HIV infection in the Women's Jail, Orange County, California, 1985 through 1991

The HIV Care Cascade Before, During, and After Incarceration: A Systematic Review and Data Synthesis

We conducted a systematic literature review of the data on HIV testing, engagement in care, and treatment in incarcerated persons, and estimated the care cascade in this group. We identified 2706 titles in MEDLINE, EBSCO, and Cochrane Library databases for studies indexed to January 13, 2015, and included 92 for analysis. We summarized HIV testing results by type (blinded, opt-out, voluntary); reviewed studies on HIV care engagement, treatment, and virological suppression; and synthesized these results into an HIV care cascade before, during, and after incarceration. The HIV care cascade following diagnosis increased during incarceration and declined substantially after release, often to levels lower than before incarceration. Incarceration provides an opportunity to address HIV care in hard-to-reach individuals, though new interventions are needed to improve postrelease care continuity.

Epidemiological characteristics of HIV-infected women with and without a history of criminal justice involvement in South Carolina

The circumstances that lead to incarceration may potentiate the HIV/AIDS epidemic and this has become an emerging public health concern. In the United States and in most jurisdictions, HIV prevalence in the correctional setting is higher among female inmates than male inmates. This dichotomy is not fully understood and few studies have focused on women in the South. Using data from the South Carolina (SC) electronic HIV/AID Reporting System, the SC Law Enforcement Criminal History database, and a public access website of the SC Department of Corrections, the authors describe the epidemiological characteristics and correctional history of a population of HIV-infected women in SC diagnosed between January 1, 1996, and December 31, 2005.

HIV and hepatitis B and C incidence rates in US correctional populations and high risk groups: a systematic review and meta-analysis

BACKGROUND

High Human Immunodeficiency Virus (HIV) prevalence and high risk behaviors have been well documented within United States (US) correctional systems. However, uncertainty remains regarding the extent to which placing people in prison or jail increases their risk of HIV infection, and regarding which inmate populations experience an increased incidence of HIV. Describing these dynamics more clearly is essential to understanding how inmates and former detainees may be a source for further spread of HIV to the general US population.

METHODS

The authors conducted a systematic review and meta-analysis of studies describing HIV incidence in US correctional facility residents and, for comparison, in high risk groups for HIV infection, such as non-incarcerated intravenous drug users (IVDU) and men who have sex with men (MSM) in the US. HIV incidence rates were further compared with Hepatitis B and Hepatitis C Virus rates in these same populations.

RESULTS

Thirty-six predominantly prospective cohort studies were included. Across all infection outcomes, continuously incarcerated inmates and treatment recruited IVDU showed the lowest incidence, while MSM and street recruited IVDU showed the highest. HIV incidence was highest among inmates released and re-incarcerated. Possible sources of heterogeneity identified among HIV studies were risk population and race.

CONCLUSIONS

Although important literature gaps were found, current evidence suggests that policies and interventions for HIV prevention in correctional populations should prioritize curtailing risk of infection during the post-release period. Future research should evaluate HIV incidence rates in inmate populations, accounting for proportion of high risk sub-groups.

HIV incidence in the United States, 1978-1999

CONTEXT

HIV incidence measurements, which reflect recent or current transmission, are valuable for monitoring the epidemic and evaluating prevention programs.

OBJECTIVES

To summarize HIV incidence patterns and trends in U.S. population groups.

DATA SOURCES

Publications in English from 1980 through mid-2000. STUDY SELECTION AND STATISTICAL METHODS: We searched the literature for reports of HIV incidence in the United States. Locally weighted scatterplot smoothing was used to generate smooth curves to estimate trends in incidence. Spearman rank correlation was used to estimate the correlation coefficient between prevalence and incidence.

DATA SYNTHESIS

In 74 eligible reports, HIV incidence varied widely (0.002-19.8 per 100 person-years [py]) depending on risk group. Among men who have sex with men (MSM), HIV incidence peaked in the early 1980s (5-20/100 py) and then declined but remained high during the 1990s (2-4/100 py). Among injection drug users (IDUs), incidence decreased since the mid-1980s but differed by geographic area; in the 1990s, incidence remained high in the East (1-3/100 py) but was lower in the West (<0.5/100 py). Throughout the late 1980s and 1990s, incidence was low and stable in broader populations (blood donors: <0.01/100 py; military personnel: 0.01-0.07/100 py). The correlation between HIV incidence and prevalence was strong in populations with a prevalence less than 1% (r = 0.94, p<.0001), moderate in populations with a prevalence from 1% to less than 10% (r = 0.57, p<.0001), and weak in populations with a prevalence at least 10% (r = 0.23, p=.09).

CONCLUSIONS

HIV prevention in the United States should continue to focus on MSM and IDUs. HIV incidence measurements should be considered for monitoring HIV transmission in MSM, IDUs, and other populations in which seroprevalence is high.

HIV and AIDS risk behaviors among female jail detainees: implications for public health policy

OBJECTIVES

We examined the sexual and injection drug use HIV and AIDS risk behaviors of female jail detainees.

METHODS

The sample (n = 948) was stratified by charge type (felony vs misdemeanor) and race/ethnicity (African American, non-Hispanic White, Hispanic, other).

RESULTS

Non-Hispanic White women, women arrested for less serious charges, women who had prior arrests, women arrested on drug charges, and women with severe mental disorders were at especially high risk for sexual and injection drug transmission of HIV and AIDS.

CONCLUSIONS

Many women at risk for HIV and AIDS--women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorders--eventually will cycle through jail. Because most jail detainees return to their communities within days, providing HIV and AIDS education in jail must become a public health priority.

Pregnancy outcomes of inmates in a large county jail setting

The purpose of this study was to examine low birthweight (LBW) and fetal death rates for women incarcerated in a large county jail during their pregnancy. Additionally, medical and support services available to these inmates were reviewed. Jail records showed this population to be both medically and socially high risk. Analysis indicated that their LBW rate was statistically higher (p < 0.05) than that of the county or state, but comparable to a matched group residing in high-risk areas of the city in which many of these women resided. During the course of the study, numerous jail policies were identified which had the potential to negatively impact the health of these women and their pregnancy outcomes.

Prevalence and incidence of HIV among incarcerated and reincarcerated women in Rhode Island

This study explores recent temporal trends in HIV prevalence among women entering prison and the incidence and associated risk factors among women reincarcerated in Rhode Island. Results from mandatory HIV testing from 1992 to 1996 for all incarcerated women were examined. In addition, a case control study was conducted on all seroconverters from 1989 to 1997. In all, 5836 HIV tests were performed on incarceration in 3146 women, 105 of whom tested positive (prevalence, 3.3%). Between 1992 and 1996, the annual prevalence of HIV among all women known to be HIV-positive was stable (p = .12). Age >25 years, nonwhite race, and prior incarceration were associated with seropositivity. Of 1081 initially seronegative women who were retested on reincarceration, 12 seroconverted during 1885 person-years (PY) of follow-up (incidence, 0.6/100 PY). Self-reported injection drug use (IDU; odds ratio [OR], 3.7; 95% confidence interval [CI], 1.3-10.1) was significantly associated with seroconversion, but sexual risk was not (OR, 1.1; 95% CI, 0.4-3.5). Incarceration serves as an opportunity for initiation of treatment and linkage to community services for a population that is at high risk for HIV infection.

Predictive factors of HIV-infection in injecting drug users upon incarceration

OBJECTIVE

To identify predictors of HIV-infection in injecting drug users upon incarceration.

PATIENTS AND METHODS

We studied 639 IDU or ex-IDU prisoners admitted to a provincial prison of Northwestern Spain between 1 January 1991 and 31 December 1995. Each was interviewed by health personnel and tested for HIV-infection (ELISA followed by immunoblot confirmation in positive cases). Statistical analysis was based on logistic regression.

RESULTS

The prevalence of HIV-infection was 46.9% (95% CI: 43.1%-50.8%). No decreasing tendency in annual prevalence of HIV-infection was observed (p = 0.88); however, for those incarcerated for the first time prevalence fell from 38% in 1991 to 19% in 1995 (p = 0.20). Gypsies (OR: 0.43; 95% CI: 0.23-0.80) and prisoners who were older upon first incarceration (OR: 0.94; 95% CI: 0.90-0.99) were associated with lesser risk of HIV-infection. Women (OR: 2.17; 95% CI: 1.29-3.65), older prisoners (OR: 1.06; 95% CI: 1.02-1.11), those with multiple incarceration histories (OR: 1.06; 95% CI: 1.01-1.11) and long-term prisoners (OR: 1.01; 95% CI: 1.00-1.02) were associated with higher risk.

CONCLUSIONS

The high prevalence of HIV-infection, especially in women, younger prisoners, repeat offenders and long-term prisoners, suggests that prevention measures directed toward the most marginal IDU have not been very effective. Harm-reduction programs must be made to reach the IDU population, both in and outside prison walls.

HIV risk reduction and service delivery strategies in criminal justice settings

Because of the HIV risk behaviors of substance abusers, particularly injection drug users and those who exchange sex for drugs, and the large numbers who are already infected with HIV or showing symptoms of AIDS, significant service delivery issues are associated with their criminal justice processing. Many strategies have been implemented in correctional settings in an effort to prevent and control the transmission of HIV. A number of these are for the purpose of lowering transmission risk in institutions, whereas others have been structured for the sake of offering prevention/intervention to inmates before they return to the free community. As such, prisons and jails represent opportune settings for HIV prevention and education. The most common HIV control/prevention/education strategies include mandatory testing of inmates for HIV, segregating infected inmates from the general prison population, establishing special health care units for HIV positive and AIDS symptomatic inmates, offering HIV prevention and risk reduction programs, and granting medical parole for the terminally ill. Because drug abuse treatment results in substantial declines in the use of heroin, cocaine, and other drugs, treatment per se can play a significant role in reducing the spread of HIV and AIDS among those coming to the attention of the criminal justice system. Most promising are continuous and integrated treatment services that are tied to the stages of correctional supervision: primary treatment while incarcerated; secondary treatment while on work release, halfway house or community supervision; and, tertiary treatment in ongoing aftercare.

Outbreak of HIV infection in a Scottish prison

OBJECTIVE--To investigate the possible spread of HIV infection and its route of transmission among prison inmates. DESIGN--In response to an outbreak of acute clinical hepatitis B and two seroconversions to HIV infection, counselling and testing for HIV were offered to all inmates over a two week period in July 1993. Information was sought about drug injecting, sexual behaviour, and previous HIV testing. SETTING--HM Prison Glenochil in Scotland. SUBJECTS--Adult male prisoners. MAIN OUTCOME MEASURES--Uptake of HIV counselling and testing; occurrence and mode of HIV transmission within the prison. RESULTS--Of a total 378 inmates, 227 (60%) were counselled and 162 (43%) tested for HIV. Twelve (7%) of those tested were positive for antibody to HIV. One third (76) of those counselled had injected drugs at some time, of whom 33 (43%) had injected in Glenochil; all 12 seropositive men belonged to this latter group. Thirty two of these 33 had shared needles and syringes in the prison. A further two inmates who injected in the prison were diagnosed as positive for HIV two months previously. Evidence based on sequential results and time of entry into prison indicated that eight transmissions definitely occurred within prison in the first half of 1993. CONCLUSION--This is the first report of an outbreak of HIV infection occurring within a prison. Restricted access to injecting equipment resulted in random sharing and placed injectors at high risk of becoming infected with HIV. Measures to prevent further spread of infection among prison injectors are urgently required.