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Unsafe Sex is Common Among HIV-Infected Prisoners Shortly After Release
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"HIV Transmission Risk Behaviors Among HIV-infected Individuals Released from Prison"
As many as 20% of HIV-infected persons in the U.S. enter and leave a correctional facility each year. To what extent HIV-infected prison releasees contribute to the spread of HIV in the communities to which they return is not well described. The author of the study, David Wohl, MD, noticed that there are many communities within the US in which the HIV infection rates and the incarceration rates are high
The study was done in North Carolina, one of the states that does not perform mandatory testing for HIV infection upon entry or exit from prison, he added.
Over half (51%) of HIV-infected releasees stated they had sex soon after being released from prison. 64% of releasees said their main sex partner from before inprisonment did not have HIV, but 24% of releasees reported having sex with their main partners soon after release from prison. Half of the releasees were women.
At follow-up interviews after release from prison, 26% had already had unprotected sex with their main sex partner, Dr. Wohl reported. The average time to sex after release was 6 days.
All of the subjects said they had told their main sex partners that they were HIV-infected, but only two thirds had told their other sex partners. Thirty percent of the subjects reported they believed it was "very likely" or "somewhat likely" that they would infect their main sex partner
This was a prospective observational study. From May 01-Oct 02, 80 HIV-infected state prison inmates within 3 months of release were enrolled. Subjects were interviewed prior to release about pre-incarceration and expected post-release sexual and drug-related HIV transmission risk behaviors. Follow-up phone interviews were conducted 30-60 days following release. The average prison stays were about 1 or 2 years
Of the 80 subjects enrolled (58% women, 87% non-white, 81% heterosexual, mean age = 36 yrs), 83% have been released. Pre-incarceration crack cocaine use was reported by 84% of subjects and 29% had injected drugs. Post-release interviews have been conducted in 85% of those eligible a mean of 36
days following release. Within 6 months of release, 2 subjects died and 4 were re-incarcerated.
Prior to incarceration, 74% of inmates had a main sex partner (MP) with whom 79% report unprotected sex during the year before incarceration (54% of MP were HIV-uninfected). Seventy-five percent (75%) of inmates had other sex partners (OP) in the year prior to incarceration (mean OP number = 12, range 1-1,460) and 74% had unprotected sex with their OP in the year before they came to prison (64% of OP were HIV-uninfected; 19% were of unknown HIV status).
Over half (51%) of releasees stated they had sex since release (mean time to sex post-release = 6 days, range 1-744 hours). A MP without HIV or of unknown HIV status was reported by 64% of releasees with a MP; however, 24% had unprotected sex with their MP since release. Given their current sex behavior, 31% of releasees felt that it was very or somewhat likely that they would infect their HIV-negative MP. Since release, 16% reported using street drugs at least once a week, 18% have used crack cocaine, and 8% have injected drugs.
The authors concluded that immediately following prison release a significant proportion of HIV-infected former inmates engage in behaviors with high risk of transmitting HIV and may play a significant role in the transmission of the virus within the communities to which they return. There is an urgent need for the development of interventions to reduce HIV transmission risk behaviors of HIV-infected releasees.
Abst. 36. Retrovirus Conference 2003, Feb 10-14, Boston, MA. D. A. Wohl, Univ of North Carolina, Chapel Hill
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