The state has eliminated more than $1 million for HIV testing and education in county jails, alarming sheriffs who fear the cuts threaten the health of inmates and those they have contact with after being released.
Sheriffs warned that the cuts will lead to eliminating staff who educate inmates about the virus; curtailing HIV testing within the jails; and ending visits by infectious disease doctors who monitor inmates’ health.
“I’m very concerned,’’ Bristol County Sheriff Thomas M. Hodgson said. “Our clientele are people who are in for a much shorter amount of time. They’re going to be going back into the community. We want them to be tested for HIV because they need to be aware if they have it, and, number two, how to manage it.’’
Federal cuts forced the state to reduce its overall AIDS prevention budget by $4.3 million, which amounted to about 25 percent of annual spending on HIV prevention. The elimination of the jails program is among the first casualties.
In the 2011 budget year, 8,211 county inmates were tested statewide, and 34 tested positive for HIV, according to the state Department of Public Health, which administers the grants from the federal Centers for Disease Control and Prevention. In many cases, the money being eliminated was the sole source of funding for AIDS prevention campaigns in jails.
Jails and houses of correction, where inmates serve no more than two years and turnover is much higher than in state prisons, have long been regarded as crucial venues for introducing prevention and testing.
As inmates return to the community, knowing their HIV status and how to protect themselves from catching or spreading the virus can break the chain of transmission, according to AIDS prevention advocates.
‘By us testing that one person, we were able to find all these other people in the community who were testing positive.’Matthew Robitaille, Bristol County sheriff’s office HIV-program coordinator
Many inmates are drug-addicted and some have been exposed to the virus by sharing dirty needles and yet are unaware they could be infected. The threat of being exposed is compounded by the risk of unprotected sexual activity within jails and houses of correction.
The federal cuts are being phased in over five years, but state authorities have already been forced to cut $2.3 million. They have eliminated about eight positions within the state HIV/AIDS office, media campaigns promoting HIV testing, and training for community providers who work directly with AIDS patients. The agency also sliced $500,000 from contracts with community agencies and made other reductions.
The $1.25 million cut to jails and houses of correction in the state’s 13 counties starts July 1.
“The decision to reduce these services is driven by the loss of funding, not the quality of the services,’’ said Kevin Cranston, director of the state Bureau of Infectious Disease. “These have been extremely valuable services, which is why we’ll be rallying with the sheriffs to minimize the impact of these cuts.’’
Some testing will still be available through routine medical care, Cranston said. But, he said, there is great concern that considerably fewer inmates will be tested.
“There were dedicated staff or concentrated services providing a level of testing that may not be able to be accomplished in routine medical care,’’ Cranston said.
The CDC said it is shifting resources from states such as Massachusetts with lower rates of HIV infection to regions with increasing rates, such as the South.
“In today’s challenging economic environment, it is more important than ever to ensure that every federal HIV prevention dollar has the greatest possible impact on the national HIV epidemic,’’ CDC spokeswoman Jennifer Ruth Horvath said in an e-mail.
The state used a similar approach in deciding where to make cuts.
Intravenous drug users - who tend to make up a large percentage of the jail population - used to be at a much higher risk of infection, but new cases of HIV increasingly are among gay and bisexual men, Cranston said.
“When injection drug use was a more common mode of exposure, jails tended to see higher HIV-positive rates,’’ he said.
Cranston said public health officials are asking AIDS prevention organizations to provide testing and education services to jails and houses of correction. But he acknowledged many of those groups are also financially strained.
The cuts will not affect state prisons, where the more stable population makes testing and prevention less expensive at $200,000 a year, Cranston said.
The state will continue paying for medication for county inmates diagnosed with the virus, he said.
In Suffolk County, where Sheriff Andrea Cabral’s office received $205,000, more than 1,500 men and women were tested last year. A spokesman declined to say how many were positive, citing confidentiality.
In Plymouth County, 702 inmates were tested last year, with three testing positive, said John Birtwell, spokesman for Sheriff Joseph McDonald Jr.
“This is a difficult pill to swallow,’’ Birtwell said. “Any infectious disease is a concern when you have this many people in close quarters. HIV is probably right at the top of the list.’’
In Bristol County, 6,500 men and women have been tested since 2006, and 16 were HIV-positive, said Matthew Robitaille, HIV program coordinator for the sheriff’s office. His position will probably be eliminated.
The number of positive cases may seem small, but learning about just one can have a huge effect, he said.
Robitaille recalled one inmate who tested positive. He had been living in an apartment with other people, sharing drugs and having unprotected sex. Public health officials tracked down the apartment and diagnosed eight others with the virus.
“It was this huge spider web that kept going out,’’ Robitaille said. “By us testing that one person, we were able to find all these other people in the community who were testing positive.’’
Still, the low rate of positive results overall probably led the state to cut funding, said Dr. Stephen L. Boswell, president of Fenway Health, a health center that lost 20 percent of its HIV prevention funding through the federal grant.
“They’re being left with a bunch of bad choices,’’ Boswell said. “The county jails in this particular case may not be the highest yield for the dollars that are spent. . . . I think it’s the least bad alternative.’’Maria Cramer can be reached at firstname.lastname@example.org.