About 91% of HIV-Positive Male Inmates in Georgia Infected Before Imprisonment, CDC Report Says

About 91% of HIV-positive men incarcerated in Georgia's prisons last fall were living with the virus before they were imprisoned, according to the April 21 issue of CDC's Morbidity and Mortality Weekly Report, the Washington Post reports (Brown, Washington Post, 4/21). The Georgia Department of Corrections in October 2005 housed 44,900 male prisoners at 73 facilities. A total of 856 of those male prisoners, or about 1.9%, were known to be HIV-positive and 780 of them tested positive upon entering prison (MMWR, 4/21). Georgia in 1988 began testing inmates upon their arrival to prison. CDC and state epidemiologists identified 88 men who tested HIV-negative upon entry but later tested HIV-positive while in prison. Researchers attempted to interview the 88 men, but some had been released, died or did not cooperate. Sixty-eight were interviewed by computer or in person. Their interviews were compared with those of HIV-negative inmates.

Survey Results
The HIV-positive participants were about 13 times as likely as the HIV-negative participants to have been tattooed in jail and about 10 times as likely to have had sex with another man in prison, according to the MMWR report. Of the 68 HIV-positive men, 45 reported having sex with another man, and 22 of those men said they had sex with male prison staff members, the Post reports. Fifteen of the HIV-positive inmates interviewed and six of the HIV-negative inmates reported having sex with female prison staff members, researchers found. According to the Post, prison staff members are not required to be tested for HIV, and sex between prisoners and staff is considered a felony in the state. Nearly three-quarters of the interviewed inmates who had sex in prison said it was consensual, the Post reports. Nearly one-third of those who said they had consensual sex said that even though condoms in prisons are considered contraband by the state they used one or used a spontaneous method for protection, such as a rubber glove or plastic wrap, the Post reports (Washington Post, 4/21). About 10% of the HIV-positive interviewees said they had used injection drugs in prison and 59% said they had received tattoos, according to the MMWR (Stobbe, AP/Macon Telegraph, 4/20). The inmates suggested condom distribution and the provision of HIV/AIDS education and safe tattooing methods as ways to reduce the spread of the virus in prison, Reuters Health reports (Reuters Health, 4/20).

Reaction
"Both inmates and society as a whole have long held the belief that [HIV] transmission is common among prison inmates," Richard Tewksbury, a professor of justice administration at the University of Louisville, said, adding, "The interesting thing about this study is that it directly contradicts that" (Washington Post, 4/21). CDC officials said they suggested that prisons distribute condoms and needle-cleaning bleach to inmates. However, Brian Owens, assistant commissioner for the Georgia corrections department, said neither policy is being considered by the state. He added that the state will use data from the study to help decide whether to house HIV-positive inmates at separate facilities (AP/Macon Telegraph, 4/20). "We can now begin the policy discussion about ways to prevent [new HIV cases] in the prison population," Owens said (Washington Post, 4/21). Patrick Sullivan, a CDC epidemiologist who oversaw the study, said there is no good data showing whether separating HIV-positive inmates reduces transmission of the virus (AP/Macon Telegraph, 4/20).

NPR's "Talk of the Nation" on Thursday included a discussion of the study. Guests on the program included Sullivan and Barry Zack, executive director of Centerforce, a nongovernmental organization working with prisoners at San Quentin Prison in California (Martin, "Talk of the Nation," NPR, 4/20). The complete segment is available online in RealPlayer.