Characteristics and Behaviors Associated With HIV Among Inmates in the North Carolina Prison System

The study authors "identified factors associated with testing HIV-positive in a prison system performing voluntary HIV testing on inmates and estimated the number of undetected HIV cases to evaluate the efficacy of risk-factor-based HIV testing."

Logistic regression was employed to estimate associations between HIV serostatus and HIV risk behaviors, mental health, co-infection status, and sociodemographic characteristics for prisoners entering the North Carolina Department of Corrections from January 2004 through May 2006. The authors estimated the number of undetected HIV cases on the basis of age-, gender-, and race-specific HIV prevalences among inmates and in the state.

Almost 3.4 percent (718/21,419) of prisoners tested were HIV-positive, with the strongest risk factors for infection among men being sex with men (odds ratio [OR]=8.0), black race (OR=6.2), other non-white race (OR=7.4), and ages 35-44 (OR=4.1). Among women, the strongest risk factor was black race (OR=3.8). Sixty-five percent of HIV-positive prisoners were also co-infected with hepatitis C virus. An estimated 223 to 1,101 HIV cases (24 percent, 61 percent, respectively) remained undetected.

"The associations between HIV serostatus and a variety of factors highlight the potential limitations of risk-factor-based HIV testing in prisons, as do the high number of potential undetected HIV cases," concluded the authors.

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