Undiagnosed HIV Infection Among New York City Jail Entrants, 2006: Results of a Blinded Serosurvey

Among New York City jail entrants, HIV testing has increased four-fold since 2004, when personnel began offering all inmates rapid testing at intake. To help improve services, the current study determined HIV prevalence among jail entrants, including the proportion undiagnosed.

In 2006, remnant serum from routine syphilis testing was salvaged for blinded HIV screening. Before permanently removing identifiers, the authors determined previously undiagnosed HIV infections by referring to HIV surveillance and electronic clinical data. "Undiagnosed" individuals were those who had not been reported to surveillance and denied HIV infection.

Among those entering jail, 68.9 percent (6,411) were tested, and total HIV prevalence was 5.2 percent (4.7 percent of males and 9.8 percent of females). Adjusting for those not in the serosurvey, total estimated prevalence was 8.7 percent (6.5 percent of males and 14 percent of females).

Of HIV infections identified in the serosurvey, 28.1 percent were undiagnosed at intake, of which only 11.5 percent were diagnosed through routine testing. Of those with undiagnosed infection, only 11.1 percent reported injection drug use or being men who have sex with men.

"About 5-9 percent of New York City jail entrants are HIV-infected," the authors concluded. "Of the infected, 28 percent are undiagnosed; most of whom denied recognized HIV risk factors. To increase inmates' acceptance of routine testing, we are working to eliminate the required separate written consent for HIV testing to allow implementation of the Centers for Disease Control and Prevention-recommended opt-out testing model."

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