Louisiana, notorious for the world's highest incarceration rate, often fails to provide basic HIV services to inmates in parish jails, endangering not only the infected individuals, but also the communities to which they return, according to the international advocacy group Human Rights Watch.
The organization released a 70-page report this week entitled, "Paying the Price: Failure to Deliver HIV Services in Louisiana Parish Jails," which documents "inadequate, haphazard, and in many cases, nonexistent HIV testing [and] treatment" inside Louisiana jails, which house nearly half the people incarcerated in the state.
"Louisiana is 'ground zero' for two epidemics in the U.S., with the highest rate of new HIV infections and an incarceration rate above the national average," said Megan McLemore, senior health researcher at Human Rights Watch and author of the report. "The lack of treatment affects both people with HIV and the entire community, because whoever goes into jail comes back out."
According to the report, based on a Human Rights Watch study conducted from October 2014 to December 2015, only five of 104 parish jails regularly offer HIV tests to inmates on entry, as recommended by the federal Centers for Disease Control and Prevention.
The five parish jails identified in the report as offering HIV testing are publicly operated and are located in the parishes of New Orleans, Jefferson, East Baton Rouge, West Baton Rouge and Lafayette. Two of those jails allow inmates to opt in for testing, while the other three provide prisoners with the option to opt out of HIV tests.
The report claims that even when someone is identified as HIV-positive, treatment is often delayed, interrupted, or denied altogether, and continuity of care outside the prison is, for the most part, nonexistent. Many inmates reported going months without medications and emerging from jail gravely ill. Some died soon after release.
"I took sick ... I had flu, congestion, bumps on my skin, I lost a lot of weight," a 32-year-old man who spent two years in a parish jail without HIV medication told Human Rights Watch. "I was scared. I was going through a crisis in there."
A 53-year-old mother of four who was held at an Ouachita Parish jail told the organization a similar story. She said jail authorities told her, "You'd better get family or someone to bring those medications in, because you're not going to get them here."
Human Rights Watch said its investigators interviewed roughly 100 individuals for the study, including inmates, experts and jail officials.
The main obstacle to testing and treatment is the cost, the organization said. HIV treatment can cost more than $50,000 per year.
"Why don't we do routine HIV testing? We cannot afford to treat someone who was identified as HIV-positive," said S. Wright, a nursing director at Caddo Parish Correctional Center in Shreveport. "It sounds cold, I know, but that is the reality."
Still, Human Rights Watch found that no parish jails were taking advantage of federal AIDS Drug Assistance Programs, which help pay for medications for people in pre-trial detention. Institutions in 17 states rely on the programs.
"Of all the life events that knock people out of HIV care, going to jail is one of the biggest," Dr. Anne Spaulding, associate professor at Emory University and a national expert on HIV in corrections, told Human Rights Watch.
"Louisiana spends billions on its prisons, but has failed to find the money to test for and treat HIV in local jails," said McLemore. "This is not acceptable for public health or human rights and creates costlier medical problems down the road."
Human Rights Watch is calling on Louisiana's government to continue to carry out criminal justice reforms that will promote alternatives to incarceration, which will reduce the fiscal burden on jails for treating chronic conditions while promoting public health.
The governor's office did not respond to a request for comment from The Huffington Post on Friday.
"The government is obligated to provide medical care to people living with HIV in parish jails," McLemore said. "But treatment in the community is a win-win situation for everyone concerned."