1. HIV Epidemiology in Corrections Albany Medical College Division of HIV Medicine HIV Regional Resource Center Updated January 2011 HIV Correctional Regional Resource Center

2. Data Source for this Module Unless otherwise noted, data in this slide set is taken directly from an HIV report from the U.S. Department of Justice’s statistical agency, The Bureau of Justice Statistics (BJS).Unless otherwise noted, data in this slide set is taken directly from an HIV report from the U.S. Department of Justice’s statistical agency, The Bureau of Justice Statistics (BJS). Report name: HIV in Prisons, 2007-2008, NCJ 228307(Statistician: Laura M. Maruschak)Report name: HIV in Prisons, 2007-2008, NCJ 228307 (Statistician: Laura M. Maruschak) These slides include highlights taken directly from the most recent HIV report available from the BJS (December 2009). The full report may be obtained from www.ojp.usdoj.gov/bjsThese slides include highlights taken directly from the most recent HIV report available from the BJS (December 2009). The full report may be obtained from www.ojp.usdoj.gov/bjs

3. General Corrections Overview On December 31, 2009, state and federal correctional authorities had jurisdiction* over 1,613,740 inmates (1,500,278 males and 113,462 females)On December 31, 2009, state and federal correctional authorities had jurisdiction* over 1,613,740 inmates (1,500,278 males and 113,462 females) This was an increase of 3,981 inmates from year end 2008.This was an increase of 3,981 inmates from year end 2008. Prisoners in 2009, BJS * Jurisdiction refers to the legal authority over a prisoner, regardless of where the prisoner is held.

4. General Corrections Overview (con’t) This 0.2% increase marked the third consecutive year of slower growth in the U.S. prison population and the smallest increase during the decade.This 0.2% increase marked the third consecutive year of slower growth in the U.S. prison population and the smallest increase during the decade. From 2000 to 2008, the state prison population increased by 159,200 prisoners, and violent offenders accounted for 60% of this increase.From 2000 to 2008, the state prison population increased by 159,200 prisoners, and violent offenders accounted for 60% of this increase. The number of drug offenders in state prisons declined by 12,400 over this period.The number of drug offenders in state prisons declined by 12,400 over this period. Prisoners in 2009, BJS

5. HIV-infected Inmates in U.S. Prisons At year end 2008, a reported 21,987 inmates held in state or federal prisons were HIV positive or had confirmed AIDS.At year end 2008, a reported 21,987 inmates held in state or federal prisons were HIV positive or had confirmed AIDS. This accounts for 1.5% of the total custody population.This accounts for 1.5% of the total custody population. Among states that reported data in 2006 through 2008, the number of inmates with HIV/AIDS was stable between 2007 and 2008.Among states that reported data in 2006 through 2008, the number of inmates with HIV/AIDS was stable between 2007 and 2008.

6. Women versus Men with HIV Infection There are a greater percent of females than males with HIV infection in the incarcerated population.There are a greater percent of females than males with HIV infection in the incarcerated population. At year end 2008, 1.5% (20,075) of male inmates and 1.9% (1,912) of female inmates held in state or federal prisons were HIV positive or had confirmed AIDS.At year end 2008, 1.5% (20,075) of male inmates and 1.9% (1,912) of female inmates held in state or federal prisons were HIV positive or had confirmed AIDS.

7. Women versus Men with HIV Infection Among states reporting data in both 2007 and 2008, the number of males with HIV/AIDS increased by 186 and the number of females decreased 214.Among states reporting data in both 2007 and 2008, the number of males with HIV/AIDS increased by 186 and the number of females decreased 214. Florida (334) reported the largest number of female inmates with HIV/AIDS, followed by New York (300),and Texas (249). Six states reported having zero female inmates with HIV/AIDS.Florida (334) reported the largest number of female inmates with HIV/AIDS, followed by New York (300),and Texas (249). Six states reported having zero female inmates with HIV/AIDS.

8. Confirmed AIDS Cases in U.S. Prisons Confirmed AIDS Cases in U.S. Prisons At year end of 2008, an estimated 5,733 state and federal inmates had confirmed AIDS. Confirmed AIDS cases made up 0.5% of inmates in state prison and 0.3% of inmates in federal prison.Confirmed AIDS cases made up 0.5% of inmates in state prison and 0.3% of inmates in federal prison. Confirmed AIDS cases accounted for nearly a quarter (24%) of all HIV/AIDS cases in state and federal prison.Confirmed AIDS cases accounted for nearly a quarter (24%) of all HIV/AIDS cases in state and federal prison.

9. AIDS-Related Mortality During 2007, the most recent year for which data on inmates deaths are available for state prisons,120 state inmates died from AIDS-related causes, down from an estimated 155 in 2006.During 2007, the most recent year for which data on inmates deaths are available for state prisons,120 state inmates died from AIDS-related causes, down from an estimated 155 in 2006. Of the 120 AIDS-related deaths among state inmate in 2007, 112 were males and 8 were femalesOf the 120 AIDS-related deaths among state inmate in 2007, 112 were males and 8 were females Florida (14) reported the largest number of AIDS- related deaths, followed by New York (11) and Texas (10).Florida (14) reported the largest number of AIDS- related deaths, followed by New York (11) and Texas (10).

10. AIDS-Related Mortality (con’t) NPS-1 = National Prisoners Statistics - 1 DCRP = Deaths in Custody Reporting Program

11. Inmate Deaths in Federal Prisons by Cause (2007 & 2008)

12. HIV Testing in Prisons Appendix Table 5 in the BJS 2007-08 report provides a breakdown of individual state’s testing policies. Go to www.ojp.usdoj.gov/bjsAppendix Table 5 in the BJS 2007-08 report provides a breakdown of individual state’s testing policies. Go to www.ojp.usdoj.gov/bjs During 2008, a total of 24 states reported testing all inmates for HIV at admission or sometime during custody.During 2008, a total of 24 states reported testing all inmates for HIV at admission or sometime during custody. Among these 24 states, 23 tested prisoners at admission, 5 tested while in custody, and 6 tested upon release.Among these 24 states, 23 tested prisoners at admission, 5 tested while in custody, and 6 tested upon release.

13. HIV Testing in Prisons (con’t) All fifty states and the federal system tested inmates if they had clinical indication of HIV infection or if they requested an HIV test.All fifty states and the federal system tested inmates if they had clinical indication of HIV infection or if they requested an HIV test. Forty-two states and the federal system tested inmates after they were involved in an incident in which an inmate was exposed to a possible HIV transmission.Forty-two states and the federal system tested inmates after they were involved in an incident in which an inmate was exposed to a possible HIV transmission. 18 states and the federal system tested inmates who belonged to specific “high-risk” groups.18 states and the federal system tested inmates who belonged to specific “high-risk” groups.

14. Concentration of HIV-infected Inmates Geographically Florida (3,626), New York (3,500), and Texas (2,450) reported the largest number of inmates who were HIV positive or had confirmed AIDS.Florida (3,626), New York (3,500), and Texas (2,450) reported the largest number of inmates who were HIV positive or had confirmed AIDS. These three states account for 24% of the total state custody population, but 46% of the state custody population who were HIV positive or had confirmed AIDS.These three states account for 24% of the total state custody population, but 46% of the state custody population who were HIV positive or had confirmed AIDS. Appendix table 1 gives state-specific data. Go to www.ojp.usdoj.gov/bjsAppendix table 1 gives state-specific data. Go to www.ojp.usdoj.gov/bjs

15. Resources AIDS Education & Training Centers National Resource Center www.aids-ed.org AIDS Education Global Information System www.aegis.com Albany Medical College Division of HIV Medicine www.amc.edu/hiv Bureau of Justice Statistics www.ojp.usdoj.gov/bjs CDC National Prevention Information Network www.cdcnpin.org HIV Clinical Resource, New York State Department of Health AIDS Institute www.hivguidelines.org Johns Hopkins AIDS Service www.hopkins-aids.edu

16. Acknowledgments Douglas G. Fish, MD Medical Director Division of HIV Medicine Albany Medical College Sarah J. Walker, M.S. Associate Director of Correctional Education Division of HIV Medicine Albany Medical College Abigail V. Gallucci Director of AIDS Education Division of HIV Medicine Albany Medical College Jim Ybarra Project Assistant Division of HIV Medicine Albany Medical College