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Trends in hepatitis C and HIV infection among inmates entering
prisons in California, 1994 versus 1999
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AIDS November 2002; 16(16):2236-2238
The prevalences of hepatitis C virus (HCV) and HIV are much higher among incarcerated populations than the general public. For example, the incidence of HCV in the United States has been estimated at 1.8% [1], and more recently at 2.5% from a population-based sample of young women living in poorer neighborhoods in California [2]. However, 41.2% of California inmates were anti-HCV positive in 1994 [3]. In 1999, 2.1% of state and federal prison inmates were known to be HIV positive [4]. Whereas rates of HCV and HIV are higher among men within the general population, greater proportions of female inmates have been found to be infected with HCV and HIV. Among female inmates entering the California correctional system in 1994, 63.5% were anti-HCV positive compared with 39.4% of male inmates [3]. The prevalence of HIV was greater among female than male inmates (3.1 versus 2.5%) of the
California prison system [3], and at nine out of 10 correctional systems across the United States [5].
Between 1995 and 2001, the incarcerated population in the United States grew an average of 4.0% annually [6]. The importance of monitoring HCV and HIV within this growing and mobile population was the reason to replicate a 1994 cross-sectional survey of inmates entering the California correctional system.
The California Department of Corrections has 13 reception centers in which male and female inmates are processed separately for entrance into the prison system. Four of the 10 male centers and two of the three female centers were selected for inclusion in the surveys. The same centers were selected in 1994 and 1999. A sample from each prison was selected based on the proportion of inmates processed at the center on a weekly basis. All incoming inmates to the California Department of Corrections receive a physical examination shortly after arrival at a reception center. During the physical examination, a blood sample is obtained for syphilis serology. Inmates cannot refuse to provide a blood sample; leftover blood was used for blinded testing of HCV and HIV antibodies. Blood specimens were collected between August and September 1994 (men) and August and October 1994 (women). Samples for 1999 were collected between January and March for both men and women. The same laboratory methods were used in 1994 and 1999. HCV antibodies were detected using the hepatitis C virus encoded antigen (recombinant c 100-3, HC-31 and HC-34) Abbott HCV enzyme-linked immunosorbent assay (EIA) 2.0 (Abbott Laboratories, North Chicago, IL, USA). Sera were tested for HIV antibodies
using the Abbott EIA. Those specimens repeatedly reactive to EIA were confirmed by immunofluorescence assay, and any discrepancy was resolved using Western blot. Unlinked survey data were used to estimate the seroprevalence of HCV and HIV antibodies; each correctional facility provided demographic information. The California Health and Welfare Agency Committee for the Protection of Human Subjects approved the study protocols for both the 1994 and 1999 studies.
A total of 4140 male and 624 female inmates were tested in 1994, and a total of 4876 male and 719 female inmates were tested in 1999. Less than 3% of the samples in both surveys (n = 137 in 1994 and n = 135 in 1999) could not be tested, either because no blood was drawn, the quantity of the sample was too small, or the specimen was not saved.
In 1999, men entering California prisons were more likely to be infected with HCV than were women; HCV seroprevalence rates were 34.2 for male inmates and 25.3 for female inmates (Table 1). HCV antibody seroprevalence declined 13% from 1994 to 1999 among male inmates overall. However, a 16% increase was found for HCV positivity among African American men. Among female inmates, a decrease of 54% was found for HCV from 1994 to 1999.
HIV seroprevalence decreased from 1994 to 1999 by 42% for men and 47% for women. Compared with white and Latino inmates, African American male and female inmates were more likely to be infected with HIV in 1999.
The decline in HCV and HIV prevalences demonstrate a possible reduction in injection drug use or an increase in safer injecting practices within California. Whereas total admissions to publicly funded drug and alcohol treatment programs in California increased from 1995 to 1999, the number of injection drug use admissions decreased 13.4% during that time [7]. Likewise, felony drugs arrests among adults in California dropped 15.6% from 1994 to 1999; arrests for narcotic drugs declined among men and women (21.8 and
5.5%, respectively) as did arrests for 'dangerous drugs' (including methamphetamines) during this period (men, -19.1%; women, -13.7%) [8]. Finally, perhaps changes in injection risk behaviors, decreases in needle sharing and increases in the use of syringe exchange programs, seen in New York City from 1990-1994 to 1995-1999 also took place in California during this decade [9].
Although rates of HCV and HIV among California prison inmates declined from 1994 to 1999, the approximately one in three male and one in four female inmates infected with HCV represents a serious public health concern. Control of HIV and HCV requires primary and secondary harm-reduction interventions targeted at correctional populations effectively to reduce risk behaviors during incarceration and after release. Our findings for African American inmates (i.e. the highest HIV prevalence in 1999 among both men and women; the highest HCV prevalence in 1999 among women, and the increase in HCV prevalence from 1994 to 1999 among men) strongly suggest that culturally appropriate interventions must be developed specifically for African American prisoners.
Juan D. Ruiza; Fred Molitorb; Julie A. Plagenhoefc
References
1.Alter MJ, Kruszon-Moran D, Nainan OV.et al. The prevalence of hepatitis C virus infection in the United States, 1988 through 1994. N Engl J Med 1999, 341:556-562.
2.Page-Shafer KA, Cahoon-Young B, Klausner JD.et al. Hepatitis C virus infection in young, low-income women: the role of sexually
transmitted infection as a potential cofactor for HCV infection. Am J Public Health 2002, 92:670-676.
3.RuiRuiz JD, Molitor F, Sun RK.et al. Prevalence and correlates of hepatitis C virus infection among inmates entering the California correctional system. West J Med 1999, 170:156-160.
4.US Department of Justice. HIV in prison and jails, 1999. Washington, DC: US Department of Justice, Bureau of Justice Statistics. July 2001, NCJ-187456.
5.Vlahov D, Brewer TF, Castro KG.et al. Prevalence of antibody to HIV-1 among entrants to US correctional facilities. JAMA 1991, 265:1129-1132.
6.US Department of Justice. Correction statistics. Washington DC: US Department of Justice, Bureau of Justice Statistics. Available at
http://www.ojp.usdoj.gov/bjs/correct.htm. Accessed 30 May, 2002.
7.State of California. California indicators of drug and alcohol abuse. Department of Alcohol and Drug Programs, Office of Applied Research and Analysis.
Available at http://www.adp.cahwnet.gov/RC/rc_comm.shtml. Accessed 3 June, 2002.
8.State of California. Report on drug arrests in Calfornia from 1990 to 1999. Office of the Attorney General, Bureau of Criminal Information and Analysis.
Available at
http://caag.state.ca.us/cjsc/publications/misc/drugarrests/drugs2.pdf.
Accessed 30 May, 2002.
9.Maslow CB, Friedman SR, Perlis TE, Rockwell R, Des Jarlais DC. Changes in HIV seroprevalence and related behaviors among male injection drug users who do and do not have sex with men: New York City, 1990-1999. Am J Public Health 2002, 92:382-384.
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