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Journal of Urban Health

, Volume 82, Issue 2, pp 312–326 | Cite as

Correlates of HIV infection among incarcerated women: Implications for improving detection of HIV infection

  • Frederick L. AlticeEmail author
  • Adrian Marinovich
  • Kaveh Khoshnood
  • Kim M. Blankenship
  • Sandra A. Springer
  • Peter A. Selwyn
Article

Abstract

The prevalence of HIV infection in correctional settings is several-fold higher than found in community settings. New approaches to identifying HIV infection among prisoners are urgently needed. In order to determine the HIV seroprevalence and to identify the correlates of HIV infection among female prisoners, an anonymous, but linked HIV serosurvey was conducted at Connecticut’s sole correctional facility for women (census=1,100). After removing all individual identifiers for inmates’ standardized clinical and risk behavior information, data are linked by a third source to blinded HIV-testing information by a third party. This three-step sequential process allows for anonymous HIV testing that can still be linked with deidentified clinical and behavioral data. Of the 3,315 subjects with complete information, 250 (7,5%) were HIV+. Of these, 157 (63%) selfreported being HIV+. Using multiple logistic regression analysis, having sex with a known HIV+ person [adjusted odds ratio (AOR)=9.1] and injection drug use (AOR=6.1) were the most highly correlated risk factors for HIV, whereas leukopenia (AOR=9.4) and hypoalbuminemia (AOR=7.2) were the most significant laboratory markers. Other independent correlates of HIV included self-report of syphilis (AOR=1.9) or genital herpes infection (AOR=2.7) and being Black (AOR=2.1) or Hispanic (AOR=2.2). The prevalence of HIV and HIV-risk behaviors is high among incarcerated women. Existing voluntary HIV counseling and testing programs do not completely target high-risk groups who remain part of the evolving epidemic. Defined demographic, behavioral, and clinical assessments may provide useful information for encouraging targeted counseling and testing. Newer targeted approaches merit further study to determine the effectiveness of this approach. Alternative methods of facilitating more widespread HIV testing, such as saliva tests, rapid serologic tests, and more routine testing in high HIV-prevalence areas should be considered both for clinical and for public health benefits.

Keywords

Condoms HIV testing HIV Hypoalbuminemia Injection drug use Prisoners Prostitution Risk behavior Seroprevalence Sexually transmitted diseases Violence Women 

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References

  1. 1.
    Fleming P, Byers RH, Sweeney PA, Daniels D, Karon JM, Janssen RS. HIV prevalence in the United States, 2000. In: Program and abstracts of the 9th Conference on Retroviruses and Opportunistic Infections; February 24–28, 2000; Seattle, Washington. Abstract 11. Available at: http://www.retroconference.org/2002/abstract/13996.htm. Accessed April 4, 2005.Google Scholar
  2. 2.
    CDC. Advancing HIV prevention: new strategies for a changing epidemic-United States, 2003. MMWR Morb Mortal Wkly Rep. 2003;52:329–332.Google Scholar
  3. 3.
    Glaser JB, Greifinger RB. Correctional health care: a public health opportunity. Ann Intern Med. 1993;118:139–145.PubMedCrossRefGoogle Scholar
  4. 4.
    Farley JL, Mitty JA, Lally MA, et al. Comprehensive medical care among HIV-positive incarcerated women: the Rhode Island experience. J Womens Health Gend Based Med. 2000;9:51–56.PubMedCrossRefGoogle Scholar
  5. 5.
    Desai AA, Latta ET, Spaulding A, et al. The importance of routine HIV testing in the incarcerated population: the Rhode Island experience. AIDS Educ Prev. 2002;14:45–52.PubMedCrossRefGoogle Scholar
  6. 6.
    Arriola KR, Kennedy SS, Coltharp JC, et al. Development and implementation of the cross-site evaluation of the CDC/HRSA corrections demonstration project. AIDS Educ. Prev. 2002;14:107–118.PubMedCrossRefGoogle Scholar
  7. 7.
    Maruschak LM. HIV in prisons, 2001. Bureau of justice statistics bulletin Jan 2004. NCJ 202293. Available at: http://www.ojp.usdoj.gov/bjs/pub/pdf/hivp01.pdf. Accessed January 17, 2004.Google Scholar
  8. 8.
    Hammett TM, Harmon MP, Rhodes W. The burden of infections disease among inmates of and releases from US correctional facilities, 1997. Am J Public Helth. 2002;92:1789–1794.CrossRefGoogle Scholar
  9. 9.
    Coons SJ. HIV in correctional facilities: a challenge and an opportunity. Clin Ther. 2002;24:1464–1465.PubMedCrossRefGoogle Scholar
  10. 10.
    Spaulding A, Stephenson B, Macalino G, et al. Human immunodeficiency virus in correctional facilities: a review. Clin Infect Dis. 2002;35:305–312.PubMedCrossRefGoogle Scholar
  11. 11.
    Altice FL, Mostashari F, Friedland GH. Trust and the acceptance of an adherence to antiretroviral therapy. J Acquir Immune Defic Syndr. 2001;28:47–58.PubMedCrossRefGoogle Scholar
  12. 12.
    Ramratnam B, Rich JD, Tsoulfas G, et al. Former prisoners’ views on mandatory HIV testing during incarceration. J Investig Med. 1996;44:A251.Google Scholar
  13. 13.
    Behrendt C, Kendig N, Dambita C, et al. Voluntary testing for human immunodeficiency virus (HIV) in a prison population with a high prevalence of HIV. Am J Epidemiol. 1994;139:918–926.PubMedGoogle Scholar
  14. 14.
    Bauserman RL, Ward MA, Eldred L, et al. Increasing voluntary HIV testing by offering oral tests in incarcerated populations. Am J Public Health. 2001;91:1226–1229.PubMedCentralPubMedCrossRefGoogle Scholar
  15. 15.
    Phillips KA, Bayer R, Chen JL. New centers for disease control and prevention’s guidelines on HIV counseling and testing for the general population and pregnant women. J Acquir Immune Defic Syndr. 2003;32:182–191.PubMedCrossRefGoogle Scholar
  16. 16.
    Greensides DR, Berkelman R, Lansly A, Sullivan PS, Alternative HIV testing methods among populations at high risk for HIV infection. Public Health Rep. 2003;118:531–539.PubMedCentralPubMedCrossRefGoogle Scholar
  17. 17.
    Cohen MH, Olszewski Y, Branson B, et al. Using point-of-care testing to make rapid HIV-1 tests in labor really rapid. AIDS. 2003;17:2121–2124.PubMedCrossRefGoogle Scholar
  18. 18.
    Revised guidelines for HIV counseling, testing and referral and revised recommendations for HIV screening of pregnant women. MMWR Morb Mortal Wkly Rep. 2001;50:1–121.Google Scholar
  19. 19.
    Crepaz N, Marks G. Towards an understanding of sexual risk behavior in people living with HIV: a review of social, psychological, and medical findings. AIDS. 2002;16:135–149.PubMedCrossRefGoogle Scholar
  20. 20.
    Incorporating HIV prevention into the medical care of persons living with HIV. MMWR Morb Mortal Wkly Rep. 2003;52:1–24.Google Scholar
  21. 21.
    Centers for Disease Control and Prevention. Cases of HIV infection and AIDS in the United States, 2002. In: HIV/AIDS Surveillance Report. Vol 14. Available at: http://www.cdc.gov/ hiv/stats/hasr1402.htm. Accessed Junuary 17, 2004.Google Scholar
  22. 22.
    Box TL, Olsen M, Oddone EZ, Keitz SA. Healthcare access and utilization by patients infected with human immunodeficiency virus: does gender matter? J Womens Health. 2003;12:391–397.CrossRefGoogle Scholar
  23. 23.
    Jain MK, Skiest DJ, Cloud JW, Jain CL, Burns D, Berggren RE. Changes in mortality related to human immunodeficiency virus infection: comparative analysis of inpatient deaths in 1995 and in 1999–2000. Clin Infect Dis. 2003;36:1030–1038.PubMedCrossRefGoogle Scholar
  24. 24.
    McKinney MM, Marconi KM. Delivering HIV services to vulnerable populations: a review of CARE act-funded research. Public Health Rep. 2002;117:99–113.PubMedCentralPubMedGoogle Scholar
  25. 25.
    Altice FL, Mostashari F, Selwyn PA, et al. Predictors of HIV infection among newly sentenced male prisoners. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18:444–453.PubMedCrossRefGoogle Scholar
  26. 26.
    Kassira EN, Bauserman RL, Tomoyasu N, Caldeira E, Swetz A, Solomon L. HIV and AIDS surveillance among inmates in Maryland prisons. J Urban Health. 2001;78:256–263.PubMedCentralPubMedCrossRefGoogle Scholar
  27. 27.
    Arriola KR, Braithwaite RL, Kennedy S, et al. A collaborative effort to enhance HIV/STI screening in five county jails. Public Health Rep. 2001;116:520–529.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Sabin KM, Frey RL Jr, Horsley R, Greby SM. Characteristics and trends of newly identified HIV infections among incarcerated populations: CDC HIV voluntary counseling, testing, and referral system, 1992–1998. J Urban Health. 2001;78:241–255.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Decker MD, Vaughn WK, Brodie JS, Hutcheson RH, Schaffner W. Seroepidemiology of hepatitis B in Tennessee prisoners. J Infect Dis. 1984;150:450–459.PubMedCrossRefGoogle Scholar
  30. 30.
    Vlahov D, Brewer F, Munoz A, et al. 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;2:283–290.PubMedGoogle Scholar
  31. 31.
    Wasserheit JN. Epidemiologic synergy: interrelationships between human immunodeficiency virus infection and other sexually transmitted diseases. Sex Transm Dis. 1992;19:61–77.PubMedCrossRefGoogle Scholar
  32. 32.
    Centers for Disease Control and Prevention. AIDS associated with injecting-drug use-United States, 1995. MMWR Morb Mortal Wkly Rep. 1996;45:392–397.Google Scholar
  33. 33.
    Easterbrook PJ, Chmiel JS, Hoover DR, et al. Racial and ethnic differences in human immunodeficiency virus type 1 (HIV-1) seroprevalence among homosexual and bisexual men. The multicenter AIDS cohort study. Am J Epidemiol. 1993;138:415–429.PubMedGoogle Scholar
  34. 34.
    Morse DL, Truman BI, Hanrahan JP, et al. AIDS behind bars: epidemiology of New York State prison inmate cases, 1980–1988. N Y State J Med. 1990;90:133–138.PubMedGoogle Scholar
  35. 35.
    D’Angelo LJ, Getson PR, Luban NLC, et al. Human immunodeficiency virus infection in urban adolescents: can we predict who is at risk? Pediatrics. 1991;88:982–986.PubMedGoogle Scholar
  36. 36.
    Barbacci MB, Dalabetta GA, Repke JT, et al. Human immunodeficiency virus infection in women attending an inner-city prenatal clinic: ineffectiveness of targeted screening. Sex Transm Dis. 1990;17:122–126.PubMedCrossRefGoogle Scholar
  37. 37.
    Mostashari F, Riley E, Selwyn PA, Altice FL. Acceptance and adherence with antiretroviral therapy among HIV-infected women in a correctional facility. J Acquir Immune Defic Syndr Hum Retrovirol. 1998;18:341–348.PubMedCrossRefGoogle Scholar
  38. 38.
    Hankins CA, Gendron S, Handley MA, et al. HIV infection among women in prison: an assessment of risk factors using a nonnominal methodology. Am J Public Health. 1994;84:1637–1640.PubMedCentralPubMedCrossRefGoogle Scholar
  39. 39.
    Dean HD, Lansky A, Fleming PL. HIV surveillance methods for the incarcerated population. AIDS Educ Prev. 2002;14:65–74.PubMedCrossRefGoogle Scholar
  40. 40.
    Monterroso ER, Hamburger ME, Vlahov D, et al. Prevention of HIV infection in streetrecruited injection drug users. The Collaborative Injection Drug User Study (CIDUS). J Acquir Immune Defic Syndr. 2000;25:63–70.PubMedCrossRefGoogle Scholar
  41. 41.
    Mahon N. New York inmates’ HIV risk behaviors: the implications for prevention policy and programs. Am J Public Health. 1996;86:1211–1215.PubMedCentralPubMedCrossRefGoogle Scholar
  42. 42.
    Brewer TF, Vlahov D, Taylor E, et al. Transmission of HIV-1 within a statewide prison system. AIDS. 1988;2:363–367.PubMedCrossRefGoogle Scholar

Copyright information

© Oxford University Press on behalf of the New York Academy of Medicine 2005

Authors and Affiliations

  • Frederick L. Altice
    • 1
    Email author
  • Adrian Marinovich
    • 1
  • Kaveh Khoshnood
    • 1
  • Kim M. Blankenship
    • 1
  • Sandra A. Springer
    • 1
  • Peter A. Selwyn
    • 2
  1. 1.Yale University, School of MedicineNew Haven
  2. 2.Albert Einstein College of MedicineBronx

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