A Short History of HIV

Boehringer Ingelheim Puts Healthcare in Prisoners’ Pockets

by Chael Needle

AIDS is estimated to be at least five times more prevalent in the prison population than the general population. Compounded not only by other epidemics such as TB and hepatitis C and a stigmatizing silence, imprisoned people living with HIV/AIDS also face institutional barriers to healthcare. According to the Web resource Understanding Prison Health Care organized by Melissa Minor, M.D., and funded by the Arts and Humanities Medical Scholars Program at Stanford School of Medicine, the missions of prisons do not include healthcare coverage of inmates, funding for healthcare gets a low priority next to other things like security, and prisons’ standards of care are not subject to external review. A&U receives many letters from prisoners decrying physical and spiritual isolation, intermittent drug regimens (or no access to meds at all), and the lack of available HIV prevention and treatment information.

A new resource–small in size, but big on potential–is helping prisoners with HIV/AIDS take control of their own health. Though it’s been in use for about a year, Boehringer Ingelheim has recently officially launched the Patient History Card, a portable, double-sided card that details an individual’s HIV/AIDS health history–such as current meds, viral loads, T-cell counts, weight history, past meds, drug allergies, hep status, among other information–in order to help HIV-positive inmates "manage and monitor the success of their HIV care both in and out of correctional facilities." "Everyone remembers from school how much information you can fit on a ‘cheat sheet’!" says Dr. David Wohl, assistant professor of medicine at the University of North Carolina and one of the designers of the card. Free-of-charge and available to all U.S. correctional facilities, the cards carry no identifying information, assuring the anonymity of the imprisoned individual living with HIV/AIDS. The words "HIV" and "AIDS" appear nowhere on the card; Dr. Wohl thinks that confidentiality is not really a problem–most AIDS-unaware people wouldn’t be able to figure out what the information describes. It is accordion-folded and can fit in a wallet. So far, Boehringer Ingelheim has had over 50,ooo requests. Patients who have not been incarcerated are finding the cards handy as well.

The card was developed when Dr. Wohl, Dr. Joe Bick, and others who work in prison healthcare were sitting around talking about ways in which drug companies could be more effective in helping those living with HIV/AIDS in prison. They approached Boehringer with the idea of the Card. Says Wohl, "There’s a gap following release from prison in picking up services. [Former inmates] often don’t make appointments–if they do, there’s a fantastic delay." Dr. Wohl has often treated patients who have come out of prison who have no idea what their medical history is: "I think I was on HIV medicine" exemplifies what he often hears. With the Card, says Wohl, individuals can rely on themselves, not the institution to maintain their own continuity of care. Continuity, of course, is important in order to stave off the often life-threatening effects of non-adherence. When someone comes into Dr. Wohl’s clinic who doesn’t remember their health history, having the card "saves us a visit." Not waiting for medical records from the institution (if they even exist) and not waiting for information culled from new blood tests "translates into maybe a two- or three-month head start on care," says Dr. Wohl.

"It’s empowering because the patient gets to keep the card on them," he adds. The Card also addresses a larger concern of patient self-empowerment: "Some people have no idea what their T-cell count is, but now they learn it when they see it instead of [say] someone in a white labcoat telling them when they might be stressed." While people with HIV/AIDS early on in the epidemic often knew as much–if not more–than their physicians about the disease and available meds, this is changing. The Card creates a way for people to become more AIDS literate.

"Wherever there’s an incarceration epidemic, there’s an HIV epidemic," says Dr. Wohl, who feels that the contribution of incarceration to the spread of HIV is "underrecognized." Incarceration fuels the HIV epidemic, but not in the way people think; it’s not like Oz, says Dr. Wohl. When you take men out of a community, people get left behind, he points out, and those people form new relationships, increasing their risk of HIV. In prison, sex becomes a commodity and creates an at-risk situation, as well; and then when people get out of prison, they want to have sex. Incarceration, he says, is a "social disruption."

Correctional facilities and others can order the card by calling (877) 933-4310, ext. 9527 or 9551.

Chael Needle wrote about Valtrex, the first FDA-approved antiviral therapy for herpes in HIVers, in the June issue.