Author:
Christopher M. Salas, et al
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Date Posted: Sun, March 04 2001, 8:00:29 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
Christopher M. Salas, BS1, Grace E. Macalino, MPH1, Josiah D. Rich, MD1, Megan E. Gaydos, BS1, Michelle McKenzie, MPH1, Anne Spaulding, MD2, and David Vlahov, PhD3 . (1) Department of Immunology, The Miriam Hospital/Brown University, 164 Summit Ave, Providence, RI 02906, (2) Rhode Island Department of Corrections/Brown University, (3) New York Academy of Medicine
Background: Prisoners are more likely to have a history of injection drug use (IDU) than the community, increasing their risk for HIV and other bloodborne pathogens. Our goals were to measure intake prevalence of bloodborne pathogens among sentenced inmates in Rhode Island, and to begin assessing intraprison transmission.
Methods: Discarded intake sera from 675 individuals (86.2% male; 62.5% white, 23.5% black, 12.9% hispanic) incarcerated between 1998-99 were tested for HIV, hepatitis B, C, and HTLV I/II in a blinded fashion. Intraprison incidence was estimated by consenting inmates continuously incarcerated for 11 months or more to a follow-up test.
Results: At intake, HIV prevalence was 1.3%, hepatitis B, 19.8%, hepatitis C, 24.7%, and HTLV-II, 1.2%. All HIV+ inmates had coinfections. Overall, 6.2% had visible track marks, compared to those that tested positive for at least one infection (21.8%). The entire study group reported rate of IDU was 13%; higher reports were given for those infected: HIV (66.7%), HBV (38.1%), HCV (46.7%), HTLV-II (50.0%). 41 of the 675 inmates were still incarcerated 11 months later, consented, and tested (53.1 person-years). No seroconversions to HIV, hepatitis C, or HTLV-II were found; two cases of hepatitis B seroconversion were detected based on HbcAb (2/53.1 person-years).
Conclusions: Among incarcerated Rhode Island inmates the intake prevalence of HIV is lower than hepatitis B and C. Preliminary data suggests intraprison transmission is very low. Since risk behaviors associated with these infections are similar, prisons represent a public health opportunity for the treatment and prevention of HIV and other bloodborne pathogens.
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