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Earlier Chance at HIV Diagnosis Probably Often Missed in Prison
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48th ICAAC, October 25-28, 2008, Washington, DC
Mark Mascolini
More than half of South Carolina prison inmates diagnosed with HIV in a 5-year-span had already passed through the correctional system at least once, a finding suggesting many missed opportunities at earlier HIV diagnosis [1]. A multiple arrest record independently raised the risk of a late HIV diagnosis, defined here as having AIDS within 1 year of getting a positive HIV test.
The investigators argued that testing prisoners "could facilitate early diagnosis of HIV infection in a population that might not otherwise have the ability to seek medical care."
The study involved 4117 people first diagnosed with HIV in prison from January 2001 through December 2005. University of South Carolina researchers analyzed arrest data for all these individuals and used logistic regression to determine the impact of previous arrests on late diagnosis of HIV.
Of the 4117 people with a positive HIV test, 2332 (57%) had at least 1 prior arrest and 1675 (41%) had been arrested within 10 years of their positive test. The researchers could classify 2350 people (68%) as late testers and 1099 (32%) as early testers. A slightly higher proportion of late testers than early testers (13% versus 9%) got arrested for drug or alcohol offenses. Although sex crime arrests accounted for only 1% of arrests in both early and late testers, these people may well have had consensual sex after passing through the correctional system with a missed HIV diagnosis.
Logistic regression analysis found that male gender, older age, and more previous arrests raised the risk of late HIV diagnosis, at the following odds ratios (OR), with 95% confidence intervals in parentheses:
· Men were 26% less likely than women to be early testers: OR 0.76 (0.59-0.88)
· 25-to-29-year-olds were 2.6 times more likely than 20-to-24-year-olds to be late testers: OR 2.60 (1.58-4.30)
· 30-to-39-year-olds were 3.7 times more likely than 20-to-24-year-olds to be late testers: OR 3.73 (2.42-5.73)
· 40-to-49-year-olds were 3.7 times more likely than 20-to-24-year-olds to be late testers: OR 3.73 (2.41-5.77)
· People 50 or older were 5.6 times more likely than 20-to-24-year-olds to be late testers: OR 5.59 (3.22-9.71)
· People with 2-4 arrests were 50% more likely than people with 1 arrest to be late testers: OR 1.50 (1.16-1.92)
· People with 5-7 arrests were twice more likely than people with 1 arrest to be late testers: OR 2.00 (1.33-3.02)
· People with 8 or more arrests were 4.5 times more likely than people with 1 arrest to be late testers: OR 4.52 (2.52-8.10)
The risk of being a late tester rose significantly with age (P < 0.001) and with number of prior arrests (P < 0.0001). HIV transmission risk group did not influence late versus early HIV diagnosis.
Other researchers estimated that 25% of all HIV-infected US residents pass through the correctional system every year [2]. The South Carolina investigators believe their findings point to "the need to implement routine HIV screening in South Carolina correctional facilities."
References
1. Duffus W, Youmans E. Missed opportunities for early HIV diagnosis in jails: South Carolina January 2001-December 2005. 48th Annual International Conference on Antimicrobial Agents and Chemotherapy (ICAAC). October 25-28, 2008. Washington, DC. Abstract H-471.
2. Spaulding A, Stephenson B, Macalino G, et al. Human immunodeficiency virus in correctional facilities: a review. Clin Infect Dis. 2002;35:305-312.
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