Groups Urge CDC to Strengthen Guidance Addressing HIV Behind Bars
In response to a CDC request for comments, 35 organizations endorsed a joint letter submitted to CDC regarding its draft implementation guidance for HIV testing expansion in correctional settings. The Center for HIV Law and Policy, Lambda Legal, and the AIDS Foundation of Chicago drafted the letter following consultation with individuals familiar with the healthcare and HIV/AIDS-related needs of incarcerated populations. The joint letter underscores the need for CDC to more widely disseminate the draft guidance and invite additional comments from diverse stakeholders, especially HIV-positive ex-inmates, correctional health officials, and community representatives. Greater community input is likely to generate more targeted recommendations needed to help correctional officials improve the response to HIV/AIDS in their facilities.
Other recommendations highlighted in the joint letter include:
- The guidance should include a section on informed consent. CDC's 2006 set of recommendations on HIV testing in healthcare settings emphasizes the voluntary nature of HIV screening. Because incarceration is by its nature coercive, the draft guide should include a separate section about the merits of voluntary HIV screening. The failure to refuse an HIV test does not constitute consent to testing.
- The guidance must recognize that there are many types of correctional facilities, including those that confine youth. A "one size fits all" approach is not workable, and the guidance should explicitly recognize that different settings will require different approaches to offers of testing and linkage to care.
- The guidance must reflect that correctional facilities have a court-recognized legal obligation to have medical services in place that respond to the serious medical needs of inmates, including those with HIV.
- The guidance should include opt-in approaches among alternatives to opt-out screening. Many jurisdictions may be unable to implement routine, opt-out screening and should therefore explore alternatives to promote awareness of HIV-status among correctional populations.
- The document needs a section with more specific guidance on planning and implementation: Readers should be urged to convene locally with state correctional health officials, policymakers, wardens, discharge planners, community-based organizations and other stakeholders.
- If HIV testing is part of a broader HIV prevention program in correctional facilities, then the guidance should also address the value of condom access and other programs that promote inmate health and therefore can increase voluntary testing.
- The guidance needs to address the complexities of pregnant prisoners' choices in treatment decisions for themselves and to prevent vertical HIV transmission, and their right to autonomy in decision-making, even when incarcerated. At present, the guidelines present as a given that all pregnant women will commence ARV to prevent transmission, regardless of personal health and choices.
Download Comments Submitted to CDC on HIV Testing in Correctional Settings
Authors drew on the community-developed set of guiding principles for local implementation of HIV testing expansion activities (available at www.hivtestingprinciples.org) in developing the joint comments.
To learn about CDC's draft guidance for HIV testing in correctional settings, see:
CDC draft implementation guidance for HIV testing in corrections.