HIV transmission in a state prison system,

HIV transmission in a state prison system,

HIV prevalence among state prison inmates in the United States is more than five times higher than among non-incarcerated persons, but HIV transmission within U.S. prisons is sparsely documented. Jafa and colleagues investigated 88 HIV seroconversions reported from 1988-2005 among male Georgia prison inmates. They analyzed medical and administrative data to describe seroconverters’ HIV testing histories and performed a case-crossover analysis of their risks before and after HIV diagnosis. The authors sequenced the gag, env, and pol genes of seroconverters’ HIV strains to identify genetically-related HIV transmission clusters and antiretroviral resistance. They combined risk, genetic, and administrative data to describe prison HIV transmission networks. Forty-one (47%) seroconverters were diagnosed with HIV from July 2003-June 2005 when voluntary annual testing was offered. Seroconverters were less likely to report sex (OR [odds ratio] = 0.02, 95% CI [confidence interval]: 0-0.10) and tattooing (OR = 0.03, 95% CI: <0.01-0.20) style="text-decoration: underline;">Of 67 seroconverters’ specimens tested, 33 (49%) fell into one of 10 genetically-related clusters; of these, 25 (76%) reported sex in prison before their HIV diagnosis. The HIV strains of 8 (61%) of 13 antiretroviral-naïve and 21 (40%) of 52 antiretroviral-treated seroconverters were antiretroviral-resistant. Half of all HIV seroconversions were identified when routine voluntary testing was offered, and seroconverters reduced their risks following their diagnosis. 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.

Although HIV testing is mandatory at prison entry since 1988 in Georgia, USA and voluntary annual testing was introduced in 2003, HIV testing and counselling is not offered to inmates at the time of release from prison. HIV prevention programming to reduce risk of HIV exposure while incarcerated, an offer of pre-release HIV testing, and referral to ensure uninterrupted medial care on release are custodial corrections responsibilities. Drug resistance testing before and during antiretroviral treatment is particularly important in closed settings such as this where resistant virus clearly is being transmitted.