Underutilization of HIV Testing Among Men with Incarceration Histories
Annual HIV testing is recommended for individuals at high risk of infection, specifically incarcerated populations. Incarcerated men carry a higher lifetime risk of acquiring HIV than the general population, yet little is known about their HIV testing behaviors. We collected Audio Computer Assisted Self Interview data for 819 men entering a state prison in North Carolina. We assessed correlates of previous HIV testing, including stigmatizing attitudes and beliefs, and explored two outcomes: (1) ever HIV tested before current incarceration, and (2) recency of last HIV test. Eighty percent had been HIV tested before; of those, 36% reported testing within the last year. Being African American, having education beyond high school, prior incarceration, and higher HIV knowledge increased odds of ever having tested. Results of this study highlight the need to expand HIV testing and education specific to incarcerated populations. Additionally, efforts should be made to monitor and encourage repeat screening.
KeywordsHIV/AIDS Utilization Prevention Incarcerated population Testing
Human Immunodeficiency Virus
The Centers for Disease Control and Prevention
The National Institute of Mental Health
North Carolina Department of Public Safety
Prison Processing Centers
Auto Computer Assisted Self Interview
Behavioral Risk Factor Surveillance System
This research was funded by the National Institute on Mental Health (R01 MH079720), National Institute on Drug Abuse (K24DA037101), and Eunice Kennedy Shriver National Institute of Childhood and Human Development, National Institute of Allergy and Infectious Diseases (K24HD06920); University of North Carolina Center for AIDS Research (AI050410). Drs. Ochtera, Golin, Powell, Rosen and Wohl participated in the research design and execution. Dr. Ochtera performed data analyses with Dr. Golin. Drs. Ochtera, Golin, Farel and Ms. Margolis wrote this article with input from Drs. Wohl, Rosen and Powell and with editorial assistance from Caitlin Biddell, Allison Pack, and Breana Castonguay. Brian Barkley and Dr. David Rosen assisted with final data analyses and preparation. None of the authors of this paper have reported conflicts of interest or financial disclosures. The authors thank the study participants, the North Carolina Department of Public Safety, and the wardens and staff of the participating facilities for their support of this project. This research would not have been possible without the assistance of the University of North Carolina at Chapel Hill Center for AIDS Research Criminal Justice Working Group.
Compliance with Ethical Standards
Conflict of interest
No conflicts of interest were reported by the authors of this paper. The authors certify that they have no affiliations with or involvement in any organization or entity with any financial or non-financial interest in the subject matter or materials discussed in this manuscript.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was received from all participants.
- 3.Anderson TJ, Atkins D, Baker-Cirac C, Bayer R, de Palomo FKB, Bolan GA, et al. Revised guidelines for HIV counseling, testing, and referral and revised recommendations for HIV screening of pregnant women. MMWR Reccom Rep. 2001;50(19):63–85.Google Scholar
- 8.McQuillan GM, Kruszon-Moran D. HIV infection in the United States household population aged 18-49 years: results from 1999-2006. 2008. Report No.: 4.Google Scholar
- 25.Centers for Disease Control and Prevention. Behavioral risk factor surveillance system survey data. Atlanta, GA: U.S. Department of Health and Human Services; 2009.Google Scholar
- 27.Ochtera R, Golin C, DeVellis RF, Zimmer C, Nyblade L, Wohl DA. New insights into defining and measuring HIV-associated stigma: an empirical test of a theoretically based conceptual model. Under Review.Google Scholar
- 28.Centers for Disease Control and Prevention. HIV testing trends in the United States, 2000–2011. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2013.Google Scholar
- 29.Maruschak L. HIV in prisons and jails, 2002. U.S. Department of Justice, Bureau of Justice Statistics Bulletin; 2004.Google Scholar
- 30.Golin C, Biddell C, Barkley B. Discrepancy between perceptions of and actual HIV risk among inmates in a state prison system. In preparation.Google Scholar
- 32.Centers for Disease Control and Prevention. HIV among people aged 50 and older. Atlanta, GA: Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention; 2018. https://www.cdc.gov/hiv/group/age/olderamericans/index.html.
- 39.Wilcox L, Patel R, Back A, Czerwinski M, Gorman P, Horvitz E, et al. Patient-clinician communication: the roadmap for HCI. In: Ext Abstr Hum Factors Computing Syst. 2013. p. 3291–4.Google Scholar
- 40.United States Department of Health and Human Services. Key features of the affordable care act by year. In: Institute of Medicine (ed.) The impacts of the affordable care act on preparedness resources and programs: workshop summary. Washington, DC: National Academies Press; 2014.Google Scholar
- 42.Kitahata MM, Dillingham PW, Chaiyakunapruk N, Buskin SE, Jones JL, Harrington RD, et al. Electronic human immunodeficiency virus (HIV) clinical reminder system improves adherence to practice guidelines among the University of Washington HIV Study Cohort. Clin Infect Dis. 2003;36(6):803–11.CrossRefPubMedGoogle Scholar
- 43.White BL, Walsh J, Rayasam S, Pathman DE, Adimora AA, Golin CE. What makes me screen for HIV? Perceived barriers and facilitators to conducting recommended routine HIV testing among primary care physicians in the Southeastern United States. J Int Assoc Provid AIDS Care. 2015;14(2):127–35.CrossRefPubMedGoogle Scholar