At the Hillsborough County Jail, where the average daily census in the first six months of 2007 was 3915 inmates with 203 bookings per day and an average length of stay of 21 days, three full-time health department employees, rotating between two facilities and funded by a federal grant, offer rapid HIV and routine syphilis testing to inmates. This is a voluntary testing program during which the staff go to the 64 open bed, direct supervision model pod and offer testing to all those who are interested. When the health department personnel arrive, an announcement is made to inform inmates they are there to offer free HIV and syphilis tests. If inmates choose to come forward for testing, the result is given face-to-face the same day. There are private rooms in each housing unit so that staff can complete a confidential pre- and post-test counseling session, including written consent for testing and provide link to care if the inmate is found to be HIV positive. The health department offers tests in the morning, performs the rapid HIV tests at the jail clinic lab, and then returns to the housing units in the afternoon to give negative results. Inmates receive HIV positive results in the clinic where there is more confidentiality and an opportunity for immediate referral to an HIV specialist and psychiatry, if indicated. Inmates sign a form stating that they received their negative or positive results, and the form becomes a permanent part of the medical record. In the first quarter of 2007 (January-March), a total of 1013 inmates (221 females, 792 males) were tested with a total of three men identified as HIV positive and 16 cases of syphilis identified. In the second quarter of 2007 (April-June), of the 828 inmates (98 females, 730 males) tested, nine men and one woman tested HIV positive, and 13 cases of syphilis were identified.

In addition to the program described above, there are other opportunities for HIV testing at the jail. Tampa Hillsborough Action Plan (THAP), through a grant under Target Outreach for Pregnant Women's Act (TOPWA) offers rapid HIV testing to women at the jail, in a similar fashion to the program described above, two days per week. Furthermore, if an inmate requests an HIV test in writing or in the clinic when seeing a provider, the test is then offered by a certified HIV counselor. There is close collaboration between Armor Correctional Health Services, who has been contracted to provide medical services at the jail since October 2005, the Hillsborough County Sheriff's office, members of the health department, THAP, and Metropolitan Charities, who provides case management services to HIV positive inmates during and after incarceration.

Linking an HIV positive inmate to an HIV specialist on site allows the inmate the opportunity to learn about HIV/AIDS; the stage of disease based on blood work, history, and the physical exam; and risks for transmission. If appropriate, HIV treatment is initiated. In addition, the HIV specialist works with the health department to link the inmate to care in the community so that funding for medications and medical care can by accomplished upon release from custody. When possible, a three day supply of medications, a prescription for a one month supply of medications, and pertinent medical records are given to the inmate and/or case manager upon release from custody.

Overall, the HIV and syphilis testing programs are very well received by inmates and detention staff. Though inmates with HIV are not permitted to work in the kitchen, they are not segregated by HIV status, and results are given to them in a very confidential manner. Inmates are also told they can receive immediate care with an HIV specialist if they turn out to be HIV positive. There are some barriers to offering HIV testing in lockdown units, mental health units, and the infirmaries, mainly due to space and/or inability to obtain proper informed consent due to mental status, and we are working on strategies around these barriers so that we can expand this screening program. Another challenge that occasionally occurs is loss to follow-up when an inmate is released from custody prior to receiving confirmatory HIV or syphilis results, in which case the health department makes every effort to track down the individual in the community.