Inmates have a right to privacy and providers have a duty to protect the confidentiality of all medical information. However, protecting confidentiality is especially challenging in correctional facilities because of the tension that exists between maintaining optimal security and safety and maintaining confidentiality of inmate medical information. Therefore, health services and custody staff must work as a team to achieve these dual goals. Further, disclosure of an inmate’s HIV status may be legally required in certain instances in accordance with the Occupational Safety and Health Administration’s Standard for Occupational Exposure to Bloodborne Pathogens (Standard Number 1910.1030), and state or local laws requiring reporting to public health authorities, community corrections (e.g., parole), spouses, or sexual partners. Facility staff should be familiar with their local and state public health confidentiality laws and incorporate them into the HIV testing program.

Recommendations for ensuring privacy and confidentiality

The following recommendations are intended to help facilities meet the challenges of protecting privacy and confidentiality while maintaining security of inmates and staff.

A. Policies and procedures

Correctional facilities should have written policies and procedures on:

• Maintaining privacy and confidentiality of protected health information
• Training correctional personnel on maintaining privacy and confidentiality
• Obtaining confidentiality agreements with personnel providing medical services
• Monitoring and evaluating how confidential policies and procedures are being followed
• Addressing breaches in confidentiality
• Obtaining inmate consent for medical screening tests, including HIV
• Disclosing of medical test results and identifying persons authorized to access medical information
• Informing inmates of the right to privacy and confidentiality
• Maintaining auditory and visual privacy when providing medical services
• Providing medical test results to inmates who have been released

B. Confidentiality and privacy considerations

Measures to protect confidentiality should be incorporated into all health care services for inmates, including HIV prevention services.

• All medical clinics should inform inmates of their right to privacy and confidentiality of medical information and on the routine voluntary nature of medical screening tests using handouts, posters, or videos. Provide information in language appropriate to the population at a 6th grade reading level or below.
• Inmate flow should be controlled to prevent healthcare provider conversations from being overheard by other inmates. If inmates hear medical staff talking about other inmates, they will not feel assured about the confidentiality of their own medical information. To achieve this,
  • Discuss inmate’s medical services and health care in private.
  • Provide medical test results, including HIV, in a private area, within security constraints.
  • Place supplies in locations to avoid interruptions during a clinic visit.
  • Place phones and fax machines in common staff areas away from inmate access.
  • Discontinue the interview or examination if an unauthorized person is present.
  • Close the door to examining room, when possible.
  • Schedule inmate janitorial services during hours when inmate clinic visits are not conducted.
• All healthcare information should be kept inaccessible to non-healthcare personnel and provisions should be made to prevent unauthorized persons from viewing inmate health care data on computer screens, desk counter tops, or logbooks.
• Avoid identification of HIV-related clinic visits.
  • Have generic waiting area for medical unit; do not have separate waiting area for HIV clinic.
  • Train several staff members to provide general HIV prevention services to avoid inmate being seen by the “HIV doctor, nurse, or counselor”.
  • HIV testing should be conducted in areas where other screening tests are conducted.
  • Use universal precautions during all clinical encounters
  • Keep inmate’s health information inaccessible to non-health care personnel.
  • Requests for sick call or medical follow-up should not disclose reason. Minimize information posted on cell-outs (e.g. diagnosis, provider name, special locations to report).
• Ensure privacy for inmates prescribed HIV medications.
  • Dispense HIV medications in private and confidential manner; avoid separate “pill lines” for HIV medications.
• Use professional interpreters or services as needed. All interpreters should have a signed confidentiality agreement on file.

C. Suggestions for providing HIV services

• Provide medical information and HIV education to all inmates during intake and at other times during incarceration (written, verbal, or video format).
• Provide brochures on a variety of medical topics (e.g., HIV, Hepatitis, TB, STD, Harm Reduction, Domestic Violence, Mental Health) in medical waiting areas, so inmates feel comfortable accessing HIV-related information.
• Conduct HIV testing as part of routine medical services.
• Disclose medical information only to personnel involved in providing care, treatment and prevention services to inmate, and as required by legislation. Inform inmates specifically who will have access to their medical information.

D. Medical records

• Keep medical records in a locked, secure location.
• Limit access to authorized staff.
• Secure medical records during inmate transport or transfer.
• Do not color-code or separate storage of charts based on disease or condition.
• Use identification number system so that inmate names are not on HIV test specimens or in HIV databases or logbooks.
• Use dedicated fax and phone lines to send all medical test results, including HIV viral loads, CD4 counts, and confirmatory test results.
• Clearly record delivery of HIV test result to the inmate in the medical record to prevent inadvertent disclosure during medical visits for inmates unaware of their HIV status.

E. Special recommendations for adolescents confined in adult correctional facilities

• Know that incarcerated adolescents may be unaware of their rights concerning medical care, privacy, and confidentiality.
• Inform adolescents that the medical information, including HIV test results will not be disclosed without their consent except as required by law. For State Policies on Minor’s access to STI services.
• Inform adolescents that their HIV status will not adversely affect their medical care or legal rights.
• Obtain consent for health care services from his/her parent or legal guardian (subject to state and local regulations or policies), unless the adolescent is an emancipated minor.

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