Medicine and the Epidemic of Incarceration in the United States

Division of Infectious Diseases, Department of Medicine, Miriam Hospital and Brown Medical School, and the Center for Prisoner Health and Human Rights, Providence, RI, USA.
New England Journal of Medicine (Impact Factor: 55.87). 06/2011; 364(22):2081-3. DOI: 10.1056/NEJMp1102385
Source: PubMed
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Available from: Sarah E Wakeman, Apr 07, 2015
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    • "The natural history of these diseases often leads to behaviors that result in incarceration. Health professionals have the chance to advocate for changes in the criminal justice system in order to reduce the number of people behind bars who would be better served in community-based treatment programs and to capitalize on the tremendous public health opportunities to diagnose and treat disease and to link patients to care after release (Rich, 2011). For example, half of all Italian prisoners are charged or sentenced for minor drug crimes. "

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    ABSTRACT: Substance abuse is linked to many new cases of HIV infection. Barriers such as the myth that drug users cannot adhere to HIV/AIDS treatment block progress in curbing the spread of HIV in that population. In this article we explain the need to aggressively seek out high-risk, hard-to-reach substance abusers and to offer them HIV testing, access to treatment, and the necessary support to remain in treatment--both for HIV and for substance abuse. We summarize evidence showing that injection drug users can successfully undergo HIV treatment; that many substance abusers adhere to antiretroviral therapy as well as do people who don't inject drugs; and that injection drug users who undergo substance abuse treatment are more likely to obtain and stay in treatment for their HIV infection. This evidence makes a strong case for integrating substance abuse treatment with HIV treatment programs and providing substance abusers with universal access to HIV treatment. But an integrated strategy will require changes in the health care system to overcome lingering obstacles that inhibit the merging of substance abuse treatment with HIV programs.
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    ABSTRACT: The incarcerated population has increased to unprecedented levels following the 1970 US declaration of war on illicit drug use. A substantial proportion of people with or at risk for HIV infection, including those with substance use and mental health disorders, have become incarcerated. The overlapping epidemics of incarceration and HIV present a need for academic medical centers to collaborate with the criminal justice system to improve the health of incarcerated populations. With coordinated collaboration and new programmatic initiatives it is possible to reduce HIV-associated risk behaviors and the likelihood of acquisition and transmission of HIV. Centers for AIDS Research (CFAR), funded by the National Institutes of Health, have proactively responded to this need through Collaboration on HIV in Corrections (CHIC) to improve the diagnosis, treatment, linkage to care, and prevention of HIV. This collaboration serves as a model for aligning academic expertise with criminal justice to confront this challenge to individual and public health. This is especially relevant given recent evidence of the effectiveness of antiretroviral therapy in reducing HIV transmission.
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