Characteristics and behaviors associated with HIV infection among inmates in the North Carolina prison system.
OBJECTIVE
We 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.


METHODS
We used logistic regression to estimate associations between HIV serostatus and HIV risk behaviors, mental health, coinfection status, and sociodemographic characteristics for prisoners entering the North Carolina Department of Correction from January 2004 through May 2006. We estimated the number of undetected HIV cases on the basis of age-, gender-, and race-specific HIV prevalences among prisoners and in the state.


RESULTS
Nearly 3.4% (718/21 419) of tested prisoners were HIV positive. The strongest risk factors for infection among men were having sex with men (odds ratio [OR] = 8.0), Black race (OR = 6.2), other non-White race (OR = 7.4), and being aged 35 to 44 years (OR = 4.1). The strongest risk factor among women was Black race (OR = 3.8). Among HIV-positive prisoners, 65% were coinfected with HCV. We estimated that between 24% (223) and 61% (1101) of HIV cases remained undetected.


CONCLUSIONS
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.
University of North Carolina, Chapel Hill, 27599-7435, USA.
David L
DL
Rosen
Victor J
VJ
Schoenbach
David A
DA
Wohl
Becky L
BL
White
Paul W
PW
Stewart
Carol E
CE
Golin
D000293:Adolescent; D000328:Adult; D001741:Black or African American; D005260:Female; D015658:HIV Infections / Q000175:diagnosis / Q000453:epidemiology*; D006526:Hepatitis C / Q000453:epidemiology; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D011329:Prisoners / Q000706:statistics & numerical data*; D012307:Risk Factors; D012309:Risk-Taking; D012725:Sexual Behavior; D019966:Substance-Related Disorders / Q000453:epidemiology; D014376:Tuberculosis / Q000453:epidemiology; D055815:Young Adult