Linkage to care in prison settings
HIV testing without an offer to link it to care is problematic. In this respect, it is problematic that prisoners cannot choose the doctor who treats them.
HIV testing without an offer to link it to care is problematic. In this respect, it is problematic that prisoners cannot choose the doctor who treats them. Prisoners might mistrust their assigned doctor. This maybe because of general fears, of previous experiences or because of what they heard from other inmates. In this case, it is more difficult for prisoners to build up a trusting relationship with their doctors and linkage to treatment and care can become difficult. A good doctor-patient relationship, based on trust, sympathy and mutual understanding, is often described as the basis to start livelong HIV-treatment outside prison. We know that achieving good adherence to treatment without this basis may be quite difficult.
From a financial perspective, linkage to HIV-treatment in Germany’s prisons does not remain a problem. However, linkage to HCV treatment is! Most prisoners tested HCV-positive in prison will very likely not receive treatment to cure their chronic infection. The high costs of modern HCV treatment, limited budgets for prison health and the high number of PWUD with HCV in prison are the reasons.
The fact that friends and family of incarcerated people are often hard to reach is an additional barrier, especially when medical decisions are necessary or emotional/psychological problems occur.
The most important question for the development of a pilot program in Germany was to guarantee that participating prisoners have control over the information about their HIV/HCV status in cases where the prisoner was not ready to consult prison health authorities to avoid the above-mentioned negative consequences. Furthermore, prison authorities needed to be convinced that cooperation with the community is not threatening but will instead offer added value for prisoners, prison doctors and staff alike.
To tackle the challenges, the German AIDS Federation developed a concept of an exemplary intervention to address these issues. As a first step to develop the concept, a group of community experts with work experience in prisons, met for a weekend to share their knowledge and to brainstorm about possible community-led interventions. Information collected guided further process. The results of the above-mentioned DRUCK study and the community testing guidelines (already existing for the community- led VCT activities outside prison) were very important for the development of the intervention.
The security of the prisoners was above all the highest concern. Based on the discussions, a consultant was hired to write the concept, which was send to all Ministries of Justice (MOJ) in Germany in order to find the approval. The intervention is realized in one of Germany’s male prisons. First results will be presented in autumn 2018. The process from the first idea to its realization took 3 years.