By Stephen Green

Areas surrounding Texas Department of Criminal Justice prison facilities have higher HIV rates than those that do not, according to a study released last spring.

Walker County was among those listed with high HIV rates in a study published in “The Professional Geographer” academic journal in May 2013. The study  titled “Vulnerable places: prison locations, socioeconomic status, and HIV infection in Texas” found that in ZIP codes with TDCJ prisons, HIV rates were significantly higher than those farther from the prisons.

“This is an important finding and suggests that prison facility locations might be considered a risk marker for places that are vulnerable to HIV infection and spread,” the study reads. “Prioritizing them for HIV surveillance and intervention will reduce the rate of new infections and help to accomplish the goals of (the National HIV/AIDS Strategy).”

The area in and around Walker County has the highest number of prison facilities in the state — a total of seven  and also elevated HIV rates — according to the Texas Department of State Health Services.

The TDSHS report from 2012 lists the HIV rate (cumulative number of people diagnosed) in Walker County as 150 per 100,000. The national rate sits at about 16 while the rate in Texas is slightly higher at 16.4, they say using data from the U.S. Census.

“The results ... indicate that areas in close proximity to TDCJ units have lower socioeconomic status and rates of HIV,” the study reads. “With increasing distance from TDCJ prison units, the HIV infection rate of the general public decreases.”

Huntsville was also listed in the top 25 cities (tied for 20th highest) in Texas in HIV infection and AIDS diagnoses, according to the TDSHS.

The researchers explain in the article that there isn’t a definite cause for this finding — likening it to a chicken-and-egg scenario.

“Do TDCJ facilities create high HIV rates by releasing prisoners (known to have high HIV rates) into the community or do TDCJ facilities locate in areas with high HIV rates?” the researchers ask. “There might not be an answer to this question.”

In other words, the study merely presents a correlation between HIV rates in communities near TDCJ prisons. However, they lean more likely to the latter.

Jason Clark, director of TDCJ public information, said it is not likely that TDCJ is causing high HIV rates, especially in Walker County, due to prisoner release because of state law.

“The vast majority of offenders released from the Huntsville Unit do not stay in Walker County,” he said. “Texas law requires that offenders return to their legal county of residence. Offenders are either picked up by family members or are issued a bus ticket to their legal county of residence and leave Walker County the same day they’re released.”

The researchers addressed that concern in the study but because of a lack of information, they did not know where released prisoners returned. This made it difficult to determine whether prisoners were from areas with TDCJ prisons or in other counties without.

Where prisons are built could be one explanation. Originally state prisons were built on farms in rural areas, they say, like Brazoria, Fort Bend, Polk and Walker counties where 19 of the 117 prison units alone are located. These areas were comparably impoverished.

“In the 1980s, when Texas began to establish prison facilities outside of the cotton belt, impoverished communities saw the prisons as a boon as they provided jobs,” the study read. “The prospect of a prison siting led financially strapped communities to engage in bidding wars, offering economic incentives including tax breaks, infrastructure subsidies such as roads and sewers, and free land.”

The communities that host TDCJ facilities also include high density counties with cities like Houston, Dallas and Beaumont. According to the Center for Disease Control, both high density and rural areas have characteristics that HIV researchers label with high risk of HIV spread: high populations of gay and bisexual men, low-income families, intravenous drug users, blacks, and Latinos.

Both TDCJ and state HIV totals have risen in the last 15 years. In 1996, TDCJ accounted for 1,377 inmates that were positive for the disease. In 2009, (the most recent data on TDCJ’s website) 2,453 inmates were positive for the virus.

“When an offender is newly identified as having HIV infection, the patient receives an extensive evaluation to assess the severity of the infection,” Clark said. “This evaluation includes baseline lab testing, a complete medical and sexual history, physical examination and referrals for counseling and support (i.e., mental health, chaplaincy, nutritional, etc.) as indicated. In addition, all HIV infected offenders are enrolled in Chronic Care Clinic and seen by a provider at a minimum of every six months.”

During visits to the clinic the patient’s labs and symptoms are evaluated to determine the need to initiate or change antiretroviral — the main combatant of the HIV and AIDS virus — therapies and, in the case of a patient with the diagnosis of AIDS, the need for prophylactic therapy to prevent opportunistic infection.

Moreover, inmates are tested prior to discharge to help set up HIV care while the inmate is transitioning from correctional care to the general public.

“The (discharge planning) team provides the patient with follow-up medical appointments, enough medications to prevent interruption of treatment, information about prescription drug  programs and referrals to community based organizations to assist with housing, job placement, transportation, etc.,” Clark said.

To help combat the spread of the virus inside prison walls, Clark said TDCJ allows inmates to request tests if they feel in danger of contracting the virus and worked to set up a program to educate inmates.

“TDCJ, in cooperation with the Texas Department of State Health Services and partnership with AIDS foundation Houston, AIDS Arms of Dallas, and other community based organizations, has implemented an offender peer education program called Wall Talk to teach offenders about prevention of HIV and other communicable diseases,” he said. “This program is currently available on 100 units and most offenders participate in this program upon entering TDCJ.”

The research team suggests future research target HIV service provider distribution and HIV rates. The team was made up of two University of North Texas professors, Dr. Joseph R. Oppong and Chetan Tiwari; Libbey Kutch, a doctoral student at Michigan State University and Sam Houston State University alumnus; and Sonia Arbona, a medical geographer and epidemiologist for TDSHS who studies spatial analysis of HIV and STD rates.