The analysis, conducted by researchers with The Miriam Hospital, The Warren Alpert Medical School of Brown University, Rhode Island Department of Corrections (RIDOC), Rhode Island Department of Health (RIDOH) and the CDC, supports previous CDC recommendations calling for HIV testing in jails and prisons as part of a routine medical evaluation.
During a eight-year period, 73 percent of all RIDOC inmates were provided HIV testing during a medical evaluation within 24 hours of incarceration. Nearly 170 new HIV diagnoses, representing more than 15 percent of all newly-diagnosed people with HIV in Rhode Island during the same time period, were identified through this RIDOC testing program.
According to lead author Curt G. Beckwith, MD, an infectious disease specialist with The Miriam Hospital, this testing rate is both noteworthy and encouraging, given that individuals who are unaware of their HIV infection are more than three times more likely to transmit the virus compared to those who are aware of their infection. In addition, HIV rates among prisoners are more than four times higher than in the general population.
"Jails and correctional facilities provide a golden opportunity to offer HIV testing to a population that is hard-to-reach and at increased risk of infection," says Beckwith. "Expansion of HIV testing within jails has the potential to increase HIV diagnoses and make more people aware of their HIV status, which could help reduce the spread of the disease in the United States."
HIV testing has been routinely offered to every person entering the RIDOC since 1991 as part an initial medical evaluation conducted within 24 hours of confinement. Test results are available within a week or two. Anyone who receives an HIV-positive result while incarcerated is notified by an HIV clinical nurse and receives prevention counseling and referrals to HIV care both in the prison setting and in the community. Individuals with a positive diagnosis who are released before they can be notified are contacted by a RIDOH outreach worker who also provides care referrals and prevention counseling.
Following a detailed review of RIDOC records and RIDOH surveillance data, researchers determined that if HIV testing had been conducted after the first 48 hours of incarceration, approximately 29 percent of detainees with new HIV diagnoses would not have been tested. What's even more troubling: if all testing had occurred beyond seven days of incarceration, 43 percent of HIV-positive inmates who had been released within that timeframe would not have been tested, resulting in a delay in their diagnosis and the opportunity for them to unknowingly spread the disease.
In addition, nearly half of the newly-diagnosed HIV-positive inmates did not disclose HIV risk behaviors, such as injection drug use or high risk sexual behaviors. Beckwith, who is also an assistant professor of medicine at Alpert Medical School and a physician with University Medicine, says this finding could be an issue for jurisdictions that rely on HIV testing based on known risk behaviors, since it appears they may miss a sizeable number of HIV-positive detainees.
"These results support policies for HIV testing upon jail intake and routinely providing voluntary, opt-out HIV testing to all detainees, regardless of reported risk factors, in order to maximize our ability to diagnose as many new cases as possible," he adds.
From 2000 through 2007, the RIDOC jail processed 140,739 criminal offenses and conducted 102,229 HIV tests. Due to multiple arrests of some detainees during this timeframe, the total number of HIV tests performed represents approximately 40,000 to 60,000 unique individuals. That's because some detainees may have been tested multiple times depending upon arrest frequency and the time between incarcerations.
The majority of newly-diagnosed detainees were male (90 percent) and more than three-quarters were between the ages of 30 and 49. Blacks and Hispanics represented 72 percent of all cases.
Study co-authors included Josiah D. Rich, MD, and Timothy P. Flanigan, MD, from The Miriam Hospital, Alpert Medical School and University Medicine; Michael M. Poshkus, MD, Ann-Marie Bandieri, Nicole Aucoin and Patricia Threats, RN, from the RIDOC; Sutopa Chowdhury, MBBS, MPH, Paul Loberti, MPH and Lucille Minuto, RN, BSN, Med, from the RIDOH; and Robin MacGowan, MPH, Andrew Margolis, MPH, Cari Courtenay-Quick, PhD, and Walter Chow from the CDC's National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention.
The Miriam Hospital, established in 1926 in Providence, RI, is a private, not-for-profit hospital affiliated with The Warren Alpert Medical School of Brown University and a founding member of the Lifespan health system. For more information about The Miriam Hospital, please visit www.miriamhospital.org
University Medicine (www.umfmed.org) is a non-profit, multi-specialty medical group practice employing many of the full-time faculty of the department of medicine of the Alpert Medical School.
Jessica Collins Grimes | EurekAlert!
Amputees can learn to control a robotic arm with their minds
28.11.2017 | University of Chicago Medical Center
The importance of biodiversity in forests could increase due to climate change
17.11.2017 | Deutsches Zentrum für integrative Biodiversitätsforschung (iDiv) Halle-Jena-Leipzig
MPQ scientists achieve long storage times for photonic quantum bits which break the lower bound for direct teleportation in a global quantum network.
Concerning the development of quantum memories for the realization of global quantum networks, scientists of the Quantum Dynamics Division led by Professor...
Researchers have developed a water cloaking concept based on electromagnetic forces that could eliminate an object's wake, greatly reducing its drag while...
Tiny pores at a cell's entryway act as miniature bouncers, letting in some electrically charged atoms--ions--but blocking others. Operating as exquisitely sensitive filters, these "ion channels" play a critical role in biological functions such as muscle contraction and the firing of brain cells.
To rapidly transport the right ions through the cell membrane, the tiny channels rely on a complex interplay between the ions and surrounding molecules,...
The miniaturization of the current technology of storage media is hindered by fundamental limits of quantum mechanics. A new approach consists in using so-called spin-crossover molecules as the smallest possible storage unit. Similar to normal hard drives, these special molecules can save information via their magnetic state. A research team from Kiel University has now managed to successfully place a new class of spin-crossover molecules onto a surface and to improve the molecule’s storage capacity. The storage density of conventional hard drives could therefore theoretically be increased by more than one hundred fold. The study has been published in the scientific journal Nano Letters.
Over the past few years, the building blocks of storage media have gotten ever smaller. But further miniaturization of the current technology is hindered by...
With innovative experiments, researchers at the Helmholtz-Zentrums Geesthacht and the Technical University Hamburg unravel why tiny metallic structures are extremely strong
Light-weight and simultaneously strong – porous metallic nanomaterials promise interesting applications as, for instance, for future aeroplanes with enhanced...
11.12.2017 | Event News
08.12.2017 | Event News
07.12.2017 | Event News
13.12.2017 | Health and Medicine
13.12.2017 | Physics and Astronomy
13.12.2017 | Life Sciences