Study confirms benefit of routine, jail-based HIV testing for inmates

Jun 24, 2010

Routine, jail-based HIV testing of inmates can successfully identify a substantial proportion of people unknowingly infected with HIV and could play a critical role in preventing the spread of the disease, according to a new report in this week's U.S. Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report.

The analysis, conducted by researchers with The Miriam Hospital, The Warren Alpert Medical School of Brown University, Rhode Island Department of Corrections (RIDOC), Rhode Island Department of Health (RIDOH) and the CDC, supports previous CDC recommendations calling for HIV testing in jails and prisons as part of a routine medical evaluation.

During a eight-year period, 73 percent of all RIDOC inmates were provided HIV testing during a medical evaluation within 24 hours of incarceration. Nearly 170 new HIV diagnoses, representing more than 15 percent of all newly-diagnosed people with HIV in Rhode Island during the same time period, were identified through this RIDOC testing program.

According to lead author Curt G. Beckwith, MD, an infectious disease specialist with The Miriam Hospital, this testing rate is both noteworthy and encouraging, given that individuals who are unaware of their are more than three times more likely to transmit the virus compared to those who are aware of their infection. In addition, HIV rates among prisoners are more than four times higher than in the general population.

"Jails and correctional facilities provide a golden opportunity to offer HIV testing to a population that is hard-to-reach and at increased risk of infection," says Beckwith. "Expansion of HIV testing within jails has the potential to increase HIV diagnoses and make more people aware of their HIV status, which could help reduce the spread of the disease in the United States."

HIV testing has been routinely offered to every person entering the RIDOC since 1991 as part an initial medical evaluation conducted within 24 hours of confinement. Test results are available within a week or two. Anyone who receives an HIV-positive result while incarcerated is notified by an HIV clinical nurse and receives prevention counseling and referrals to HIV care both in the prison setting and in the community. Individuals with a positive diagnosis who are released before they can be notified are contacted by a RIDOH outreach worker who also provides care referrals and prevention counseling.

Following a detailed review of RIDOC records and RIDOH surveillance data, researchers determined that if HIV testing had been conducted after the first 48 hours of incarceration, approximately 29 percent of detainees with new HIV diagnoses would not have been tested. What's even more troubling: if all testing had occurred beyond seven days of incarceration, 43 percent of HIV-positive inmates who had been released within that timeframe would not have been tested, resulting in a delay in their diagnosis and the opportunity for them to unknowingly spread the disease.

In addition, nearly half of the newly-diagnosed HIV-positive inmates did not disclose HIV risk behaviors, such as injection drug use or high risk sexual behaviors. Beckwith, who is also an assistant professor of medicine at Alpert Medical School and a physician with University Medicine, says this finding could be an issue for jurisdictions that rely on HIV testing based on known risk behaviors, since it appears they may miss a sizeable number of HIV-positive detainees.

"These results support policies for HIV testing upon jail intake and routinely providing voluntary, opt-out HIV testing to all detainees, regardless of reported risk factors, in order to maximize our ability to diagnose as many new cases as possible," he adds.

From 2000 through 2007, the RIDOC jail processed 140,739 criminal offenses and conducted 102,229 tests. Due to multiple arrests of some detainees during this timeframe, the total number of performed represents approximately 40,000 to 60,000 unique individuals. That's because some detainees may have been tested multiple times depending upon arrest frequency and the time between incarcerations.

The majority of newly-diagnosed detainees were male (90 percent) and more than three-quarters were between the ages of 30 and 49. Blacks and Hispanics represented 72 percent of all cases.

Explore further: Intimacy a strong motivator for PrEP HIV prevention

More information: The study is available at: www.cdc.gov/mmwr/preview/mmwrh… htm?s_cid=mm5924a3_w

add to favorites email to friend print save as pdf

Related Stories

Testing times: Detecting HIV in resource-limited settings

Nov 29, 2007

Integrating HIV testing programmes into primary medical care can help achieve early diagnosis of HIV infection, even in relatively poor areas, research published in the online open access journal AIDS Research and Therapy ...

Brown researchers create first-ever HIV rapid test video

Dec 12, 2007

Researchers at The Warren Alpert Medical School of Brown University have created the first educational video for patients to explain rapid tests for HIV, a relatively new tool in the fight against the AIDS epidemic.

Feds want HIV tests to become routine

May 08, 2006

Federal officials are reportedly planning to recommend U.S. physicians provide routine HIV testing for all of their patients ages 13 to 64.

Recommended for you

Obese British man in court fight for surgery

Jul 11, 2011

A British man weighing 22 stone (139 kilograms, 306 pounds) launched a court appeal Monday against a decision to refuse him state-funded obesity surgery because he is not fat enough.

2008 crisis spurred rise in suicides in Europe

Jul 08, 2011

The financial crisis that began to hit Europe in mid-2008 reversed a steady, years-long fall in suicides among people of working age, according to a letter published on Friday by The Lancet.

New food labels dished up to keep Europe healthy

Jul 06, 2011

A groundbreaking deal on compulsory new food labels Wednesday is set to give Europeans clear information on the nutritional and energy content of products, as well as country of origin.

Overweight men have poorer sperm count

Jul 04, 2011

Overweight or obese men, like their female counterparts, have a lower chance of becoming a parent, according to a comparison of sperm quality presented at a European fertility meeting Monday.

User comments : 0