Given the many associated public health consequences of sexual violence, Wolfe et al. conducted a study to estimate the prevalence of sexual victimization within an unidentified state prison system. The weighted estimates, which were constructed by gender and facility size, show that rates of inmate-on-inmate sexual victimization, defined as either abusive sexual contact (intentional touching of specified areas of the body) or nonconsensual sex acts (forced sex acts, including oral and anal sex), in the previous six months were highest for female inmates (212 per 1,000), more than four times higher than the rates for males (43 per 1,000). Additionally, abusive sexual conduct, was more likely between inmates and between staff and inmates than nonconsensual sexual acts, such as rape. These results were based on an audio-computer assisted interviews administered to 6,964 male and 564 female inmates housed in the twelve prison facilities. Extrapolating from the estimates, the authors suggest that the number of potential victims susceptible to HIV and other health consequences of sexual victimization could be as high as 22,000 male and over 3,200 female inmates on a national level. These staggering numbers underscore the need for targeted interventions to reduce this level of abuse.
Sexual Violence Inside Prisons: Rates and Victimization. Wolff, N et al. Journal of Urban Health. 2006;83(5):835-48.
Researchers at the University of North Carolina, utilizing data from each of the 100 counties in that state, found that county rates of sexually transmitted infections (STI) and teenage pregnancies consistently increased with increasing incarceration rates. Thomas and Torrone obtained the results, which are published in the American Journal of Public Health, by calculating the correlation between rates of incarceration in state prisons and county jails and rates of STIs and teenage pregnancies during the period of 1995 to 2002. The authors use the strong associations, especially between teenage pregnancy and the most common STIs, to propose that high incarceration rates have the unintended consequence of destabilizing communities and contributing to adverse health outcomes. Specifically, they note that fewer than one half of one percent of reported gonorrhea and chlamydial infections in 2000 were reported in correctional facilities, suggesting that many of the adverse effects are felt most strongly in the community, rather than the prison. The high rates of incarceration, the authors state, create a situation of "forced migration", not unlike that found in South Africa in the late 1930's, greatly altering gender ratios, which have been shown to affect rates of teenage pregnancy, and STIs such as syphilis, and gonorrhea. Despite the correlation, the authors do not believe that the negative community health effects alone will create a dramatic policy shift regarding alternatives to incarceration.
Incarceration as Forced Migration: Effects on Selected Community Health Outcomes. Thomas, JC et al. American Journal of Public Health. 2006;96(10):1762-65.
Due to the limited amount of information regarding the prevalence of bacterial STI infection in prison based settings, Bernstein et al set out to estimate the prevalence of Chlamydia trachomatis and Neisseria gonorrheae among newly arrived inmates at six California prisons. The cross sectional study of 698 men aged 18 to 25 years and 572 women aged 18 years and older revealed a high prevalence of C. trachomatis in both groups. Among men aged 18 to 25, the overall prevalence was 9.9%, while women of the same age exhibited a prevalence of 8.9%. The prevalence among all women was 3.3%. In contrast, only three cases of N. gonorrhoeae were detected with an overall prevalence of 0.24%, which was consistent with recent findings from other settings. The study of men was limited to an examination of those between the ages of 18-25, and given the high prevalence among this group, further study of all men entering prison may be justified. Despite the limitations, the authors suggest that the high prevalence of C. trachomatis infection, especially among young female and male inmates, supports routine screening upon entry into prison. Furthermore, the authors assert that screening in a jail setting, prior to entry into prison, may represent an excellent opportunity to identify and treat these infections, thus preventing complications and the burden of infection among this high-risk population.
Chlamydia trachomatis and Neisseria gonorrhoeae Infections Among Men and Women Entering California Prisons. Bernstein, KT et al. American Journal of Public Health. 2006;96(10):1862-66.
Working within a Massachusetts county jail, researchers found that the implementation of a routine, voluntary HIV testing program resulted in a significant increase in testing rates among inmates. The study, published in the Journal of Urban Health, details the program in which inmates were provided group counseling and then offered private HIV testing. Among the group receiving intervention, 73.1% (734 of 1,004) of eligible inmates accepted testing, compared to 18.0% (318 of 1,723) of inmates in the control group, receiving only inmate or physician requested testing. The most commonly cited reason for refusal in the study group was "tested in the prior year" (47.5%), followed by "not at risk" (29.4%). These results indicate a higher level of acceptance than previous studies of correctional HIV testing, due perhaps, the authors suggest, to improvements in HIV treatment or testing a population with a high background testing rate. Of the study group, 457 or 45.5% had been tested for HIV in prior years, most receiving their last test within a prison setting (78.2%). While cautioning against over-testing and redundancy among inmates, the authors use their results to emphasize that routine HIV counseling, testing, and referral is acceptable to inmates and results in high rates of testing.
Implementing a Routine, Voluntary HIV Testing Program in a Massachusetts County Prison. Liddicoat, RV et al. Journal of Urban Health. Epublished ahead of print.