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![]() Epidemiologic Notes and Reports Acquired Immunodeficiency Syndrome in Correctional Facilities: A Report of the National Institute of Justice and the American Correctional AssociationRecently, the National Institute of Justice (NIJ) of the U.S. Department of Justice, and the American Correctional Association (ACA) jointly sponsored the development of a report on the incidence of acquired immunodeficiency syndrome (AIDS) in correctional facilities, the issues and options facing correctional administrators in formulating policy responses to the problem, and the rationales advanced for various policy choices (1). The report was based, in part, on a questionnaire mailed to all 50 state correctional departments, the Federal Bureau of Prisons, and 37 large city and county jail systems. Following are key findings of the report.
Reported by TM Hammett, PhD, Abt Associates, Inc, Cambridge, Massachusetts; National Institute of Justice, US Dept of Justice, Washington, DC; American Correctional Association, College Park, Maryland; AIDS Program, Center for Infectious Diseases, CDC. Editorial NoteEditorial Note:The NIJ/ACA report illustrates both the scope of the AIDS problem in correctional facilities and the diversity of the responses such facilities are taking. The apparent lack of reported AIDS cases among correctional staff as a result of contact with inmates is consistent with previous findings that the risk of HTLV-III/LAV transmission in occupational settings is extremely low and does not appear to result from casual contact. Correctional staff should follow published guidelines for preventing transmission of HTLV-III/LAV infection in the workplace (3). Since IV drug abuse is an important predisposing factor to both incarceration and HTLV-III/LAV infection, it is not surprising to find AIDS cases in inmate populations. It is also not surprising that a high proportion of cases among inmates has been reported from correctional facilities in New York and New Jersey, since those two states have reported 62% of all U.S. AIDS cases associated with histories of IV drug abuse. In addition, the proportion of IV drug abusers with HTLV-III/LAV antibody is reported to be higher in New York City and northern New Jersey than in other parts of the country (4). Incarceration is not, in itself, associated with a risk of HTLV-III/LAV transmission. The risk of transmission in inmate populations depends on the prevalence of infection among persons who have been incarcerated and the frequency with which such persons might participate in IV drug abuse, with sharing of needles, or in sexual contact with other inmates. However, data to quantify this risk have been quite limited. Thus far, the only study of HTLV-III/LAV transmission among inmates was conducted by the Maryland Division of Corrections (5). In that study, conducted from April through July 1985, serologic testing for HTLV-III/LAV antibody was offered at one facility to all 360 inmates who had been incarcerated 7 years or longer. Of the 137 inmates who participated, two (1%), both of whom had been incarcerated for 9 years, were seropositive by both enzyme immunoassay and Western blot methods. Because testing was done in a way to preserve anonymity, additional information about the seropositive inmates was not available. The possible effects of selection bias in this study are also unknown. Additional data are available from correctional facilities on the incidence of infection with hepatitis B virus (HBV), which has routes of transmission generally similar to those of HTLV-III/LAV. In two recent studies of inmates incarcerated for 1 year, annual seroconversion rates to HBV ranged from 0.8% to 1.3% (6,7). It is clear from the NIJ/ACA report that many correctional systems have given high priority to AIDS education programs and that such programs are the basis for AIDS-prevention activities in these systems. At present, most correctional systems are performing serologic tests for HTLV-III/LAV antibody on a limited basis. More extensive use of the tests, such as testing all inmates, all new inmates, or all inmates known to belong to risk groups, would undoubtedly identify additional seropositive persons, who might then Disclaimer All MMWR HTML documents published before January 1993 are electronic conversions from ASCII text into HTML. This conversion may have resulted in character translation or format errors in the HTML version. Users should not rely on this HTML document, but are referred to the original MMWR paper copy for the official text, figures, and tables. An original paper copy of this issue can be obtained from the Superintendent of Documents, U.S. Government Printing Office (GPO), Washington, DC 20402-9371; telephone: (202) 512-1800. Contact GPO for current prices. **Questions or messages regarding errors in formatting should be addressed to mmwrq@cdc.gov.Page converted: 08/05/98 |
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