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Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2001 Jun;78(2):241–255. doi: 10.1093/jurban/78.2.241

Characteristics and trends of newly identified HIV infections among incarcerated populations: CDC HIV voluntary counseling, testing, and referral system, 1992–1998

Keith M Sabin 1,✉, Robert L Frey Jr 1, Rosemarie Horsley 1, Stacie M Greby 1
PMCID: PMC3456357  PMID: 11419578

Abstract

Inmate contact with the correctional health care system provides public health professionals an opportunity to offer HIV screening to a population that might prove difficult to reach otherwise. We report on publicly funded human immunodeficiency virus (HIV) voluntary counseling, testing, and referral (VCTR) services provided to incarcerated persons in the United States. Incarcerated persons seeking VCTR services received pretest counseling and gave a blood specimen for HIV antibody testing. Specimens were considered positive if the enzyme immunoassays were repeatedly reactive and the Western blot or immunofluorescent assay was reactive. Demographics, HIV risk information, and laboratory test results were collected from each test episode. Additional counseling sessions provided more data. From 1992 to 1998, there were 527,937 records available from correctional facilities from 48 project areas; 484,277 records included a test result and 459,155 (87.0%) tests came with complete data. Overall, 3.4% (16,797) of all tests were reactive for HIV antibodies. Of reactive tests accompanied by self-reports of previous HIV test results (15,888), previous test results were 44% positive, 23% negative, 6% inconclusive or unspecified, and 27% no previous test. This indicates that 56% of positive tests were newly identified. During the study period, the number of tests per year increased three-fold. Testing increased among all racial/ethnic groups and both sexes. The largest increase was for heterosexuals who reported no other risk, followed by persons with a sex partner at risk. Overall, the greatest number of tests was reported for injection drug users (IDUs) (128,262), followed by men who have sex with men (MSM) (19,928); however, episodes for MSM doubled during the study, while for IDUs, they increased 74%. The absolute number of HIV-positive (HIV+) tests increased 50%; however, the percentage of all tests that were HIV+ decreased nearly 50% due to the increased number of tests performed. HIV+ tests fell 50% among blacks (7.6% to 3.7%), Hispanics (6.7% to 2.5%), and males (5.1% to 2.5%); 33% among females (4.5% to 3.1%); 95% among IDUs (8.6% to 4.4%); and 64% among MSM (19.3% to 11.8%). Among HIV+ episodes, those for IDUs dropped from 61.5% to 36.6%, while episodes for heterosexuals with no reported risk factor increased from 4.3% to 18.2%. The use of VCTR services by incarcerated persons rose steadily from 1992 to 1998, and 56% of HIV+ tests were newly identified. High numbers of tests that recorded risk behaviors for

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References

  • 1.Beck AJ. Prison and Jail Inmates at Midyear 1999. Washington, DC: US Dept of Justice; 2000. [Google Scholar]
  • 2.Anderson JE, Wilson RW, Barker P, Doll L, Jones TS, Holtgrave D. Prevalence of sexual and drug-related HIV risk behaviors in the US adult population: results of the 1996 National Household Survey on Drug Abuse. J Acquir Immune Defic Syndr. 1999;21(2):148–156. [PubMed] [Google Scholar]
  • 3.Mumola CJ. Substance Abuse and Treatment, State and Federal Prisoners, 1997. Washington, DC: US Dept of Justice; 2000. [Google Scholar]
  • 4.Wilson DJ. Drug Use, Testing and Treatment in Jails. Washington, DC: US Dept of Justice; 2000. [Google Scholar]
  • 5.Hammett TM, Harmon P, Maruschak LM. Issues and Practices in Criminal Justice: 1996–1997 Update: HIV/AIDS, STDs, and TB in Correctional Facilities. Washington, DC: US Dept of Justice; 1999. [Google Scholar]
  • 6.Vlahov D, Canthony AC, Munoz A, et al. The ALIVE Study, a longitudinal study of HIV-1 infection in intravenous drug users: description of methods and characteristics of participants. NIDA Res Monogr. 1991;109:75–100. [PubMed] [Google Scholar]
  • 7.Ouellet LJ, Thorpe LE, Huo DZ, et al. Prevalence and incidence of HIV among out-of-treatment injecting drug users, Chicago, 1994–1996. J Acquir Immune Defic Syndr. 2000;25(5):443–450. doi: 10.1097/00042560-200012150-00010. [DOI] [PubMed] [Google Scholar]
  • 8.Correctional Populations in the United States, 1997. Washington, DC: US Dept of Justice; 2000. [Google Scholar]
  • 9.US Census Bureau. 1990 US Census Data: Database C90STF1C. Available at: http://venus.census.gov/cdrom/lookup. Accessed May 11, 2000.
  • 10.Karon JM, Rosenberg PS, McQuillan G, Khare M, Gwinn M, Petersen LR. Prevalence of HIV infection in the United States, 1984 to 1992. JAMA. 1996;276(2):126–131. doi: 10.1001/jama.276.2.126. [DOI] [PubMed] [Google Scholar]
  • 11.Behrendt C, Kendig N, Dambita C, Horman J, Lawlor J, Vlahov D. Voluntary counseling and testing for human immunodeficiency virus (HIV) in a prison population with a high prevalence of HIV. Am J Epidemiol. 1994;139(9):918–926. doi: 10.1093/oxfordjournals.aje.a117098. [DOI] [PubMed] [Google Scholar]
  • 12.Horsburgh CR, Jr, Jarvis JQ, McArthur T, Ignacio T, Stock P. Seroconversion to human immunodeficiency virus in prison inmates. Am J Public Health. 1990;80(2):209–210. doi: 10.2105/AJPH.80.2.209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 13.Vlahov D, Brewer F, Munoz A, Hall D, Taylor E, Polk BF. Temporal trends of human immunodeficiency virus type 1 (HIV-1) infection among inmates entering a statewide prison system, 1985–1987. J Acquir Immune Defic Syndr. 1989;2(3):283–290. [PubMed] [Google Scholar]
  • 14.Altice FL, Mostashari F, Selwyn PA, et al. Predictors of HIV infection among newly sentenced male prisoners. J Acquir Immune Defic Syndr. 1998;18(5):444–453. doi: 10.1097/00042560-199808150-00005. [DOI] [PubMed] [Google Scholar]
  • 15.Rich JD, Dickinson BP, Macalino G, et al. Prevalence and incidence of HIV among incarcerated and reincarcerated women in Rhode Island. J Acquir Immune Defic Syndr. 1999;22(2):161–166. doi: 10.1097/00126334-199910010-00008. [DOI] [PubMed] [Google Scholar]
  • 16.Ruiz JD, Mikanda J. Seroprevalence of HIV, hepatitis B, hepatitis C and risk behaviors among inmates entering the California correctional system. Sacramento: California Dept of Health Services; 1996. [Google Scholar]
  • 17.Kamb ML, Fishbein M, Douglas JM, et al. Efficacy of risk reduction counseling to prevent human immunodeficiency virus and sexually transmitted diseases: a randomized controlled trial. JAMA. 1998;280:1161–1167. doi: 10.1001/jama.280.13.1161. [DOI] [PubMed] [Google Scholar]
  • 18.Sweeney P, Fleming PL, Ward JW, et al. HIV testing circumstances and sexual behavior change among persons likely to be recently infected. In: conference record of the 12th International Conference on AIDS, June 28–July 3, 1998; Geneva, Switzerland. Abstract 43146.
  • 19.Centers for Disease Control and Prevention Anonymous or confidential HIV counseling and voluntary testing in federally funded testing sites—United States, 1995–1997. MMWR Morb Mortal Wkly Rep. 1999;48:509–513. [PubMed] [Google Scholar]
  • 20.HIV Counseling, Testing, and Referral: Standards and Guidelines. Atlanta, GA: US Dept of Health and Human Services; 1994. [Google Scholar]
  • 21.Centers for Disease control and Prevention. Revised Guidelines for HIV Counseling, Testing, and Referral.MMWR Morb Mortal Wkly Rep. In press. [PubMed]
  • 22.Weber JT, Frey RL, Horsley R, Gwinn ML. Publicly funded HIV counseling and testing in the United States, 1992–1995. AIDS Educ Prev. 1997;9(suppl B):79–91. [PubMed] [Google Scholar]
  • 23.HIV Counseling and Testing in Publicly Funded Sites: 1996 Annual Report. Atlanta, GA: US Dept of Health and Human Services, Centers for Disease Control and Prevention; 1998. [Google Scholar]
  • 24.Irwin KL, Valdiserri RO, Holmberg SD. The acceptability of voluntary HIV antibody testing in the United States: a decade of lessons learned. AIDS. 1996;10:1707–1717. doi: 10.1097/00002030-199612000-00016. [DOI] [PubMed] [Google Scholar]
  • 25.LaChance-McCollough ML, Tesoriero JM, Sorin MD, Lee C. Correlates of HIV seroprevalence among male New York State prison inmates. Results from the New York State AIDS Institute Criminal Justice Initiative. J Prison Jail Health: Med Law Correction Ethics. 1993;12(2):103–134. [Google Scholar]
  • 26.Decker MD, Vaughn WK, Brodie JS, Hutcheson RH, Schaffner W. Seroepidemiology of hepatitis B in Tennessee prisoners. J Infect Dis. 1984;150:450–459. doi: 10.1093/infdis/150.3.450. [DOI] [PubMed] [Google Scholar]
  • 27.Anda RF, Perlman SB, D'Alessio DJ. Hepatitis B in Wisconsin male prisoners: considerations for serologic screening and vaccination. Am J Public Health. 1985;75:1182–1185. doi: 10.2105/AJPH.75.10.1182. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 28.Hull HF, Lyons LH, Mann JM, et al. Incidence of hepatitis B in the penitentiary of New Mexico. Am J Public Health. 1985;75:1213–1215. doi: 10.2105/AJPH.75.10.1213. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Confronting AIDS: Directions for Public Health, Health Care and Research. Washington, DC: Institute of Medicine; 1986. [PubMed] [Google Scholar]
  • 30.Vlahov D, Brewer TF, Castro KG, et al. Prevalence of antibody to HIV-1 among entrants to US correctional facilities. JAMA. 1991;265(9):1129–1132. doi: 10.1001/jama.265.9.1129. [DOI] [PubMed] [Google Scholar]
  • 31.Standards for Health Services in Jails. Chicago: National Commission on Correctional Health Care; 1996. pp. 167–170. [Google Scholar]

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