Characteristics and trends of newly identified HIV infections among incarcerated populations: CDC HIV voluntary counseling, testing, and referral system, 1992-1998

Inmate contact with the correctional health care system Provides public hea lth professionals an opportunity to offer HIV screening to a population tha t might prove difficult to reach otherwise. We report on publicly funded hu man immunodeficiency virus (HIV) voluntary counseling, testing, and referra l (VCTR) services provided to incarcerated persons in the United States. In carcerated Persons seeking VCTR services received pretest counseling and ga ve a blood specimen for HIV antibody testing. Specimens were considered pos itive if the enzyme immunoassays were repeatedly reactive and the Western b lot or immunofluorescent assay was reactive. Demographics, HIV risk informa tion, and laboratory test results were collected from each test episode. Ad ditional counseling sessions provided more data. From 1992 to 1998, there w ere 527,937 records available from correctional facilities from 48 project areas; 484,277 records included a test result and 459,155 (87.0%) tests cam e with complete data. Overall, 3.4% (16,797) of all tests were reactive for HIV antibodies. Of reactive rests accompanied by self-reports of previous HIV test results (15,888), previous test results were 44% positive, 23% neg ative, 6% inconclusive or unspecified, and 27% no previous test. This indic ates that 56% of positive tests were newly identified. During the study per iod, the number of tests per year increased three-fold. Testing increased a mong all racial/ethnic groups and both sexes. The largest increase was for heterosexuals who reported no other risk, followed by persons with a sex pa rtner at risk. Overall, the greatest number of tests was reported for injec tion drug users (ID Us) (128,262), followed by men who have sex with men (M SM) (19,928); however, episodes for MSM doubled during the study, while for IDUs, they increased 74%. The absolute number of HIV-positive (HIV+) tests increased 50%; however, the percentage of all rests that were HIV+ decreas ed nearly 50% due to the increased number of tests performed. HIV+ tests fe ll 50% among blacks (7.6% to 3.7%), Hispanics (6.7% to 2.5%), and males (5. 1% to 2.5%); 33% among females (4.5% to 3.1%); 95% among IDUs (8.6% to 4.4% ); and 64% among MSM (19.3% to 11.8%). Among HIV+ episodes, those for IDUs dropped from 61.5% to 36.6%, while episodes for heterosexuals with no repor ted risk factor increased from 4.3% to 18.2%. The use of VCTR services by i ncarcerated Persons rose steadily from 1992 to 1998, and 56% of HIV+ tests were newly identified. High numbers of tests that recorded risk behaviors f or contracting HIV indicate that correctional facilities provide an importa nt access point for prevention efforts.