Data for 1993 indicate that 16% of services are for reproductive health and 23% are for preventive health.

Funding: Funding sources may include the state maternal and child health program, other state funding, local funds, foundations, and reimbursement from public and private insurance.

Prisons7

A range of health care services is available through the prison system to the 1.725 million persons in prisons and jails throughout the country at any one time. Approximately 5% to 7% of prisoners are women (120,000). AIDS incidence among state and federal prisoners is 20 times the rate in the population at large. Ninety-two percent of female prisoners are of childbearing age (under 45) and a greater percentage of female prisoners are HIV-positive. Access to health care services and testing, counseling, and therapeutic regimens for HIV varies significantly from jurisdiction to jurisdiction. The fact that roughly 700,000 women are released from prisons each year highlights both the importance and the difficulty in establishing and maintaining good access to needed HIV services.

Services provided: Services provided in the city and county jail systems and the state and federal prison systems are difficult to characterize because of their variability. While many prisons directly provide health care services by their own staff, the practice of contracting with outside agencies is rapidly increasing. Contracts generally are arranged with university medical schools and correctional health care companies, the latter on a capitated basis. The policy for HIV testing of pregnant females is the same as for other inmates in most systems. Seven state systems and the federal prison system have mandatory or routine testing of incoming pregnant women, but provide voluntary or on-request testing for other inmates. There are no data about routine counseling of pregnant inmates regarding testing. A survey conducted by ABT Associates, Inc. revealed that 90% or more of prisons report the availability of prenatal care, ZDV therapy and combination therapies. Information on how accessible these services are to inmates is not available, nor is there any information about follow-up and referral once a prisoner is identified and/or treated and then released.

Drug Treatment Facilities8

Funded primarily through the Federal Substance Abuse, Prevention, and Treatment Block Grant, totaling $1.3 billion, and state and local funds, this public

7  

Much of the data in this section was obtained in an interview with Theodore Hammett, ABT Associates, Boston, MA, April 9, 1998.

8  

1995 funding sources obtained from state Resources and Services Related to Alcohol and Other Drug Problems: Fiscal Year 1995, National Association of State Alcohol and Drug Abuse Directors, Inc.



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