Voluntary testing for Human Immunodeficiency Virus (HIV) in a prison population with a high prevalence of HIV

From Corrections to Communities as an HIV Priority

“…Adjusting for demographic and drug use characteristics, multivariate analyses demonstrated no statistically significant differences in HIV seroprevalence among male entrants across the four study periods. A 1991 survey of male entrants in Maryland prisons noted an increase, albeit modest, to 8.5%, 15 and the most recent reports after 2000 indicate a modest decline in prevalence among entrants into prison. 16,17 As the earlier Maryland studies were performed during the same three months for each of the four years, the potential that seasonal variation might mask true changes in temporal trend was investigated.…”

“…49,50 However, when voluntary testing was established in Maryland state prisons, where prevalence was relatively high, at 8%, acceptance by inmates was about 50% and detection of HIV infected inmates 33%. 15 Reasons for refusal were not related to confidentiality concerns but instead were due to inaccurate perceptions of risk of knowledge of HIV status prior to incarceration. 15 These results from Maryland reflected the early experience (i.e., first year) of the voluntary HIV testing program; follow-up after several years of implementation showed similar levels of acceptance.…”

“…15 Reasons for refusal were not related to confidentiality concerns but instead were due to inaccurate perceptions of risk of knowledge of HIV status prior to incarceration. 15 These results from Maryland reflected the early experience (i.e., first year) of the voluntary HIV testing program; follow-up after several years of implementation showed similar levels of acceptance. 16 HIV testing has come to have clear clinical utility with the advent of potent antiretroviral therapies.…”

“…To assess this, extensive HIV testing was done in prisons and jails in the U.S.; rates were highest along the Eastern seaboard (approaching the rates noted above that might trigger an explosive spread of an HIV epidemic) and the South, with rates lowest in the Midwest and Western states. 6,[14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] As single seroprevalence surveys might not capture possible increasing rates over time, several longitudinal studies were performed, and reassuringly, all showed essentially stable or modest increase in rates of HIV infection among entrants into prison. 12,14,15,[27][28][29][30] For example, during the months of April through June 1985June , 1986June , 1987June and 1988, sera obtained from consecutive male entrants to the Maryland Division of Correction was assayed for antibody to HIV-1; the rate of HIV-1 infection among male entrants was 7.0, 7.7, 7.0, and 8.1%, respectively 12,14 ; factors associated with HIV infection on entry into prison included being 925 years old, being African American, using injection drugs (ascertained by history and observation of needle-track marks), and being from urban as opposed to suburban/rural areas of the state.…”

HIV counselling and testing utilisation and attitudes of male inmates in a South African prison

“…This is an indication for inmates to be encouraged to undergo VCT as they have access to health care and this will assist in reducing the prevalence of HIV/AIDS in prisons as those who test negative for HIV will be given health education on issues of healthy sex practices so that they maintain their negative HIV status, and those who test positive for HIV have access to other related services like antiretroviral therapy, sexually transmitted infections (STIs) clinics and TB prevention programmes in time. A review of the literature demonstrates the reasons prisoners opt to undergo or not undergo VCT include being injecting drug users, fear of HIV infection while in prison through blood contact such as during fights, recent risky sexual behaviours or previous contact with an HI-positive person, previous HIV-positive test, low-risk lifestyle, negative HIV test 2 -12 months previously, no prior HIV test mentioned, concern over confidentiality of results, dislike of venipuncture, and release within six month (Behrendt et al, 1994;Burchell et al, 2003). Haggerty and Nesselroth (2000) also report that 'Stigmatization, the potential threat of violence, poor HIV education, and lack of confidentiality may cause many prisoners to avoid voluntary testing even when they know that they are at risk of infection.…”