WEPE613 - Poster Exhibition
The economics of HIV in prisons and beyond: a comparison of costs of prison care and re-integration methods to reduce recidivism
H. Strauss, A. Ferguson, F. Nota
AIDS Care Group, Sharon Hill, United States
Background: The United States has 5% of the world's population and 25% of the world's prisoners: 2.3 million. The State of Pennsylvania has 51,000 prisoners-each costing $32,000 per year; 825 have HIV/AIDS; each with anti-retroviral medications costing $24,000 per year. The state's prison system is over-crowded and costly; with a pressing need to address economics through early release.
Methods: Standard methods of cost and threshold analysis were employed in this study. Medical homes were used to introduce structured re-integration services by providing a social service framework to the medical therapeutic plan. Priorities include establishing identity; finding shelter, clothing, food, and transportation; quieting the urges of addictions; dealing with mental illness or the stress from domestic chaos and ostracism. Mental illness treatment options are fulfilled with direct care and utilization of telemedicine. Research funded by the Health Resources Services Administration, Special Projects of National Significance.
Results: For prisoners living with HIV/AIDS, cost of housing and providing health care is calculated at $8,992 per prisoner per year. HIV clinical markers all improved. Recidivism was reduced from 67% (average State prison rate) to under 40%. Failures were identified to addictions and relapse into criminal behaviors. Successes were matched to durable housing, community relations building, and family support. Costs of medical care were spread between Medicaid reimbursement or Ryan White programs. Housing costs were supported by HOPWA and other social programs. Food vouchers through community programs were utilized. Medication costs were reduced through federal programs available to non-incarcerated individuals.
Conclusions: Early release programs cost under $9,000 per prisoner per year and would save states considerable prison-based housing and medical expenditures for those living with HIV/AIDS. Early release programs that utilize the medical home concepts should be rewarded by receiving funding from state correctional divisions equal to 1/3 the costs of housing a prisoner per year.
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