Important note: Information in this article was accurate in 2003. The state of the art may have changed since the publication date. Despite the large impact HIV/AIDS is having on correctional populations - and the increasing attention this issue is receiving - only one oral session and one poster at the conference addressed HIV/AIDS among inmates.
Unsafe sex common among recently-released HIV-positive inmates David Alain Wohl, M.D., of the University of North Carolina, presented results of a study1 of the post-release sexual practices of 86 HIV-infected state prison inmates. Wohl conducted the study to better understand the extent to which HIV-infected prison releasees contribute to the spread of HIV in communities to which they return.
"We noticed that there are many communities within the US in which the HIV infection rates and the incarceration rates are high," Wohl told conference participants. "And we were wondering if this is more than just a coincidence."
The study found that more than half of the HIV-infected inmates (51%) reported that they had sex soon after they are released from prison (the mean time was six days), and about one third of these individuals (26%) reported that they had unprotected sex with their main sex partner, on average within nine days of being released.
Interviews were conducted during incarceration and within three months after release. Average prison stays were about one or two years.
More than half (58%) of the study participants were women, 87% were non-white, and 81% were heterosexual. The study was done in North Carolina, a state that does not perform mandatory HIV testing upon entry or exit from prison.
The data were "surprising," Wohl said. Seventy-five percent said they had a "main" sex partner and 78% of these individuals reported having unprotected sex with that person one year before they went to prison.
Of the 57% who reported having other sex partners, the average number of partners was eight. The majority of partners in both categories were not known to have HIV infection.
All of the study participants said they had told their main sex partners that they were HIV-positive, but only two-thirds had told their other sex partners.
Thirty percent reported they believed it was "very likely" or "somewhat likely" that they would infect their main sex partner.
"In many communities, prisons facilitate the transmission of HIV by disrupting the social fabric and sexual network...and also by taking people out of the community, locking them up, and then releasing them to the community," Wohl said. "Our experience has been that when people get out of prison, there are two things they want to do, and one of them is to get a 'Big Mac."'
A poster presentation2 by Stephenson, et al examined health beliefs and adherence in a group of 65 North Carolina state inmates with HIV infection. Inmates almost uniformly believed that the PIs are worth taking and likely would prolong their life. Three-quarters trusted that their health care provider prescribed the best HIV medications and offered high-quality medical care. Finally, 68% preferred to self medicate ("Keep On Person") rather than receive Directly Observed Therapy (DOT) due to inconvenience and stigmatization issues.
* Nothing to disclose
1. HIV Transmission Risk Behaviors Among HIV-Infected Individuals Released from Prison. D A Wohl, L Shain, M Adamian, B L Stephenson, R Strauss, C Golin, A Kaplan. Conf Retroviruses Opportunistic Infect. 2003 Feb 10-15;10th: Abstract No. 36.
2. HIV-related Health Beliefs, Attitudes, and Adherence of Inmates in a Directly Observed Treatment Setting. B L Stephenson, D Wohl, R D Hays, C E Golin, H Liu, G Simpson, A H Kaplan, N Kiziah. Conf Retroviruses Opportunistic Infect. 2003 Feb 10-15;10th: Abstract No. 917.
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©1997,1998,1999,2000,2001,2002, 2003. The recently formed HIV Education Prison Project (HEPP) is a medical education program that targets a growing population, inmates in correctional facilities, that has been underserved in HIV care. It is part of the Brown University AIDS Program. Permission to use and reproduce portions of this newsletter is hereby granted provided that author and publication are fully credited and both copyright and permission notice appear with reprinted material. Inquiries may be directed to heppnews@brown.edu. Website: HIV Education Prison Project.
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