC efforts illustrate how integration of the principles of primary care and public health can be promoted through professional training.

Interprofessional collaborative practice incorporating training for alcohol and drug use screening for healthcare providers in rural areas

ABSTRACT Interprofessional collaborative practice expands resources in rural and underserved communities. This article explores the impact of an online education programme on the perceptions of healthcare providers about interprofessional care within alcohol and drug use screening for rural residents. Nurses, behavioural health counsellors, and public health professionals participated in an evidence-based practice (screening, brief intervention, and referral to treatment—SBIRT) model that targets individuals who use alcohol and other drugs in a risky manner. SBIRT is recommended by the United States Preventive Services Task Force as a universal, evidence-based screening tool. Online modules, case simulation practice, and interprofessional dialogues are used to deliver practice-based learning experiences. A quasi-experimental method with pre-tests and post-tests was utilised. Results indicate increased perceptions of professional competence, need for cooperation, actual cooperation, and role values pre-to-post training. Implications suggest that online interprofessional education is useful but the added component of professional dialogues regarding patient cases offers promise in promoting collaborative practice.

HIV/AIDS and Mental Disorders

Despite advances in treatment that have resulted in decreased mortality and hospitalizations, and improved quality of life, human immunodeficiency virus (HIV) infection leading to acquired immunodeficiency syndrome (AIDS) remains a life-long, life-threatening, infectious disease that requires ongoing medical intervention and monitoring as well as intervention to reduce risk of reinfection and transmission to others. Women with HIV face many challenges in obtaining medical care, accessing services, and dealing with life circumstances that often interfere with quality self-care. Women with HIV and mental illness face additional social, economic, and healthcare challenges that are different than those that occur for the general population, as well as an increased risk of infection and decreased ability to obtain proper treatment.

Living and working behind bars.

As we approach the year 2000, we are faced with a crisis in our prisons and jails. This crisis has been fueled by changes in criminal law and sentencing, resulting in an exploding number of persons being incarcerated. These overcrowded prisons are environments that are conducive to violence and disease transmission. Correctional facilities nationally house nearly 2 million men and women with an increasing number of these individuals incarcerated with chronic disease, mental illness, chemical dependency, and histories of physical and emotional abuse. Due to mandatory lengthy sentences, correctional facilities are faced with a growing geriatric population. Unfortunately, prisons and jails are often serving as our psychiatric institutions due to the increased criminalization of the mentally ill. Incarcerated persons with HIV disease, due to treatment advances, are confronted with hope for the future contingent upon having access to the emerging HIV treatment. Amid the increased need for quality clinical care, adequately trained correctional health care providers, and serious public health challenges confronting these providers, funding for correctional health care services is often inadequate thereby limiting access to hopeful new treatment for HIV disease. The number of inmates with HIV disease continues to grow, placing increased clinical demands and ethical obligations for correctional facilities to provide HIV clinical care, HIV prevention education, and support services. With fewer opportunities for the incarcerated to participate in treatment programs, jobs, and education within correctional facilities, nurses have an important role in humanizing this often chaotic and hostile environment by providing care and comfort to this often forgotten population. Nurses are key in providing HIV prevention education and risk reduction to incarcerated men and women as well as providing specialized clinical care and support services. New challenges for nursing include assuming a leadership and advocacy role in developing correctional policies that support HIV treatment adherence, peer education, and address the existing and emerging health care issues for the incarcerated, including substance abuse, violence, sexually transmitted disease, and hepatitis. This issue, “HIV Behind Bars: Implications for Prevention, Treatment, and Policy,” is aimed at providing a forum to discuss the complicated issues for persons living with HIV disease behind bars, the nurses who care for them, and correctional policy implications. After nearly 10 years of conducting HIV education and training for health care providers within correctional facilities and in designing and conducting HIV peer education programs, it has become quite obvious to me that nurses are the cornerstone of care, treatment, and compassion within the correctional system. Without them, many persons with HIV disease would not have access to care and support. With limited opportunities for recognition and reinforcement within the correctional system, the work of nurses in prisons and jails has often gone unnoticed and unappreciated. This lack of recognition occurs not only from the correctional system itself, but from the nursing community outside of the system. Despite this, nurses working in prisons and jails continue to provide compassionate care and hope to inmates in environments that are often less than optimal due to limited resources, inadequate clinical staffing, and regimentation with the context of containment and punishment. Just as inmates with HIV are required to live with HIV disease behind bars, nurses working in corrections must provide HIV care behind bars. This is not an easy task, but a most important and critical role for nursing in the HIV epidemic. Editorial