PREDICTORS OF HIV-INFECTION AMONG NEWLY SENTENCED MALE PRISONERS

The prevalence of individuals with or at risk for HIV infection in pri sons and jails is severalfold higher than age-adjusted rates In surrou nding communities. This HIV serosurvey of 975 newly sentenced male pri soners employed a new methodology that anonymously linked individual i nformation to HIV serologic data. The HIV prevalence was 6.1%; multiva riate regression analysis indicated injection drug use (OR = 18.9), bl ack race (OR = 5.5), Hispanic ethnicity (OR = 3.4), psychiatric illnes s (OR = 3.1) and a history of having had a sexually transmitted diseas e(OR = 2.2) were independent predictors of HIV infection. Laboratory m arkers such as hypoalbuminemia, an elevated aspartate aminotransferase (AST) level, leukopenia, anemia, and thrombocytopenia suggest increas ed risk for HIV among prisoners, particularly in settings where HIV te sting resources are scarce. This study, unlike those reported in other geographic regions, indicated that the majority (71%) of HIV-seroposi tive persons self-reported their HIV status. This finding may suggest that HIV-infected individuals will self-report their status if HIV car e is comprehensive and consistent. The large number of HIV-infected in dividuals within prisons makes prisons important sites for the introdu ction of comprehensive HIV-related care. This is particularly relevant in that development of new guidelines issued for the management of HI V infection in which potent combination antiretroviral therapy has bee n demonstrated to decrease morbidity and mortality. The high prevalenc e of HIV-seronegative inmates with self-reported high-risk behaviors a lso suggests the importance of prisons as sites for the introduction o f appropriate risk-reduction interventions.