For immediate release: March 21, 2007

GALVESTON, Texas - Crack dealers and prostitutes wait for the bus from Huntsville to Houston. They come to meet the newly released prisoners from the Texas Department of Criminal Justice.

Dealers know that a TDCJ prisoner gets $50 at release. The first rock of crack is free; the next one is $50. Or, a prostitute may get the money.

"Predators are waiting for them," said Dr. David Paar, a Correctional Managed Care physician at University of Texas Medical Branch at Galveston who is in charge of HIV/AIDS treatment for TDCJ. But, he noted, in the case of HIV-positive inmates released, "some community-based AIDS service organizations really make an effort, even to sending a taxi to the bus station."

Paar and a group of providers provide telemedicine from Galveston, all using the same procedures. Paar also works in helping released inmates with the virus make transitions to the outside world.

"Before, we had to transfer patients to Galveston physically to see an infectious disease specialist." Dr. Owen Murray, UTMB's associate vice president for Correctional Managed Care, noted. Now, UTMB employees at TDCJ facilities are trained in early identification of opportunistic infections and other issues in order to provide most treatment on-site.

About 2,500 TDCJ inmates are HIV/AIDS patients, 1,800 of them on medication, Murray said. He noted that inmates have access to all drugs available on the "outside," plus the option of new medicines available in clinical trials.

HIV-positive prison population deaths have declined in recent years, along with deaths among the HIV-positive population in general, Murray said. He said changes in medication formulations help make compliance easier. Now, a patient may take a few pills a day, combining several drugs, in contrast to the dozens common in previous years.

Also, a prison's structured environment improves compliance.

"We're very much in control," Murray said, though inmates still must "stand in the pill line" for medications. "It helps make it easier to intervene earlier if a person is not cooperating in his therapy." Another reason for good outcomes is lack of access to high-risk behaviors in prison.

Paar hopes getting patients into continuing care will ensure good progress after prison. He noted that preliminary data regarding discharge planning for HIV patients shows that, of the 50 discharged patients in Harris County studied, 35 of them - 70 percent - showed up at an AIDS agency. TDCJ releases about 100 HIV positive inmates per month.

A crucial tool is "Causeway For Success," a personal health diary and medical history, said Victoria Korschgen, CMC nursing program coordinator. Nurses help inmates fill out the information and understand their viral load, CD4 cell count and medications, aiding transition to outside care. Another book, "Pictures That Give Hope" (also available in Spanish), by Dr. Eric Avery, clinical associate professor of psychiatry at UTMB, helps nurses show inmates about their disease.

Paar has applied for a grant for a larger study regarding discharge planning for HIV/AIDS patients. He said preliminary studies in other states show that such programs reduce the individuals' return to prison.

"Also, if they can get into care it keeps their viral load down, which makes them less likely to transmit the disease even if they engage in unsafe behaviors," Paar said, "And if they are in care, they are less likely to engage in unsafe behavior."
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