Overview and Inventory of HHS Efforts to Assist Incarcerated and Reentering Individuals and their Families . HIV/AIDS Health Improvement for Reentering Ex-Offenders Initiative (HIRE)


Type of Activity: Demonstration

Funding Mechanism:  Cooperative Agreement

Total Available Funding:  $1,974,999

Number of Awards: 8

Award Amount:  $230,000 to $250,000

Length of Project Period: 3 years; September 1, 2009 - August 31, 2012

Federal Partners: Not applicable

Summary: As the lead agency to improve and protect the health of racial and ethnic minority populations through the development of health policies and programs that will eliminate health disparities, the Office of Minority Health (SMH), through the mechanism of the HIRE Program, seeks to bridge healthcare gaps that exist with this epidemic to improve the HIV/AIDS health outcomes of ex-offenders reentering the mainstream population. This demonstration project supports 8 grantees located in the three states with the highest incidence of inmates known to be infected with HIV or to have confirmed AIDS in state prisons at year end 2006: New York (4,000), Florida (3,412) and Texas (2,693). Through a systems navigation approach, the HIRE Program seeks to provide access to prevention and treatment services to the reentry population in an effort to support the Healthy People 2010 overarching goals to increase quality and years of healthy life and to eliminate health disparities. Grantees are required to form stakeholder partnerships that will plan, develop and provide community-based HIV/AIDS-related services, transitional assistance, and substance abuse and mental health services for the reentry population. Community-based and faith-based organizations will be provided the opportunity to deliver comprehensive HIV/AIDS-related services and transition assistance to include prescription drug assistance and substance abuse and mental health services as well as issues surrounding employment, family, education, housing, and community involvement. The HIRE Program places primary focus on the reentry populations in the three targeted states, with special emphasis on the following reentry subpopulations: substance abusers, men who have sex with men, and individuals impacted by mental health disorders.

Background:  Reentry into society for ex-offenders living with HIV/AIDS is a complex process. The stigma and physical challenges associated with HIV/AIDS creates barriers to employment, housing and reunification with family and friends. The need for assistance with health care is integral to an ex-offender’s ability to remain healthy and productive. The HIRE project seeks to bring together multiple stakeholders, within the public health system, to work together to implement a model transition process by establishing a connection between ex-offenders and community-based, minority-serving organizations that will provide comprehensive HIV/AIDS-related services and transition assistance to ex-offenders who are moving back into society.

According to the Bureau of Justice Statistics, the rate of AIDS has been higher among prison inmates than in the general population since 1991. At the end of 2005, the rate of confirmed AIDS cases for state and federal prisoners (0.46%) was about 2½ times that in the U.S. general population (0.17%) Three states, New York, Florida, and Texas housed 49% of all inmates known to be infected with HIV or to have confirmed AIDS in state prisons at year end 2006.

In the examination of the need for reentry population programs before the House Committee on the Judiciary in 2006, Scott A. Sylak, the President of the National TASC (Treatment Accountability for Safer Communities), a nonprofit association representing individual and agency programs across the United States that aims to improve the professional delivery of screening, assessment and case management services to justice-involved persons with substance abuse or behavioral health problems, stated that “…an estimated 80% of the state prison population report histories of substance abuse, 90% fail to obtain those services while incarcerated.” He testified that “it is estimated that only 10% of offenders receive appropriate community linkage and follow-up services upon release.” Sylak also testified that “a majority of those returning are young, lack a job, have two or more minor children and have a lower educational attainment and housing stability history than those who have never been incarcerated. More than two out of three returning from prison have a substance abuse or mental health history that will require treatment and support. Many also need medications to treat HIV and other communicable diseases. A growing number of released offenders do not have housing and become homeless after discharge from criminal justice custody. Without case management and appropriate services, this population will continue to drive up costs to our communities. Combining targeted clinical case management with services and resources that prevent new crime can solve many of these problems.”

The Office of Minority Health seeks to bridge healthcare gaps that exist with this epidemic by collaborating with SAMHSA and HIS in providing prevention and treatment services to an affected and captive population that could result in cost savings for health care and law enforcement and more importantly, save lives and support the Second Chance Act of 2007 as critically important legislation that can address multiple challenges related to the return of incarcerated persons from prisons to their communities. The Second Chance Act is a response to the increasing number of people who return to their communities from prison and jail. According to the Reentry Population Council, there are currently 1.7 million people serving time in federal and state prisons, and millions of people cycling through local jails every year. Ninety-five percent of all prisoners incarcerated today will eventually be released. The Second Chance Act helps ensure the transition ex-offenders make from prison or jail to the community is safe and successful. The Office of Minority Health, with its Federal partners, can assist that goal by improving the HIV/AIDS health outcomes of ex-offenders re-entering the mainstream population by supporting community-based efforts to ensure the successful transition of ex-offenders as they complete their state or federal prison sentences and return to the community.

Current Grantees: 

  • Long Island Association for AIDS Care, Inc., Hauppauge, NY
  • City of Dallas Environmental and Health Services, Dallas, TX
  • Housing Works, Inc., Brooklyn, NY
  • The Osborne Association, Bronx, NY
  • FACES NY, Inc., New York, NY
  • Healing BALM of NE Florida (DBA Fla Community Prevention Ctr), Fernandina Beach, FL
  • Metropolitan Charities, Inc., St. Petersburg, FL
  • Alamo Area Resource Center, San Antonio, TX

Evaluation Activities:  The grantees evaluation plan must clearly articulate how the applicant will evaluate program activities. It is expected that evaluation was implemented at the commencement of the program in order to document actions contributing to program outcomes. The evaluation plan must be able to produce documented results that demonstrate whether and how the strategies and activities funded under the program made a difference in improving the HIV/AIDS health outcomes of ex-offenders re-entering the mainstream population. The plans identify the expected results for each major objective and activity. Grantee evaluation plans include data collection and analysis methods, demographic data to be collected on project participants, measures describing indicators to be used to monitor and gauge progress towards reaching projected results by objectives, outcome measures accomplished, planned activities, and impact measures demonstrating achievement of the objectives to have a positive impact on the health outcomes of ex-offenders affected by HIV/AIDS.

Anticipated results of the HIRE program include the following:

  • Increased availability of HIV testing, counseling and referral services for reentry populations;
  • Increased access and improved coordination of health, social and support services for reentry populations;
  • Increased utilization of health services and adherence to HIV treatment plans;
  • Behavior modification;
  • Systems change relative to the development or enhancement of integrated community-based health, social and support services for reentry populations.

Outcome Measures:

  • Increase the number of HIV infected ethnic and racial minority ex-offenders surviving 3 years after a diagnosis of AIDS
  • Reduce the percentage of diagnosis with AIDS when first diagnosed with HIV among racial and ethnic minority ex-offenders
  • Reduce the rate of new HIV infections among racial and ethnic minority ex-offenders in the United States

OMH monitoring activities include review of annual and other progress reports, quarterly group conference calls, group email list service, electronic message boarding, and individual project communication by telephone and e-mail, and site visits. Mandatory reports include the progress/mid-year and annual reports.

Future Prospects:  Unknown. Dependent upon project results and availability of MAI funds in FY 2012.


Sonsiere Cobb-Souza
Director, Division of Program Operations
Office of Minority Health
Phone: (240) 453-8444
Email: Sonsiere.Cobb-Souze@hhs.gov

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