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Linkages to services for HIV-infected inmates are critically important; however, little is known about the challenges faced by staff coordinating these linkages. This qualitative evaluation describes the challenges and strategies of frontline staff involved in HIV-related services for inmates and releasees participating in the Centers for Disease Control and Prevention/Health Resources and Services Administration Corrections Demonstration Project. Eight focus groups were held during a national meeting of community-based organizations. Content analysis revealed multiple themes. This evaluation emphasizes the lack of and difficulty obtaining services for this population. Staff recognize the role of security and safety when working in facilities and have identified methods to coordinate and communicate to facilitate their work. Communication with key partners and colleagues is important to understand the challenges and identify strategies; however, political advocacy is important for increased awareness and resources. Consideration of these issues within an ecological framework may help frontline staff translate findings to practice.

The elevated rates of HIV/AIDS among inmates are due in part to the high concentration of incarcerated persons with behavioral risk factors for HIV infection. Corrections, public health, and community-based organizations should partner to take full advantage of the opportunity to maximize effectiveness and efficiency in addressing HIV/AIDS in inmate populations. The purpose of this study is to document issues inhibiting collaboration, service delivery, and multisite evaluation as identified by members of the U.S. Centers for Disease Control and Prevention/Health Resources and Services Administration Corrections Demonstration Project (CDP). Examining the barriers (and identifying ways to resolve them) is important in developing and maintaining successful programs that ultimately benefit HIV-infected inmates and the communities to which they return.

U.S. prisons and jails have the nation's highest concentration of individuals infected with and at risk for HIV infection. Many correctional institutions offer 1-HIV care, but advances are oftentimes lost when individuals with a lack of health insurance and access to care are released into the community. In 1999 the Centers for Disease Control and Prevention and the Health Resources and Services Administration jointly funded seven health departments to address this need. These projects target soon-to-be-released inmates of jails, prisons, and juvenile facilities and offer enhanced discharge planning, case management, HIV prevention, disease screening, and staff training. The Evaluation and Program Support Center (EPSC) at Emory University and Abt Associates was funded to oversee a cross-site evaluation of these demonstration projects. This paper describes the process of developing a cross-site evaluation, the implementation of this evaluation, and lessons learned by the EPSC throughout this process.