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State budget could cut AIDS drugs in county jails Alameda County may be forced to pay for expensive program.
 
 
  By Chris Metinko
Oakland Tribune
Updated: 03/20/2010 06:48:48 AM PDT
 
While many HIV and AIDS advocates applauded the governor's proposed budget that included $87.5 million for the state's AIDS Drug Assistance Program, the lack of funding for one particularly needy group has left some worried.
 
In January, Gov. Arnold Schwarzenegger committed to providing the money in the proposed budget for the program, which provides the uninsured and underinsured access to costly drugs. Not included in that amount, however, was $9.5 million in funding to provide medications for HIV-positive people incarcerated in county jails. Instead, the governor's proposal would shift drug-assistance expenses for county jail inmates to the respective jails in which they are incarcerated.
 
"The governor's proposed funding switch introduces a new layer of uncertainty about treatment continuity and increases the expense of treatment," said Kabir Hypolite, director for Alameda County's Office of AIDS Administration.
 
Hypolite said the drug-assistance expenditures at the county's Santa Rita Jail in Dublin are about $525,000 - money that historically has come from the state. The governor's proposal likely would shift that expense to the jail or perhaps the county health department. Either way, Alameda County, like most other cash-strapped counties around the state, is not in any position to pick up the bill.
 
All of which leaves AIDS/HIV treatment of inmates, who will be released back into the general population, in a precarious spot.
 
The proposal "increases the risk of treatment disruptions to HIV-positive individuals in incarceration facilities," said Hypolite, adding that about 250 Alameda County inmates received AIDS Drug Assistance Program medications throughout the past year.
 
Hypolite said any disruption in treatment increases the risk of a patient developing HIV viral resistance to the drugs, which could result in a surge in drug-resistant HIV strains. He also said untreated individuals and those with drug-resistant strains may have higher viral loads, which means they are more infectious to their partners than patients whose viral loads are undetectable.
 
Courtney Mulhern-Pearson, director of state and local affairs for the San Francisco AIDS Foundation, said the possible disruption in care to inmates could be extremely damaging and is one of the reasons her organization is concerned about the governor's proposed cuts.
 
"These people need a continuum of care," Mulhern-Pearson said. "It's everybody's responsibility to make sure that care is provided."
 
Mulhern-Pearson said that if the state cannot come up with the additional $9.5 million for drug assistance in jails, the money must come from somewhere. Hypolite said counties across the state may try to band together to buy AIDS/HIV drugs in bulk and get a discounted price.
 
Anne Donnelly, director of health care policy for San Francisco-based AIDS/HIV group Project Inform, said creative thinking may be needed to come up with the necessary funds to keep the program alive - especially in these tough financial times.
 
"The counties have been strapped by state funding, and the state also asking for money back," Donnelly said. "Nevertheless, the concern is for the people who are incarcerated to get their treatment."
 
Hypolite said jails already present an AIDS/HIV problem to county health officers because inmates are generally not screened for HIV unless they request a test or are ordered to take one by a court.
 
According to the Alameda County's HIV services plan published last year by the county's public health department, it is estimated that approximately 2,000 inmates with HIV or AIDS have been released from county jails or state facilities back into communities around Alameda and Contra Costa counties between 2006 and 2008.
 
Hypolite said all newly incarcerated inmates are offered HIV tests upon entry into jail and again after two weeks, but many refuse to be tested because HIV-positive inmates face potentially serious physical hostility from other inmates if their status becomes known.
 
 
 
 
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