Model-Based Estimates of HIV Acquisition Due to Prison Rape

Abstract

Nearly 1.4 million men are incarcerated in federal and state prisons in the United States. These men are disproportionately affected by HIV in comparison with the at-large male population. The elevated prevalence of HIV infection in U.S. prisons has raised concerns over the potential for intraprison HIV transmission due to rape and other forms of sexual victimization. However, the number of men who acquire HIV after being raped in U.S. prisons is not known. We developed a mathematical model of HIV transmission to estimate the likelihood that an incarcerated man would become infected as a result of prison rape and to provide preliminary estimates of the number of prison rape victims who acquire HIV. Our results suggest that between 43 and 93 currently incarcerated men already have or will acquire HIV as a result of being raped in prison. Keywords prison rape; HIV; mathematical modelMore than 2 million U.S. adults were incarcerated in federal and state prisons and local jails at the end of 2003 (Harrison & Beck, 2004). Federal and state prisons alone house nearly 1.5 million inmates, the majority (93%) of whom are men (Harrison & Beck, 2004).A disproportionate number of U.S. prison inmates are infected with HIV-the virus that causes AIDS-in comparison with the at-large population. Approximately 1.9% of men and 2.8% of women incarcerated in state and federal prisons are known to have HIV (Maruschak, 2004); the true prevalence of infection is likely to be higher. The elevated prevalence of HIV infection in U.S. prisons has raised concerns over the potential for intraprison HIV transmission due to rape and other forms of sexual victimization (Dumond, 1992;Krebs, 2002;Mair, Frattaroli, & Teret, 2003;Mariner, 2001;Robertson, 2003; Stop Prisoner Rape, 2005).Although estimates of the frequency of prison rape vary widely, prisoner-on-prisoner sexual assaults occur with alarming regularity. A recent meta-analysis of published studies of prison sexual assault indicated that approximately 1.9% of all inmates are raped or otherwise seriously assaulted while in prison (Gaes & Goldberg, 2004). Notably, prison rape incidents often involve multiple perpetrators (Banbury, 2004;Mariner, 2001; Struckman-Johnson, StruckmanJohnson, Rucker, Bumby, & Donaldson, 1996) and sometimes cause serious injury to the victim, including trauma to rectal and vaginal tissue (Dumond & Dumond, 2002), both of which increase HIV risk (Schoub, 1999). Moreover, unlike sexual assault in the general community, a person who is raped in prison may be unable to remove him-or herself from the vicinity of the perpetrator or perpetrators and thus may be raped repeatedly while incarcerated (Banbury, 2004;Dumond, 2003;Mariner, 2001;Struckman-Johnson et al., 1996). Context of Prison RapeMost of the available evidence regarding the experiences of men who are raped in prison is anecdotal, informal, or otherwise drawn from first-person accounts (e.g., Anderson, 2001;Brook, 2004;Chonco, 1989;Mariner, 2001). These accounts suggest that many initial rape attempt...

Sex, violence and HIV on the inside: cultures of violence, denial, gender inequality and homophobia negatively influence the health outcomes of those in closed settings

“…The importance of prisoners as a key population in the global epidemic was recently reinforced by the WHO guidelines for key populations (WHO 2014). Closed settings have been identified to pose a substantial risk for HIV as a result of sexual behaviour (including rape), injecting drug use and body modification practices such as tattooing (Richters et al 2012;Pinkerton, Galletly, and Seal 2007;Angora et al 2011;Krebs 2002). This is true in all countries, but especially in resource-poor settings where the prevalence of HIV in closed settings is often higher than among the general population (Angora et al 2011), thus begging the question, is HIV 'on the inside' in PNG?…”

Sexual and Gender Diversity Within the Black Men Who Have Sex with Men HIV Epidemiological Category

“…However, there are no data available regarding the rate of HIV transmission due to rape in prison. Pinkerton and colleagues (2007) estimated the prison rape HIV transmission rate through a model that considered existing data on number of assaults and HIV prevalence. Even under a very conservative estimate that 1% of prisoners are raped, their model predicted that between 43 federal and 93 state MAB prisoners will acquire HIV during their incarceration annually.…”

Addressing Ethical Non-Sequiturs in Botswana's HIV and AIDS Policies: Harmonising the Halo Effect

“…Other sources indicating that male inmates are at greatest risk of contracting HIV in prison through sexual activity include Braithwaite et al (2002) as cited in Collica 2007, andMorrow et al (2007). Furthermore, Pinkerton et al (2007) contend that high rates of HIV in prisons raise concern over the potential for intra-prison HIV transmission due to rape and other forms of sexual victimisation. It has been established that in Botswana HIV is transmitted mainly through unprotected penetrative sex (Lekoko 2009) and that, in prisons, such behaviour frequently occurs among male inmates (Masetlhe 2002).…”