Tuesday, August 28, 2012
Chicago Tribune
by Naomi Nix

Every day about 200 people pass through the doorways of the Cook County Jail to have their clothes inspected, their pictures taken and their backgrounds checked.

Now the incarcerated face one more examination: an HIV test.

The Cook County Jail is testing everyone who goes through the intake process for HIV, unless they refuse, hoping to put a dent in the number of people who have the virus but don't know it.

The approach, called opt-out HIV testing, has been in place for female inmates since April 2011, but the jail system expanded the program to include male inmates in late June.

Meanwhile, health officials plan to adopt a similar program for state prisons in the coming months.

Experts say correctional facilities have become a key battleground in the fight against HIV.

"It's a window of opportunity for reaching them for education purposes," said Cajetan Luna, executive director of the Center for Health Justice. "Once people get out in the community, it's much harder to do that work."

Each year, 1 in 7 people living with HIV pass through a correctional facility, according to the Centers for Disease Control and Prevention. Inmates are more than twice as likely to be infected with AIDS than people in the general population, particularly if they engage in risky behavior such as injection drug use or commercial sex work.

Improving HIV rates among inmates has benefits for people outside the system too. Undiagnosed inmates who leave the jail setting might go on to have other partners in the community who could become infected, experts say.

Before opt-out testing, inmates at the Cook County Jail were tested for HIV at their request or at a doctor's urging.

"While lots of people did ask … the number of them was a fraction of what we really wanted to be tested," said Dr. Chad Zawitz, director of infectious disease for the jail. "We try to make sure that nobody falls through the cracks."

Now inmates are told during the intake process that everyone is tested for HIV, but if they don't want the test they have to sign a form acknowledging their refusal. The American Civil Liberties Union of Illinois has not made any formal objections to the new procedure.

"Our general concern in testing is that it not be coercive so that people know that they have the ability to say no," said John Knight, director of the LGBT and AIDS Project at the American Civil Liberties Union of Illinois. "But we have not at this stage posed any objection to this testing."

Blood samples from those who take the test are sent to John H. Stroger Jr. Hospital, where they are tested overnight. By the next weekday a medical specialist is informed of the results.

Though the shift to opt-out testing is largely procedural, officials say it removes a psychological barrier to getting the test.

Misconceived notions about the virus's connection with homosexuality and how it is passed on to others persist inside and outside of jail, experts said. In a correctional facility setting, such perceptions can make inmates reluctant to take the test or even take medication for the virus for fear of unwanted attention.

"If one of them is … going to see the doctor for any reason, while (people are) not immediately suspicious for HIV, people will say, 'Why you going to see the doctor?'" Zawitz said. "I try to give them plausible reasons on why they are seeing me other than they got it."

Compared with the previous year, the number of HIV tests taken since opt out began for female inmates has about tripled, Zawitz said.

The Cook County Health and Hospitals System is paying about $275,000 a year for the increased testing at the jail.

The state prison system hopes to adopt a similar approach. Currently inmates are offered a test at their parent facility. But in the fall, inmates will be told only of their option to refuse a test when they enter a reception and classification center.

"It's certainly a significant change," said agency medical director Louis Shicker. "We're hoping that we will catch more people and possibly pick up more positives."

The initiative will be paid for by part of a $7 million grant awarded two years ago to researchers at the University of Illinois at Chicago.

The group also is experimenting with using inmate social networks to find and diagnose more HIV-positive people. As part of the initiative, HIV-positive people who have been released from prison recently may receive coupons to give to their friends that would give them $10 in exchange for taking an HIV test.

Doctors hope to produce a study measuring the effects of opt-out testing on the number of tests taken and the positive diagnoses made.

"The more people we can find who are positive and start treatment and educate them … the better off everyone is," Shicker said. "The treatment is so effective (that) people can live pretty normally for a long period of time."