8.4: Pennsylvania Special Population

HIV Macro Study

Pennsylvania DOCS considers HIV positive inmates a special population and has addressed the matter in policy and practice. HIV in prison populations is considered one of the most significant issues facing our prison administrators (Elliot, 2007). The percentage of HIV infected individuals is far greater in prison than in the general population (Elliot, 2007). Some surmise that this is in part because of the high percentage of prison population that use drugs in a regular basis. For these reasons, the corrections system must be sensitive to issues surrounding HIV policies and procedures in the prison system.

A highly influential study performed by Macalino, Sanford-Colby, Patel, Salas, Rich, Vlahov, & Sabin (2004) addressed the issue of HIV and the impact it has on the prison population. Their methodology observed the intake of 4,269 inmates at the Rhode Island Adult Correctional Institute during a two year time period of 1998-2000. The results revealed that approximately 20% of the inmates were infected with HIV; primarily associated with intravenous drug use. The study concluded a significant community health issue was the result of HIV prevalence in prison and the release of the inmate back into the civilian population, generally with shorter sentences due to non-violent nature of the crime and recidivism statistics indicate the inmate will recommit in a short period of time. The issue of recommitting is rather vague and ambiguous in the study but it is assumed that the return to shared needles and drug use will increase the spread of HIV once released. The authors proposed that correctional administrators focus on general disease prevention efforts such as screening, education, and vaccinations.

Another study performed by McClelland, Teplin, Abram, & Jacobs, (2002) supported these findings in relation to the female inmate population. In their study, the researchers canvassed 948 female inmates and found that those with “high risk” of contracting HIV were those females that had mental disorders, were homeless, has multiple prior arrests and were arrested on drug charges. Being that these high risk females often had shorter sentences, they were released back into the community sooner, which creates a serious health risk for the general public. The authors recommended that HIV in jails become a major public health priority.

HIV/Psychiatric Dual Populations

Psychiatric disorders such as bipolar disorder, schizophrenia and depression have long been associated with risk behaviors for HIV, hepatitis C virus (HCV) and hepatitis B virus (HBV). The US prison population is reported to have elevated rates of HIV, hepatitis and most psychiatric disorders (Baillargeon, Paar, Wu, Giordano, Murray, Raimer, Avery, Diamond, and Pulvino, 2008, p. 124). The US prison system has become an important front in the effort to control HIV primarily due to the increase in drug-related convictions in the US prison system over the last 20 years. This fact alone has resulted in substantial increases in the proportion of offenders with HIV and HIV-related risk factors (Baillargeon, et al., 2008).

Psychiatric disorders including schizophrenia, bipolar disorder and major depression may underlie the high rates of HIV and hepatitis in prison populations by way of increased rates of high-risk sexual behavior and injection drug use. The elevated risk of these behaviors among patients with psychiatric disorders has been linked to a number of factors, including limited impulse control, difficulties in establishing stable social and sexual relationships, limited knowledge about HIV related risk factors, increased susceptibility to coercion and co-morbid alcohol and drug use (Baillargeon, et al., 2008).

Although previous studies have reported a strong association between psychiatric disorders and HIV infection in prison inmates (Baillargeon, Ducate et al., 2003; Treisman et al., 2001), no published research has assessed the association of psychiatric disorders and HIV/ hepatitis co-infection in the correctional setting. In a recent study of non-incarcerated patients with mental illness (Rosenberg et al., 2005), HIV/HCV-co-infected patients were reported to exhibit greater severity and chronicity of psychiatric disease than their HIV-mono-infected counterparts. It is plausible that HIV/hepatitis coinfection is associated with more severe or diverse psychiatric disease by way of behavioral risk factors, although no research has assessed these underlying characteristics (Baillargeon, Ducate, Pulvino, Bradshaw, Pulvino, Murray, and Olivera, 2003).

Pennsylvania DOCS Approach

PA DOCS considers special population as the following: geriatric, infirm, women inmates with special medical needs and disabled, mental-illness and Young Adult Offender Inmates (Personal Communications Chuck Roberts, Dep. Asst. Administrator & Denise Wood, Records Administrator, and February 16, 2012). PA DOCS Policies provides the authority and general ethical intent of providing care or treatment for the categories discussed thus far. The categories are not exhaustive and are amended annually for the purposes of providing treatment and services in accordance with judicial review and legislative acts (Personal Communications Chuck Roberts, Dep. Asst. Administrator & Denise Wood, Records Administrator, February 16, 2012).

PA DOCS SCI’s are Americans with Disability Act compliant according to Roberts and Woods (Personal Communication, February 16, 2011) to include cells, service areas, and infirmaries. Therefore most infirmaries at each institution can provide adequate care for many of the situations that arise. This is particularly true for HIV infected inmates as previously discussed. The more severe a patient/inmate health issue, they are transferred to a special housing facility for skilled care beyond the capabilities of the SCI’s infirmary. In previous discussions the Death with Dignity program permits certain inmates transfer possibilities to hospice care facilities outside the PA DOC control (Personal Communications Chuck Roberts, Dep. Asst. Administrator & Denise Wood, Records Administrator, February 16, 2012; PA Corrections Reform-Act 81).

In addition to general health care, Roberts & Wood (Personal Communication, February 16, 2011) maintains that female inmates requiring Obstetric Care is contracted with local hospitals in the area of the SCI. This contracted service includes female inmates being transferred to a local hospital for birthing of a child and contrary to popular belief, no child is born within prison walls in Pennsylvania unless as an emergency situation may provide. Policy dictates that all contracted services as described are provided by external health care providers. They further contend that in extreme or chronic medical care situations for inmates at SCI’s outside care providers may be considered (Personal Communications Chuck Roberts, Dep. Asst. Administrator & Denise Wood, Records Administrator, February 16, 2012).

The table provided in Appendix A-SCI’s is highlighted in red for review of the three main skilled care facilities providing services to inmates within the PA DOCS. The Forensic Unit at Waymart is the designated facility for mental-illness care beyond the capability of the SCI infirmary. The facility at Waymart as of 12/31/2011 indicates a 90% capacity rate with an inmate population of 1,458. According to Roberts & Wood (Personal Communication, February 16, 2011) the population of PA DOCS inmates requiring mental health care is misleading as a percentage of those inmates listed are healthy inmates that provide upkeep for the facility. However the unit does provide services for the more severe cases within the PA DOCS population, but the actual number of inmates requiring the advanced level of care and treatment is not available.