U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics Bureau of Justice Statistics Bulletin HIV in Prisons 1994 March 1996, NCJ-158020 This report is one in a series. More recent editions may be available. To view a list of all in the series go to http://www.ojp.usdoj.gov/bjs/pubalp2.htm#hivpj Full text with tables available from: Bureau of Justice Statistics Clearinghouse 800-732-3277 Box 179 Annapolis Junction, MD. 20701-0179 FAX Number (for report orders and mail list signup only): 410-792-4358 ******************** HIV in Prisons 1994 ******************** By Peter M. Brien and Allen J. Beck, Ph.D. BJS Statisticians ********** Highlights ********** HIV-positive inmates -------------------- Percent of custody Year Number population -------------------------------------- 1991 17,551 2.2% 1992 20,651 2.5 1993 21,538 2.4 1994 22,713 2.3 *Between 1991 and 1994, the number of HIV-positive inmates grew at about the same rate (29%) as the overall prison population (26%). *At yearend 1994, 3.9% of all female State prison inmates were HIV positive compared to 2.4% of male State prisoners. *Of all HIV-positive inmates, 21% were confirmed AIDS cases. In State prisons, 21% of HIV-positive inmates had AIDS; in Federal prisons, 38%. Inmates with confirmed AIDS -------------------- Percent of custody Year Number population ------------------------------------- 1991 1,682 0.21% 1992 2,644 0.34 1993 3,765 0.43 1994 4,849 0.52 *The overall rate of confirmed AIDS among the Nation's prison population (0.52%) was more than 7 times the rate in the general population (0.07%). HIV-positive inmates ------------ Percent of custody Jurisdiction Number population ------------------------------------ New York 8,295 2.4% Florida 1,986 3.5 Texas 1,584 1.6 California 1,055 .8 Federal system 964 1.1 Connecticut 940 6.6 Georgia 854 2.6 Maryland 774 3.7 New Jersey 770 3.6 Illinois 600 1.6 North Carolina 521 2.2 Based on jurisdictions with more than 500 HIV-positive inmates. ------------------------------------ *New York held more than a third of all inmates (8,295 inmates) known to be HIV-positive at yearend 1994. *There were 955 AIDS-related deaths in 1994, comprising over a third (35.1%) of all State prisoner deaths during the year. *Twenty-six States reported that less than 1.0% of their inmates were HIV positive, and 7 States held fewer than 10 HIV-positive inmates. *Between 1991 and 1994, the rate of confirmed AIDS in the prison population increased at nearly the same pace as confirmed AIDS in the general population, more than doubling in 4 years. ******************** HIV in Prisons 1994 ******************** At yearend 1994, 2.3% of the 999,693 State and Federal prison inmates were known to be infected with the human immunodeficiency virus (HIV). In State prisons, 21,749 inmates were HIV positive (2.5% of the total), and in Federal prisons, 964 (1.1%). Of all inmates in U.S. prisons, 4,849 prisoners, (0.5%), had confirmed AIDS and 17,480 prisoners were HIV positive without having confirmed AIDS. In 1994, 955 State inmates died of AIDS-related causes, up from 520 in 1991. For every 100,000 State inmates in 1994, 104 died of AIDS-related causes. The percentage of inmate deaths because of AIDS has increased in recent years (28% of inmate deaths in 1991and 35% in 1994). ************* Data sources ************* Data on HIV/AIDS were provided by the departments of corrections in 50 States and the District of Columbia and by the Federal Bureau of Prisons. Since 1991 respondents have reported their HIV-testing policies and the number of HIV-infected inmates in their custody at yearend. Those inmates are reported to be asymptomatic, symptomatic, or with confirmed AIDS. Respondents have also reported for each year the number of inmate deaths from HIV-related infections as well as other causes. ***************************************** Trends in HIV infection in U.S. prisons ***************************************** At yearend 1994, 22,713 inmates in State and Federal prisons were known to be infected with the human immunodeficiency virus (HIV). In 1991, 16,921 State prisoners were HIV positive; in 1994, 21,749 were HIV positive, a 29% increase. The Federal Bureau of Prisons held 630 HIV-positive inmates in 1991 and 964 in 1994, a 53% increase. Between 1991 and 1994 the number of HIV-positive inmates has grown at about the same rate as the overall prison population (29% compared to 26%). As a result, the percentage of all prisoners infected with HIV rose from 2.2% in 1991 to 2.3% in 1994. HIV-positive inmates comprised 2.3% of the State prison population in 1991 and 2.5% in 1994. In Federal prisons HIV-positive inmates were 1.0% of all prisoners in 1991 and 1.1% in 1994. HIV-infected inmates are concentrated in a small number of States. New York and Florida house the largest number of HIV-positive inmates. In 1994 these two States held nearly half of all HIV-positive inmates in the Nation. New York had the highest percentage of inmates known to be HIV positive (12.4%), followed by Connecticut (6.6%), Rhode Island (3.8%), Maryland (3.7%), and New Jersey (3.6%). Seven States reported having fewer than 10 cases of HIV-positive inmates in their prisons. Vermont reported no HIV-positive inmates. Twenty-six States reported that fewer than 1.0% of their inmate population were HIV positive. Texas reported the largest growth in the number of HIV-positive inmates, from 615 in 1991 to 1,584 in 1994. Substantial increases were also reported in Florida (an increase of 881 inmates), Connecticut (366), and North Carolina (351). ************************************* Confirmed AIDS cases in U.S. prisons ************************************* At the end of 1994, 4,849 confirmed AIDS cases were in U.S. prisons--4,478 State inmates and 371 Federal inmates. Of the remaining HIV-positive inmates, 2,492 showed symptoms of HIV infection and 14,988 were asymptomatic. The number of prison inmates with confirmed AIDS has nearly tripled since 1991, when there were 1,682. The number of inmates with lesser or no symptoms of HIV infection grew by 13%. Other than Confirmed confirmed Year AIDS cases AIDS cases ---------------------------------- 1991 1,682 15,797 1992 2,644 18,087 1993 3,765 17,773 1994 4,849 17,864 Note: Care should be exercised when comparing the number of reported cases over time. In January 1993 the Centers for Disease Control and Prevention revised the HIV classification system and expanded the surveillance case definition for AIDS to include specific CD4+ T-lymphocyte criteria and three additional clinical conditions--pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer. This expansion resulted in a substantial increase in the number of reported AIDS cases during 1993. See Methodology. ----------------------------------- The States with the largest number of confirmed AIDS cases were New York (1,228), Florida (619), and California (390), which accounted for exactly half of all AIDS cases in State prisons. Eighteen States reported having fewer than 10 inmates with confirmed AIDS in their prison systems. Confirmed AIDS cases comprised a half of one percent of all inmates in State and Federal prisons. Of those HIV-positive inmates in prison, a fifth were confirmed AIDS cases. As a percentage of the total prison population in each State, the highest number of confirmed AIDS cases was in Rhode Island (2.2% of inmates in the State), followed by New York (1.8%) and Connecticut (1.3%). In 20 States, confirmed AIDS cases comprised 0.1% or less of State inmates. ******************************************* Comparison to the U.S. resident population ******************************************* At the end of 1994, the rate of confirmed AIDS in State and Federal prisons was more than 7 times higher than in the total U.S. population. Approximately 0.52% of all prisoners had confirmed AIDS, compared to 0.07% of the U.S. population. Percent of population with confirmed AIDS -------------------------- U.S. Federal general prison Year population inmates ---------------------------------- 1991 0.03% 0.21% 1992 0.03 0.33 1993 0.06 0.50 1994 0.07 0.52 Note: The percent of the general population with confirmed AIDS in each year may be overestimated due to delays in death reports. Care should be exercised when comparing percentages over time, because of changes in the case definition for AIDS. See Methodology. ----------------------------------- Over the last 3 years, the available data indicate that the rates for confirmed AIDS cases have been much higher in prisons than in the general population. In 1993 the incidence of AIDS was over 8 times greater inside prisons than in the general population. The rate of AIDS infection in 1992 was about 9.5 times higher for prisoners than the general population, and in 1991, the AIDS-infection rate was over 6.5 times higher inside prisons than in the general population. ************************************* AIDS-related deaths in State prisons ************************************* In 1994, 955 State inmates died of Pneumocystis carinii pneumonia, Kaposi's sarcoma, or other AIDS-related diseases. These AIDS-related deaths comprised over a third of all deaths of State prisoners. AIDS-related deaths as a percent of all deaths --------------------------- U.S. general State population, prison Year age 15-54* inmates ----------------------------------- 1991 10.4% 28.0% 1992 11.7 35.2 1993 11.9 33.2 1994 -- 35.1 --Not available. *See Methodology for source of data. ------------------------------------- The rate of death because of AIDS is about 3 times higher in the prison population than in the total U.S. population age 15 to 54. Between 1991 and 1993 about 1 in every 3 prisoner deaths were attributable to AIDS-related causes, compared to 1 in 10 deaths in the general population. In every year since 1991, AIDS-related causes has been the second leading cause of death for State prisoners behind "illness and natural causes." For every 100,000 State inmates in 1994, 104 died of AIDS-related causes. The number of AIDS-related deaths in prison has increased 84% since 1991, making AIDS the fastest rising cause of State inmate deaths. In 1994 AIDS-related causes accounted for over half of all inmate deaths in New York (60%), Connecticut (60%), Florida (56%), Massachusetts (54%), and New Jersey (51%). Fifteen States reported having no AIDS-related deaths, and 8 States reported only 1 AIDS-related death. ********************************************** HIV infection of male and female State inmates ********************************************** At the end of 1994, there were 19,762 male and 1,953 female State inmates infected with HIV--2.4% of all male and 3.9% of all female State inmates. The rate of HIV infection was higher for women than men in every region and in most States. Since 1991 the number of male State inmates infected with HIV has increased 22% while the number of female inmates infected has increased at a much faster rate--69%. Percent custody Number population HIV in reporting Year positive States ---------------------------------- Males 1991 16,150 2.2% 1992 18,266 2.6% 1993 18,218 2.5% 1994 19,762 2.4% Percent change, 1991-94* 22.4% Females 1991 1,159 3.0% 1992 1,598 4.0% 1993 1,796 4.2% 1994 1,953 3.9% Percent change, 1991-94* 68.5% Note: Includes State inmates only. *In 1991 North Carolina, South Dakota, and the District of Columbia did not report data by sex. In 1994 Delaware, Indiana, Alaska, and the District of Columbia did not report data by sex. ------------------------------------ In three States more than 10% of female inmates were known to be HIV positive--New York (20%), Connecticut (15%), and Massachusetts (12%). New York (12%) was the only State in which more than 10% of the male inmates were known to be infected with HIV. ********************* HIV-testing policies ********************* Each State, the District of Columbia, and the Federal Bureau of Prisons test their inmates for HIV based on certain criteria. Most jurisdictions (45 out of 52) test inmates if they have HIV-related symptoms or if the inmates request a test. Twenty-six States test inmates after they are involved in an incident, and 15 States test inmates who belong to specific "high-risk groups." Seventeen States and the Federal Bureau of Prisons test all inmates who enter their facilities. Three of these States (Alabama, Missouri and Nevada) and the Federal Bureau of Prisons also test inmates upon their release. Rhode Island, Utah, and Wyoming test all inmates currently in custody. New York, Hawaii, and the Federal Bureau of Prisons test inmates selected at random. Number of Testing policy jurisdictions -------------------------------------------- Upon inmate request 42 Upon clinical indication of need 40 Upon involvement in an incident 26 All incoming inmates 17 High-risk groups 15 All inmates at time of release 4 Random sample 3 All inmates currently in custody 3 --------------------------------------------- Note: Detail adds to more than 52 because a jurisdiction may have more than one policy. --------------------------------------------- ************ Methodology ************ National Prisoner Statistics ---------------------------- The National Prisoner Statistics series (NPS-1) includes an annual yearend count of prisoners by jurisdiction, sex, race, Hispanic origin, and admissions and releases during the year. The series consists of yearly reports to BJS from the departments of corrections of the 50 States and the District of Columbia and from the Federal Bureau of Prisons. Since 1991 respondents have been asked to indicate their policies for testing for HIV and to provide the number of HIV-infected inmates in their custody on the last day of the calendar year. AIDS in the U.S. resident population ------------------------------------ The number of persons with confirmed AIDS in the U.S. general population (aged 13 and over) was derived from the Centers for Disease Control and Prevention (CDC), HIV/AIDS Surveillance Report, yearend editions 1991-94. For each year, the number of active AIDS cases in the United States was calculated by subtracting the number of cumulative AIDS deaths at yearend from the cumulative number of total AIDS cases at yearend as listed in the HIV/AIDS Surveillance Report. The data for the U.S. general population, excluding persons under age 13, were taken from U.S. Population Estimates, by Age, Sex, Race, and Hispanic Origin: 1990 to 1994. Population Division: U.S. Bureau of the Census, March, 1995. PPL-21 pp. 12, 13, 15, 17. The rate of confirmed AIDS cases in the U.S. resident population was calculated by dividing the annual totals for individuals with AIDS into the population estimates for the U.S. resident population. The classification system for HIV infection and case definition for AIDS were expanded in 1993. This expansion improved estimates of the number and characteristics of persons with HIV disease, but complicated interpretation of AIDS trends. The increase in reported AIDS cases in 1993 was largely the consequence of the added surveillance criteria. (See CDC, Morbidity and Mortality Weekly Report, Vol. 43, No. 45, Nov. 18, 1994.) AIDS-related deaths in the United States ---------------------------------------- The number of AIDS-related deaths for persons age 15-54 was derived from the CDC, HIV/AIDS Surveillance Report, yearend editions 1993 and 1994, pp. 18, 20. Deaths in the U.S. population for persons age 15-54 were taken from the CDC, Monthly Vital Statistics Reports, Vol. 42, No. 2(S); Vol. 43, No. 12; and Vol. 43, No. 6(S). AIDS-related deaths as a percentage of all deaths in the U.S. population were calculated by dividing the national estimate of AIDS deaths of persons age 15-54 into the national mortality estimates of persons age 15-54 in a given year. Other reports on HIV/AIDS --------------------------- HIV/AIDS-related data are collected through regularly scheduled BJS censuses and surveys of correctional agencies and offenders under correctional supervision. Annual publications provide only the most recently obtained information. See previous BJS reports for HIV/AIDS data in local jails and HIV test results reported by State prisoners. The data published from the BJS collections complement those collected in surveys sponsored by the National Institute of Justice and the Centers for Disease Control and Prevention. The most recent report, 1994 Update: HIV/AIDS and STDs in Correctional Facilities, contains detailed reporting about the prevalence, testing, education, and prevention for HIV and AIDS in Federal, State, and 29 large city/ county correctional systems. The 1994 update provides cumulative total inmate deaths by region, total current AIDS cases, and HIV-seroprevalence data by both jurisdiction and type of testing policy. The Bureau of Justice Statistics is the statistical arm of the U.S. Department of Justice. Jan M. Chaiken, Ph.D., is director. BJS Bulletins present the first release of findings from permanent data collections. Peter M. Brien wrote this report under the supervision of Allen J. Beck. Tom Hester edited the report, assisted by Ida Hines. Marilyn Marbrook administered final production, assisted by Yvonne Boston and Jayne Robinson. Data collection and processing were carried out by Marita Perez and Jeanne Benetti, under the supervision of Gertrude Odom and Kathy Creighton of the Demographic Surveys Division, U.S. Bureau of the Census. March 1996, NCJ-158020 This report and other BJS reports and data are available on the Internet: http://www.ojp.usdoj.gov/bjs/ (hard copy: call 1-800-732-3277). (end of file)