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AIDS November 2002; 16(16):2236-2238
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Date Posted: Sun, October 27 2002, 10:04:57 PST
In reply to:
American Public Health Association
's message, "The APHA Standards for Health Care in Correctional Institutions Revised" on Sun, March 04 2001, 7:56:54 PST
Trends in hepatitis C and HIV infection among inmates entering prisons in California, 1994 versus 1999
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 Analy sis.
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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