HIV Transmission in a State Prison System, 1988-2005

HIV prevalence among state prison inmates is estimated to be more than five time higher than for the general US population, the study authors noted. However, data on transmission, risk modification after diagnosis, transmission networks, and antiretroviral (ARV) resistance within large state prison systems are sparse. In the current study, investigators analyzed 88 HIV seroconversions reported during 1988-2005 among male prison inmates in Georgia.

The authors analyzed medical and administrative records to determine HIV testing histories, and they performed a case-crossover analysis of HIV risks before and after diagnosis. Seroconverters' HIV strains were studied to identify genetically related transmission clusters and ARV resistance.

Among all seroconverters, 41 (47 percent) were diagnosed when voluntary annual HIV testing was offered, from July 2003 to June 2005. Compared to before their diagnoses, HIV seroconverters were less likely after diagnosis to report sex (odds ratio [OR]=0.02, 95 percent confidence interval [CI]: 0-0.10) and tattooing (OR=0.03, 95 percent CI: less than 0.01-0.20) in prison. Of 67 seroconverters' specimens tested, 33 (49 percent) fell into one of 10 genetically related clusters. Among these, 25 (76 percent) reported sex in prison before their diagnosis. The viral strains of eight out of 13 (61 percent) ARV-naive prisoners were ARV-resistant, as were 21 out of 52 (40 percent) ARV-experienced prisoners.

"Half of all HIV seroconversions were identified when routine voluntary testing was offered, and seroconverters reduced their risks following their diagnosis," concluded the authors. "Most genetically related seroconverters reported sex in prison, suggesting HIV transmission through sexual networks. Resistance testing before initiating antiretroviral therapy is important for newly diagnosed inmates."

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