health services deal with the HIV-infected individual has important implications to the overall care of the HIV-infected population. Routine HIV testing is well accepted as a procedure offered to incoming prison inmates. Combination antiretroviral therapy has been associated with a reduction in mortality in prisons. A link between community HIV specialists and correctional health care providers is an important partnership for ensuring that HIV-infected patients have optimal care both inside prison and after release (Spaulding et al., 2002).


The current environment of HIV care is both more hopeful and more complex than it was 20 years ago. The early HIV care system was designed—consciously or not—to manage patients who entered with symptomatic, advanced disease and who died after several years of increasingly untreatable opportunistic diseases. A substantial portion of this time was spent in acute care hospitals and involved use of cumbersome, expensive, and invasive therapies. This model of care no longer applies. The changes in the treated natural history of HIV infection from an acute to a chronic disease model and the shift in populations most affected must be considered when crafting policies for the public financing and delivery of HIV care. The public care system must take advantage of the opportunities offered by effective treatments such as HAART while working to meet the challenges of the new epidemic.


  • Despite remarkable advances in the treatment of HIV, the epidemic remains a threat to public health.

  • Access to HAART is the cornerstone of HIV care. Without it, individuals face increased illness, disability, and death.

  • Nearly complete adherence to the prescribed HAART regimen is crucial for both optimal treatment benefit and the prevention of drug resistance.

  • The demographics of the HIV epidemic are shifting into populations that are highly vulnerable in terms of having access to care, continuity of care, and adherence to treatment, such as racial and ethnic minorities, low-income women, individuals who are mentally ill or have substance abuse disorders, and homeless individuals.

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