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The program serves as an advocate for inmates and operates separately from the infectious diseases clinic, where doctors specializing in HIV visit twice a week and see an average of 16 patients per day, Carvajal says.
Brenda Thomas, an HIV educator, toured the jail HIV facility several years ago and found it impressive. "That's a big surprise to me [that inmates complain] because they have one of the best HIV programs in the country down there," she says. "At one time it was considered a model program for all jails."
Carvajal admits the program has not been operating optimally, but that's because it lost funding three years ago for two case managers who helped link inmates leaving the jail with outside resources. As it stands now, inmates are given pamphlets for clinics and are released with little more than whatever's left of their medication. Carvajal recently obtained another grant to fill those two positions this month. Then, it will be a perfect program again, he says. Not being a permanent part of the sheriff's budget worries him. There is always the chance that the grants will be denied.
Carvajal says he has "cried in everybody's coffee," trying to find more funding. However, grants are hard to come by for the sheriff's department. The Ryan White Planning Council, a county-level group that receives money straight from the federal government and distributes it to community organizations, is prohibited from giving funds to jails or prison, because by law inmates are the responsibility of the incarcerating institution.
"There is this attitude that everyone needs help, but the criminal deserves less help than the noncriminal," Carvajal says. "We have limited money, so why give it to criminals? [Funders] have that attitude, but no one says it."
According to records obtained by the Press, Harris County Jail has tested 33,312 inmates for HIV from 1996 to 2000. In that time the rate of people testing positive has fallen from 9.26 percent to 3.49 percent.
However, testing is voluntary, not mandatory, so it's hard to discern exactly how many people are infected. A blind study by the CDC, the City of Houston and the Harris County sheriff's department found that 5.67 percent of the jail population was positive.
HIV-positive inmates are not segregated, because that would give a false sense of security for others to behave in a risky manner, and anyone can have HIV, Carvajal says. Although Harris County Jail requires all inmates to be screened for tuberculosis, it does not require the same for HIV. Neither does the Texas Department of Criminal Justice, leaving authorities guessing as to how much the epidemic has spread.
Among the flower shops that line Fannin in the Museum District, the Donald R. Watkins Memorial Foundation clinic sits quietly. Started by Dr. Joseph Gathe, a nationally known HIV specialist, the clinic serves about 800 low-income clients, most of whom are African-American. About 30 percent of the clients have been incarcerated, according to executive director Steven Walker, and the clinic receives roughly five to ten requests per week from people leaving prison or jail.
A 1999 CDC study of prison inmates from 1994 to 1996 reported that the prevalence of AIDS was six times higher among them than the national rate. According to data from TDCJ (which runs 114 institutions across the state), 714 inmates tested positive for HIV last year and 837 did in 1999. More than 900 inmates with HIV are living in Houston-area facilities.
To Walker, it seems like the prison and jail systems could be doing more to stem the rate of infection. "Everybody seems to deny sexual contact happens in the prison system," Walker says.
Walker has noticed that many patients leaving long-term detention facilities were taking single-drug therapy even though the more effective multiple-drug therapy has been standard practice for the last five years.
HIV-positive convicts don't stay in prison forever, Walker points out. And many people in county jail serve short sentences, or are simply waiting for court dates.
"Some people may not even know they are HIV-positive and return to normal lives and spread HIV in the community," Walker says. At the Watkins clinic, half of the African-American female clients were infected by males who were incarcerated.
This year the city's Community Planning Group, which gives recommendations on identifying at-risk populations, declared the incarcerated population as its No. 1 priority.
Kirby Powell, who heads the city's HIV-prevention task force on incarcerated people, says most inmates he has encountered have very little knowledge about HIV. Most still think of it as a white gay male epidemic.
"Some of them think it was put here to kill a certain population of people. Some people have the notion that we're going to die of something anyway. Others think it's a conspiracy, that it was put here by the government, something like that."
Community HIV and AIDS organizations also seem to lack information on incarcerated HIV patients, or they just don't want to talk about it. Several local organizations contacted by the Press had little to say on the subject.
"We really have no comment on that," said AIDS Foundation Houston spokesperson Laura Rupport. Rupport said she didn't know of any HIV organizations that worked in prisons. Yet her own organization has teamed up with the Montrose Counseling Center to provide case management to inmates at several state jails.