Abstract
IntroductionHIV prevalence among state prison inmates in the United States is more than five times higher than among nonincarcerated persons, but HIV transmission within U.S. prisons is sparsely documented. We investigated 88 HIV seroconversions reported from 1988–2005 among male Georgia prison inmates.MethodsWe analyzed medical and administrative data to describe seroconverters' HIV testing histories and performed a case-crossover analysis of their risks before and after HIV diagnosis. We sequenced the gag, env, and pol genes of seroconverters' HIV strains to identify genetically-related HIV transmission clusters and antiretroviral resistance. We combined risk, genetic, and administrative data to describe prison HIV transmission networks.ResultsForty-one (47%) seroconverters were diagnosed with HIV from July 2003–June 2005 when voluntary annual testing was offered. Seroconverters were less likely to report sex (OR [odds ratio] = 0.02, 95% CI [confidence interval]: 0–0.10) and tattooing (OR = 0.03, 95% CI: <0.01–0.20) in prison after their HIV diagnosis than before. Of 67 seroconverters' specimens tested, 33 (49%) fell into one of 10 genetically-related clusters; of these, 25 (76%) reported sex in prison before their HIV diagnosis. The HIV strains of 8 (61%) of 13 antiretroviral-naïve and 21 (40%) of 52 antiretroviral-treated seroconverters were antiretroviral-resistant.DiscussionHalf of all HIV seroconversions were identified when routine voluntary testing was offered, and seroconverters reduced their risks following their diagnosis. Most genetically-related seroconverters reported sex in prison, suggesting HIV transmission through sexual networks. Resistance testing before initiating antiretroviral therapy is important for newly-diagnosed inmates.
Highlights
HIV prevalence among state prison inmates in the United States is more than five times higher than among nonincarcerated persons, but HIV transmission within U.S prisons is sparsely documented
In a previous case-control study among Georgia Department of Corrections (GDC) male inmates, we found that sex in prison, tattooing in prison, black race, and a body mass index of 25.4 kg/m2 or less were significantly associated with HIV seroconversion [7]
Facility of infection{ Definite facility identified Probable facility identified Unknown facility of infection Incarceration Previously incarcerated in Georgia prison system Median # of previous incarcerations Current incarceration: primary offense
Summary
HIV prevalence among state prison inmates in the United States is more than five times higher than among nonincarcerated persons, but HIV transmission within U.S prisons is sparsely documented. We investigated 88 HIV seroconversions reported from 1988–2005 among male Georgia prison inmates. The estimated prevalence of HIV infection in the United States is more than five times higher among state prison inmates (1.9%) than for the general population (0.37%) [1,2]. Most inmates with HIV are infected before they enter prison, HIV risk behaviors, and occasionally HIV infection, during incarceration have been reported [3,4,5,6,7]. In a previous case-control study among GDC male inmates, we found that sex in prison, tattooing in prison, black race, and a body mass index of 25.4 kg/m2 or less were significantly associated with HIV seroconversion [7]
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