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The professor and the pop star

Through her research, Anne Spaulding (left) found that the HIV infection rate among inmates in the United States is more than three times higher than among the general public. Her new program, funded by the Elton John AIDS Foundation, links diagnosed inmates with care before they leave the correctional system.

It was an opportunity that Emory HIV researcher Anne Spaulding couldn't pass up. Her friend had secured an invitation for her and a group of pals to meet Elton John and view his expansive photography collection at his Atlanta penthouse. Spaulding had recently been looking for funding for her HIV testing program, and her friend thought John might be a viable funding source.

The day proved fruitful for Spaulding. John talked with her about the HIV/AIDS infection rate among orphans in developing countries, and in return, Spaulding mentioned her work to test county inmate volunteers for HIV. She also said that she was looking for funding to expand the program. John listened and referred her to his AIDS foundation. She took his advice and recently was awarded $50,000.

"I found John personable, approachable, and passionate," says Spaulding. "I'm excited by the opportunity to have the attention of his foundation and support from someone who is an advocate for the needs of the community and for those at the margins of society."

Spaulding's program provides voluntary HIV testing for new detainees at the Fulton County Jail. The program tracks new cases and whether inmates stay in care after they are released from jail. From January 2011 to March 2012, 52 new cases of HIV were found, and 80 were found in 2013. "I don't believe that there is a higher percentage of people coming into jail with HIV," Spaulding says of the uptick in new diagnoses. "More people are more comfortable with testing. In fact, inmates are asking for it."

She is seeking to expand her work through a new "Link to Care" program for previously and newly diagnosed inmates. Case managers would work with inmates and connect them to community HIV/AIDS treatment centers upon their release. Afterward, case managers would help them achieve the personal goals they set for themselves, such as employment, housing, or reuniting with their families.

"Everything that could be a barrier to care seems aggravated by the incarceration system—job loss, substance abuse, domestic violence," Spaulding says. "Reintegration into the community is challenging. Visits with their probation officer need to be a priority. Getting HIV care might fall off their list of priorities."

Spaulding would like to see jails and prisons in Atlanta and elsewhere adopt a model that offers these types of wraparound services for inmates. "When I worked as the medical director of the correction system in Rhode Island, this was the model that we used. The same person worked with an inmate on the inside and outside. It was a porous system, where a wall was not a barrier to continuing care," she explains. "I am hoping that we will change the way HIV prevention is done in this city and that rapid HIV testing in jails currently financed grant by grant will become a priority for funding by public health agencies."

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