Each month, Brown Medical School distributes its Infectious Diseases in Corrections Report, a noteworthy publication for anyone in corrections, but especially important for   physicians, nurses, outreach workers and case managers. IDCR serves not only as an overview of the correctional medicine issues health care providers face today, but also as a viable training mechanism for medical professionals.

This month, IDCR comments on the CDC's Morbidity and Mortality Monthly Report that reviewed an human immunodeficiency virus (HIV) study conducted at the Georgia Department of Corrections.

In 1988, the GADOC began mandatory HIV testing of male inmates upon entry, and voluntary HIV testing of inmates upon request. It also provided annual voluntary HIV testing to inmates between July 2003 and June 2005. Between July 1988 and February 2005, 88 male inmates who tested negative for HIV upon prison entry were confirmed to be HIV positive during incarceration.

In October 2004, the GADOC and the Georgia Division of Public Health invited the CDC to help investigate HIV risk behaviors and transmission patterns among male inmates within GADOC facilities and to make HIV prevention recommendations.

The CDC noted that “HIV transmission among inmates in Georgia's prison system was associated with male to male sex, and tattooing,” and highlighted the need for more effective HIV prevention among inmates.

It then recommended that “HIV education, testing, and prevention counseling be made available to populations at increased behavioral or clinical risk for HIV infection, including inmates in correctional facilities,” and that prevention education should address male to male sex, tattooing, and injection drug use that occurs during incarceration and after release.

The CDC also suggested that HIV screening be “provided upon entry into prison and before release, and that voluntary HIV testing be offered periodically during incarceration.”

IDCR analyzes this study further and provides additional  input from Joseph Paris, a former GADOC medical director (and current IDCR board member), and Madeleine LaMarre, an author of the CDC report. 

IDCR  board members had varying opinions on the CDC's findings and recommendations. Some felt the report was a “wake-up call” to significantly increase HIV prevention methods, which should focus on distributing condoms, as they are an effective “HIV and STD prevention tool that has been repeatedly demonstrated in a variety of settings.”

Other members counter that much is already being done to prevent HIV transmission in prisons, and that transmission events like in the GADOC are rare. They claim future efforts to reduce the spread of HIV should focus on abstinence and not condoms.

Several also caution that the CDC's report was based on self-reported data from inmates, making it unsubstantiated information. They also found inmate reports of sex with prison staff troubling, but suggested they not be taken in complete earnest.

Most agreed that HIV screening is an important part of prevention, and the fact that “half of the HIV seroconversions in the GADOC were detected via annual voluntary testing was an important finding of the MMWR report.”

Through its coverage and opinion, IDCR  hopes to encourage readers to review studies like the MMWR report and understand the perspectives of key individuals involved so they can make their own informed opinions about very relevant and very important topics. It is the Correction Connection's  intent to do the same.

For more on the May IDCR report click here.

Click here for the CDC's entire Morbidity and Mortality Monthly Report on  HIV Transmission Among Male Inmates in a State Prison System --- Georgia, 1992--2005

To subscribe to the IDCR monthly report, click here.