High Rates of AIDS in Prisons Raise Public Health Issues

ATLANTA—AIDS prevalence among inmates of US prisons is five times higher than that of the general population, Theodore Hammett, PhD, said at the National HIV Prevention Conference.

In 1997, he said, 8,900 prisoners (0.5%) had AIDS, and an additional 35,000 to 47,000 were HIV positive. Among inmates of county/city jails, 1.2% to 1.8% were infected as were 2.3% to 2.98% of those in state and federal prisons—prevalence rates 4 to 10 times higher than that of the total population. Further, Dr. Hammett said, in 1997, an estimated 78,000 inmates had syphilis infection and about 43,000 had chlamydia infection.

Few Education Programs

Dr. Hammett emphasized that the prison systems do little to educate prisoners about how to prevent transmission once they are released. Only 10% of state and federal prisons and 5% of city and county jails make comprehensive HIV prevention programs available to inmates.

Comprehensive programs include instructor-led education, peer-led programs, pre- and post-test counseling, and multisession prevention counseling.

 Dr. Hammett noted that 7.75 million people are released from jails and prisons each year. In 1996, released prisoners made up 17% (39,000 cases) of the total number of US AIDS cases and 13.1% to 19.3% of all people with HIV infection (98,000 to 145,000). Yet, in 1997, less than one third of correctional systems made appointments for inmates with HIV/AIDS being released to receive medical, psychosocial, and other services in the community.

These findings suggest, Dr. Hammett said, that society is missing an important opportunity to provide prevention and treatment services in a high-risk “captive” population. Interventions would benefit not only inmates, their families and partners, but also the larger public health. “Such efforts could have ripple effects for public health, with possible downstream savings in costs of health care, law enforcement, and incarceration,” he said.

Data Used in the Study

Dr. Hammett, of Abt Associates Inc, a research and consulting firm in Cambridge, Massachusetts, conducted the study for the National Commission on Correctional Health Care, a Chicago-based organization that seeks to improve health care in prisons.

The estimates were based on data from surveys, journal articles, unpublished reports, and statistics on correctional populations, as well as data from Abt’s 1997 survey of US correctional systems, funded by the CDC and the National Institute of Justice, to examine the correctional policy response to HIV/AIDS and sexually transmitted diseases.