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Study Reports on Undiagnosed HIV Infections in New York City Jails

by Matt Clarke

An article in the May 2011 issue of the Journal of Acquired Immune Deficiency Syndrome reported that the HIV infection rate among people being booked into New York City jails was much higher than the average in the general population, but lower than the 1998 rate. In the first study of undiagnosed HIV in jails, the article noted that 28.1% of those testing positive for HIV were previously undiagnosed.

The New York City Department of Correction operated 11 jails that processed 64,383 unique male and 8,073 unique female arrestees in 2006. Upon being booked into jail a blood test for syphilis is required, but a consent form must be signed to receive an HIV test. Because only one-third of detainees on average consent to HIV testing, the New York Department of Health and Mental Hygiene conducted HIV tests using the remnants from blood samples taken for syphilis testing to determine whether jail prisoners who were HIV-positive were not being diagnosed.

The study did not include all persons admitted into the jails, because 8.9% of the arrestees had no intake health data and 31.15% of those with intake health data had no remnant blood samples. The study targeted over 6,000 unique men and women admitted into New York City jails beginning on May 1, 2006. After ensuring that the blood sample remnants represented unique individuals, all identification data was removed from the samples and the sample database.

“Of the 6,411 specimens that were tested in the serosurvey, 389 (5.2%) tested HIV positive, 5,977 (94.1%) tested HIV negative, and 45 had indeterminate results (0.7%). Only 7 of 5,977 inmates who tested negative (0.11%) self-reported being HIV infected at intake,” the study found.

Of the 398 HIV-positive prisoners, 232 (59.5%) were in the city’s HIV/AIDS Reporting System (HARS), which tracks persons infected with HIV, at the time of their admission. Of those 232 listed in HARS, 169 (72.4%) self-reported being infected while 63 (27.6%) did not. Among the HIV-infected prisoners not in HARS, 53 (32.4%) self-reported as being HIV positive. The remaining 104 not listed in HARS (28.1% of all HIV-positive prisoners) did not self-report being HIV infected, and thus were considered to have undiagnosed HIV infection at intake.

“HIV prevalence for all inmates in the serosurvey was 5.2%: 4.7% in men and 9.8% in women.” When the prevalence was adjusted to reflect all new admissions, both with and without remnant blood samples, “based on proportional match-ing to HARS, the estimated true New York City inmate [HIV infection] prevalence would be 8.7% overall.” This included an adjusted rate of 6.5% in males and 14% in females. Although that is about three times the general population rate for men and around 17 times the rate for women, it represents a reduction from the jail’s HIV rates as determined in the past. In 1998, the HIV infection rate for male jail prisoners was 7.6% while the rate for female prisoners was 18.1%.

The study concluded that 104 (28.1%) of the 389 prisoners testing positive for HIV had not been previously diagnosed. Only 13 (11.1%) of the prisoners with previously undiagnosed HIV reported the common risk factors of intravenous drug use or male homosexual sex. Forty-one (39%) reported other factors such as previous sexually-transmitted diseases, multiple sex partners and/or unprotected sex.

The study’s main suggestion was to change the jail system’s opt-in policy for HIV testing to one in which all new prisoners are tested for HIV without consent unless they refuse to allow such testing. That approach has been successful in other jail systems, which report HIV testing rates of up to 86% for new jail admissions.

Source: Journal of Acquired Immune Deficiency Syndrome, “Undiagnosed HIV Infection Among New York City Jail En-trants, 2006: Results of a Blinded Serosurvey” (May 2011)

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