South Carolina (SC) is one of two states (with Alabama) where HIV testing on prison entry is mandatory and all of those found to be HIV+ are assigned to a separate facility. The purported advantages of the separation of HIV+ inmates include cost-effective and efficient delivery of HIV-specific medical care and counseling, as well as protection of HIV+ inmates from discrimination from other inmates. SC officials have also stated that the policy reduces the risk of intramural spread of HIV. However, critics of this polic point to a number of potential disadvantages. The specialized facilities for HIV+ inmates are maximum-security facilities where access to the work release and other programs that are available at lower security facilities can be restricted. Further, separation of HIV+ inmates can potentially lead to inadvertent disclosure of HIV status as inmates sent to these facilities may be marked as HIV+. Lastly, disease outbreaks (e.g., tuberculosis) can occur when immune- compromised inmates are co-housed. However, despite the on-going and protracted debate there are practically no data with which to evaluate the policy and its effect on critical outcomes of interest. Specifically, no research has been conducted to assess the perceptions of the merits and faults of the policy among those most affected by it - the inmates of the South Carolina Department of Corrections (SCDC). Further, given the uncertain fate of the policy, there are limited data to inform how best to accomplish the integration of HIV+ inmates were the policy to end. In response, we have established a team of experts in correctional HIV health care, health behavior, qualitative research, epidemiology, and criminology from academic centers and state public health agencies to critically examine, using a mixed-methods approach, the perceptions and experiences of inmates who live or have lived under the SCDC HIV housing policy and the prison staff who work within this system. In this 3-year R01 we will also assess the quality of HIV care in the prison system using established quality metrics for HIV clinical care. Such independent and rigorously conducted research can significantly and meaningfully inform this debate and, ultimately, policy.
The proposed project examines an important issue in correctional HIV health care with significant implications for the health of this population of HIV inmates. The studies in this application will collect perspectives among those most impacted by the South Carolina prison system policy of segregating HIV+ inmates and will assess the quality of HIV care delivered in this prison system, which has been criticized by the US Department of Justice.