The AIDS Beacon™

A group of researchers found that while the total number of incarcerated individuals affected by HIV/AIDS has remained nearly the same from 1997 to 2006, the percentage of incarcerated individuals with HIV has declined. Their findings were published in PLoS ONE, an online peer-reviewed journal.

In 1997, 7.3 million people were released from a United States correctional facility. Nearly one in five, or 20 percent, of all HIV-infected Americans was among those released. By 2006, that percentage declined. Nearly 14 percent, or one in seven, of Americans affected by the disease were among the 9.1 million individuals released from a correctional facility that year.

For their study, researchers relied on reports from the Bureau of Justice Statistics (BJS), which gathers statistics from the state and federal prison system. BJS estimates annually the number of HIV/AIDS cases, although to date no uniform HIV testing system for incarcerated individuals exists among the states.

The study also relied on additional data on HIV rates among incarcerated persons from the Centers for Disease Control.

The study suggests four factors that may be responsible for the decline in the share of HIV-positive patients that are incarcerated. One factor may be improved treatment for the disease, which has prolonged life expectancy among HIV/AIDS patients, allowing individuals to age beyond their crime-prone years.

The authors of the study also point towards the declining prison AIDS mortality rate, which makes it much more likely that detained individuals afflicted with the disease will get out and stay out of correctional facilities.

A third factor suggested is the decline in HIV/AIDS rates and numbers among intravenous drug users over the past ten years. Finally, researchers credit initiatives within the prison system that improve discharge planning for those impacted by the disease, thereby decreasing the number of HIV-positive individuals who are rearrested.

The authors of the study stress that correctional facilities remain an opportunity-rich environment for health interventions. Since inmates are a captive population, prison education efforts and counseling along with HIV testing can be particularly effective.

Although treatment and testing for HIV/AIDS among incarcerated individuals remains controversial, some strategies have yielded promising results.

In one prospective controlled trial among male inmates in an urban New Haven jail, researchers found that routine opt-out HIV testing within 24 hours of the person entering jail resulted in the highest rates of HIV testing. Although waiting at least 24 hours resulted in fewer people declining testing, more people were released during that time.

Still, in spite of the growing sophistication of available health interventions, inmates released from correctional facilities remain much more likely to be impacted by HIV/AIDS than other Americans.

According to a 2008 BJS report released by the Department of Justice, federal and state prisoners were HIV positive or had confirmed AIDS at a rate that is two-and-a-half times the rate in the general U.S. population.

Researchers point out that the effects of this public health challenge ripple out far beyond correctional facilities because almost all people entering the prison system are eventually released.

For more information, please see the full article on the PLoS ONE Web site.