Incarceration

HIV/AIDS and Incarceration

Inmates in jails and prisons across the United States are disproportionately affected by multiple health problems, including HIV as well as other sexually transmitted infections (STIs), tuberculosis (TB), and viral hepatitis, according to the CDC. Incarceration, then, presents important opportunities for HIV prevention, diagnosis, and linkage to care and treatment for inmates.

[The terms “jail” and “prison” are often used interchangeably—but there are key distinctions. Prisons are State or Federal facilities that confine people who have been convicted of a criminal or civil offense and sentenced to one year or more. Jails, however, are facilities operated by local jurisdictions whose inmates are typically sentenced for one year or less or are awaiting trial or sentencing following trial. The average jail stay is 10 to 20 days, according to the U.S. Department of Justice.]

More than 2 million people are incarcerated in the United States. Each year, an estimated 1 in 7 persons living with HIV pass through a correctional facility. Most of them acquired HIV in the community, not while they were incarcerated. Compared with those who have not been incarcerated, incarcerated populations have more risk factors that are associated with acquiring and transmitting HIV, including injection drug and other drug use, commercial sex work, untreated mental illness, and lower socioeconomic status.

According to the U.S. Department of Justice’s Bureau of Justice Statistics, at yearend 2008 (the most recent year for which data is available), the reported number of state and federal inmates who were HIV positive or had confirmed AIDS totaled 21,987. This figure breaks out to 20,449 state prisoners and 1,538 federal prisoners and is equal to approximately 1.4% of the total prison population. Among states reporting data in 2006 through 2008, the number of inmates with HIV/AIDS was stable between 2007 and 2008. Of the state and federal inmates who were HIV positive or had confirmed AIDS, a reported 20,075 were men and 1,912 were women. Between 2007 and 2008, the percentage of male inmates with HIV/AIDS remained stable at 1.5 percent, while the percentage of female inmates with HIV/AIDS decreased slightly from 2.1 percent to 1.9 percent. [Note: During 2008, a total of 24 states reported testing all inmates for HIV at admission or sometime during custody. Among these 24 states, 23 tested at admission, five tested while in custody, and six tested upon release. Fifty states and the federal system tested inmates if they had HIV-related symptoms or if they requested an HIV test. Forty-two states and the federal system tested inmates after they were involved in an incident in which an inmate was exposed to a possible HIV transmission, and 18 states and the federal system tested inmates who belonged to specific high-risk groups.]

Thus, correctional facilities can provide inmates at risk for or living with HIV the opportunity for HIV testing, linkage into primary care, and prevention counseling.

In addition to opportunities for diagnoses and initiation of HIV care, our nation’s prisons and jails have important opportunities to connect inmates living with HIV services that continue and support their ongoing HIV care upon their release from incarceration.  The National HIV/AIDS Strategy observes, “Although the available data suggests that relatively few infections occur in prison settings, there is evidence that some people with HIV who had received medical care while incarcerated have difficulty accessing HIV medications upon release—affecting their health and potentially increasing the likelihood that they will transmit HIV.” Thus, correctional systems also have an opportunity to coordinate with local public health officials and community-based organizations to ensure linkages to continued prevention and treatment interventions for inmates living with HIV upon their release to the community.

Federal Resources

There are a number of Federal resources that address the issue of HIV/AIDS in correctional settings:

Bureau of Justice Statistics (BJS), U.S. Department of Justice

BJS–HIV in Prisons and Jails
Statistics on inmates with HIV infections.

Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services

HIV in Correctional Settings
This fact sheet from CDC provides an overview of HIV/AIDS in prisons and jails and discusses prevention challenges and opportunities

CDC–Correctional Health
Collection of HIV/AIDS-related resources relevant to inmate populations, including background information and statistics, guidelines and recommendations, journal articles by CDC authors, and health educational materials for patients and professionals.

CDC–Demonstration Projects for State and Local Health Departments: Routine Rapid HIV Testing of Inmates in Short-Stay Correctional Facilities
Fact sheet on a demonstration project to provide routine rapid HIV testing in short-stay correctional facilities, from which inmates are more likely to be released before results from traditional testing are available.

CDC–HIV Testing Implementation Guidance for Correctional Settings
Background statistics on HIV/AIDS in correctional facilities and information on inmate privacy and confidentiality, opt-out HIV screening in correctional medical clinics, HIV testing procedures, and HIV/AIDS case reporting.

CDC National Prevention Information Network–Prisoners: Communities at Risk
Links to resources on prisoners and HIV/AIDS, including information on associated opportunistic infections.

Health Resources and Services Administration (HRSA), U.S. Department of Health and Human Services

HRSA, HIV/AIDS Bureau–CDC/HRSA Corrections Demonstration Project
Description of a collaborative corrections initiative for HIV Prevention, Intervention, and Continuity of Care within Correctional Settings and the Community, including links to relevant journal articles.

HRSA, HIV/AIDS Bureau–HIV Care in Correctional Settings
Section from the Guide for HIV/AIDS in Clinical Care, a manual developed to provide HIV/AIDS clinicians with ready access to practical, current, treatment information so that they may provide quality care to people living with HIV.

HRSA’s AIDS Education & Training Centers

AETC National Resource Center–HIV/AIDS Care in the Correctional Setting
Four videos of presentations on HIV/AIDS care in correctional settings from the 2008 NW AETC annual conference in Olympia, WA.

AETC National Resource Center–Resources on HIV Prevention, Care and Treatment in Corrections Settings
Articles, guidelines, fact sheets, and other materials on the prevention, care, and treatment of people with HIV/AIDS in correctional facilities.

Northwest AETC–HIV in the Correctional Setting
Information on training opportunities for correctional staff members, as well as links to statistics, journal articles, and other resources on people with HIV/AIDS in correctional settings.

National Institute of Corrections (NIC), U.S. Department of Justice

NIC–HIV/AIDS
Links to NIC Corrections Community blog posts and other resources and information on people living with HIV/AIDS in correctional settings.

National Criminal Justice Reference Service (NCJRS), U.S. Department of Justice

NCJRS–HIV/AIDS
Links to abstracts of published research studies on HIV/AIDS that are included in the NCJRS library collection and Federal Justice web pages related to the topic of HIV/AIDS and correctional systems.

NCJRS–Inmate Assistance: Health
Links to information about health care for inmates, including how elderly inmates can obtain Federal disability benefits, and statistics on inmates living with HIV/AIDS.

National Institutes of Health (NIH), U.S. Department of Health and Human Services

NIH AIDSinfo Resources–Corrections
List of HIV/AIDS-related resources relevant to inmate populations.

National Library of Medicine-Special Populations: Prisoners
Resources on prisoners and HIV/AIDS complied by the National Library of Medicine’s Specialized Information Services.

Non-federal Resources

National Alliance of State and Territorial AIDS Directors (NASTAD)–Understanding State Departments of Health and Corrections Collaboration
Summary of findings from survey conducted to better understand the degree to which State Departments of Health interact with State Departments of Corrections on the prevention, care, and treatment of HIV and viral hepatitis in State correctional facilities.