U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics Bulletin HIV in Prisons, 2004 November 2006, NCJ 213897 --------------------------------------------------------- This file is text only without graphics and many of the tables. A Zip archive of the tables in this report in spreadsheet format (.csv)and the full report including tables and graphics in .pdf format re available from: http://www.opj.usdoj.gov/bjs/abstract/hivp04.htm 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 ---------------------------------------------------------- By Laura M. Maruschak BJS Statistician ----------------------------------------------------- Highlights Number of HIV-infected inmates steadily decreasing since 1999 * Between 2003 and 2004 the number of HIV-positive prisoners decreased 2.6%, while the overall prison population grew 1.7% during the same period. * At yearend 2004, 2.6% of all female State prison inmates were HIV positive, compared to 1.8% of males. * During 2004, 20 States reported a decrease in the number of HIV-positive prisoners, and 24 States and the Federal system reported an increase. * New York held about a fifth of all inmates(4,500 inmates) known to be HIV positive at yearend 2004. * Florida, with an increase of 138 HIV-positive inmates, reported the largest increase, followed by Mississippi(up 54). * The overall rate of confirmed AIDS among the prison population (0.50%) was more than 3 times the rate in the U.S. general population (0.15%). Rate of AIDS-related deaths in State prisons decreased in 2004 * In 2004, 203 prisoners died from AIDS-related causes --185 State inmates and 18 Federal inmates. * The number of AIDS-related deaths in State prisons decreased 82% from 1995 to 2004. * Pennsylvania reported the largest number of AIDS-related deaths (21), followed by New York and Florida (both 20). Twenty States reported having no AIDS-related deaths. ---------------------------------------------------------- On December 31, 2004, 1.9% of State prison inmates and 1.1% of Federal prison inmates were known to be infected with the human immunodeficiency virus (HIV). Correctional authorities reported that 21,366 State inmates and 1,680 Federal inmates were HIV positive. The number known to be HIV positive totaled 23,046, down from 23,663 at yearend 2003. Of those known to be HIV positive in all U.S. prisons at yearend 2004, an estimated 6,027 were confirmed AIDS cases, up from 5,944 in 2003. Among State inmates, 0.5% had AIDS; among Federal inmates, 0.4%. During 2004, 185 State prisoners died from AIDS-related causes, down from 268 in 2003. In 2004, 6% of State inmate deaths were attributed to AIDS, down from 32% in 1995. Among Federal prisoners 18 died from AIDS-related causes, up 4 deaths from the total in 2003. This report is based on the 2004 National Prisoners Statistics (NPS-1) and the Deaths in Custody Reporting Program (DCRP). Data from NPS-1 are reported on one form by the departments of corrections in 50 States and by the Federal Bureau of Prisons. DCRP data are from individual records for each death. A record includes information on the deceased's characteristics such as gender, age, and race/Hispanic origin. Nearly half of HIV-infected State prison inmates at yearend 2004 were housed in three States At yearend 2004, HIV-infected inmates were concentrated in a small number of States. New York(4,500), Florida(3,250), and Texas(2,405) held the largest number of HIV-positive inmates. These three States housed nearly half(48%)of all HIV-infected inmates in State prisons. Excluding New York, the number of HIV-infected inmates has been stable among the States. Since reaching a peak of 19,333 in 2000, the number has fluctuated reaching a low of 18,546 in 2004. New York estimates are based on data obtained through blind sero-prevalence studies conducted biennially by the New York Department of Health.***New York draws blood from all entering inmates. Every other year an extra sample from 1,000 sequential receptions in each of 4 reception centers is tested for various diseases including HIV. The percentage with HIV-infection is applied to the total inmate population and then adjusted for length of stay and findings from other studies. Projections are made for the interim years without the blind studies.*** Due to this estimation method, New York has reported very large decreases in the number of HIV-positive inmates from year to year. HIV-positive inmates comprised 1.9% of the State prison population in 2004, down from 2.0% in 2003. In Federal prisons HIV-positive inmates comprised 1.1% in 2004, unchanged since 2002. After remaining constant at 1.9% in 2002 and 2003, the overall percentage of the total prison population with HIV decreased to 1.8% in 2004. Inmates in the Northeast had the highest rate of HIV infection In the Northeast, 4.1% of the prison population were known to be HIV positive in 2004, followed by 2.1% in the South, 0.9% in the Midwest, and 0.7% in the West. New York had the highest percentage of inmates known to be HIV positive (7.0%), followed by Rhode Island (5.1%) and Florida (3.9%). North Dakota, South Dakota, Montana, and Wyoming reported fewer than 10 HIV-positive inmates in their prisons. In 2004 every reporting jurisdiction held at least one HIV-positive inmate. Six States reported that fewer than 0.5% of their inmate population were HIV positive. Between 2003 and 2004, 20 States reported a decrease in the number of HIV-positive inmates. The largest decrease was reported in New York (down 500), followed by Maryland (196), Connecticut (95), and Pennsylvania (82). Twenty-four States and the Federal system reported an increase. The largest increases were reported in Florida (up 138), Mississippi(54), the Federal system(49), Delaware(44), and Rhode Island (41). A greater percentage of females than males with HIV infection On December 31, 2004, 20,668 male inmates and 2,084 female inmates in State and Federal prisons were known to be HIV positive (table 2). Overall, 1.7% of male inmates and 2.4% of all female inmates were known to be HIV positive. New York reported the largest numbers of male and female HIV-positive inmates (4,100 and 400, respectively). The second largest numbers of HIV-positive male and female inmates were in Florida (2,911 and 339, respectively), followed by Texas (2,199 and 206, respectively). Two States, Vermont and Montana, reported having no HIV-positive female inmates. Every reporting State had some HIV-positive male inmates. Over 10% of all female inmates were known to be HIV positive in two States — Rhode Island (15.6%) and New York (14.2%). New York (with 6.7%) was the only State with more than 5% of male inmates known to be HIV positive. Number of HIV-positive male and female inmates in State prisons declined during 2004 Based on these yearend estimates, the number of HIV-infected females in State prisons decreased from 2,131 to 1,983 and the number of infected males in State prisons decreased from 20,060 to 19,383 during 2004. The estimated number of male HIV-positive inmates in State prisons increased between 1998 and 1999 and has decreased every year since 1999. The estimated number of female HIV-positive inmates in State prisons decreased between 1998 and 1999, increased in 2000, and has decreased every year since 2000. Between 1998 and 2004 the percentage of male HIV-positive inmates decreased from 2.2% to 1.8%, and the percentage of female inmates fell from 3.8% to 2.4%. Confirmed AIDS cases in U.S. prisons increased during 2004 At the end of 2004, a reported 5,483 inmates in U.S. prisons had confirmed AIDS, up from 5,227 in 2003. Among those with confirmed AIDS, 4,842 were in State prisons, and 641 were in Federal prisons. For States that did not provide a breakdown of the number of HIV cases by type of HIV infection, estimates of the number of confirmed AIDS cases were made to provide comparable year-to- year data. Based on yearly estimates, the number of confirmed AIDS cases increased from 5,944 in 2003 to 6,027 in 2004. Between 1998 and 2004, 32 States and the Federal system consistently reported the number of inmates with confirmed AIDS. As with the reported and estimated numbers, the comparable number of inmates with confirmed AIDS declined between 1998 and 2004, from 5,859 to 5,070. Confirmed AIDS cases made up 0.5% of inmates in State prisons and 0.4% of those in Federal prisons. Of those known to be HIV- positive inmates, nearly a quarter had confirmed AIDS. The States with the largest number of confirmed AIDS cases were Texas (801), New York (800), and Florida (721). Combined, these States held nearly half of all confirmed AIDS cases in State prisons. The Federal system held 641 inmates with confirmed AIDS. Thirteen States reported having fewer than 10 confirmed AIDS cases in their prisons; 3 reported having none. Rhode Island (1.8%) had the highest percentage of confirmed AIDS, followed by Connecticut and New York(both 1.2%). In 13 States, confirmed AIDS cases comprised 0.1% or less of State inmates. During 2004, 11 States reported a decrease in the number of confirmed AIDS cases. Maryland, with a decrease of 49, had the largest drop in the number of confirmed AIDS cases, followed by Pennsylvania (48) and New Mexico (25). Eighteen States and the Federal system reported an increase in the number of confirmed AIDS cases, led by Illinois (up 91) and New Jersey (34). Rate of confirmed AIDS 3 times higher among prison inmates than in the U.S. general population In every year since 1991, the rate of confirmed AIDS has been higher among prison inmates than in the general population. At yearend 2004 the rate of confirmed AIDS in State and Federal prisons was more than 3 times higher than in the total U.S. population. About 50 in every 10,000 prison inmates had confirmed AIDS, compared to 15 in 10,000 persons in the U.S. general population. Twenty States test all inmates for HIV at admission or while in prison Forty-eight States and the Federal Bureau of Prisons reported that they test inmates if they have HIV-related symptoms or if the inmates request a test. Forty-one States and the Federal system test inmates after they are involved in an incident in which an inmate is exposed to possible HIV transmission, and 17 States and the Federal system test inmates who belong to specific "high-risk" groups. Missouri, Alabama, and Florida test all inmates upon their release. Arkansas and Nevada test all inmates while in custody. Three States (New York, Alabama, and Oregon) test inmates selected at random. AIDS-related deaths in State prisons dropped between 1995 to 2004 The number of State inmates who died of Pneumocystis carinii pneumonia, Kaposi's sarcoma, or other AIDS-related diseases peaked in 1995 and steadily decreased until 2001. According to data reported in the NPS-1, the number of AIDS-related deaths decreased by 85 from 213 in 2003 to 128 in 2004. This was the largest decrease reported since 1999. Overall, since 1995 the number of AIDS-related deaths has decreased by 882. Among Federal inmates, 18 died from AIDS-related causes, up from 14 in 2003. In 2004 for every 100,000 inmates, 10 died from AIDS-related causes. These AIDS-related deaths accounted for 5% of all deaths in Federal prison. The introduction of protease inhibitors and combination antiretroviral therapies produced a substantial improvement in the effectiveness of HIV/AIDS care in correctional facilities. See Hammett and Harmon, "Medical Treatment and a Continuum of Care" in 1996-1997 Update: HIV/AIDS, STDs and TB in Correctional Facilities (July 1999, NCJ 176344). Deaths in Custody Reporting Program identifies more States with AIDS-related deaths in State prisons Pursuant to the Death in Custody Reporting Act of 2000, BJS began in 2001 to collect individual-level information about deaths in State prisons (DCRP). Overall, 14 States under-reported AIDS- related deaths in the NPS-1 collection, while 3 States under- reported AIDS-related deaths in DCRP. For a total of AIDS-related deaths in prisons, DCRP and NPS-1 data were combined. The most complete data for each State's number of deaths were used to calculate the totals for 2001 through 2004. An additional 57 AIDS-related deaths were identified in 2004, 55 in 2003, 68 in 2002, and 55 in 2001. Adjusted for under-reporting, the number of AIDS-related deaths was 14 per 100,000 State prison inmates in 2004, down from 21 in 2003. For the general population the percentage of deaths due to AIDS remained constant at 4.4% in 2003. In 2003 the percentage of deaths due to AIDS was more than 1½ times higher in the prison population than in the U.S. general population ages 15-54. Nearly 1 in every 13 prisoner deaths were attributable to AIDS- related causes compared to 1 in 23 deaths in the general population. In 2004 about 1 in 18 deaths in State prisons due to AIDS-related illnesses In 2004 for every 100,000 State inmates, 14 died from AIDS- related causes. The most AIDS-related deaths were reported in the South (84), followed by the Northeast (60). Together, these two regions accounted for more than three-quarters of AIDS- related deaths in State prisons. Pennsylvania reported the largest number of AIDS-related deaths (21), followed by New York and Florida (both 20). Twenty States reported having no AIDS-related deaths. Relative to the number of inmates, Maryland had the highest rate of AIDS-related deaths (63 per 100,000 inmates), followed by Connecticut (55 per 100,000), Pennsylvania (52 per 100,000), and New York (31 per 100,000). For AIDS-related deaths among inmates rates higher for males, blacks, and those age 45 or older Of the 179 AIDS-related deaths reported in DCRP in 2004, information on gender, age, and race/Hispanic origin is known for 145. Of those, 138 were male, and 7 were female. Inmates between ages 35 and 44 accounted for almost half of all AIDS- related deaths (69). Black non-Hispanic inmates accounted for about two-thirds of AIDS-related deaths (96). Relative to the total number of inmates under State jurisdiction, males (12 deaths per 100,000) were 1½ times as likely as females (8 per 100,000) to die from AIDS-related causes during 2004. Black non-Hispanic inmates (19 per 100,000) were nearly 2½ times more likely than whites (8 per 100,000) and almost 5 times more likely than Hispanics (4 per 100,000) to die from AIDS. Inmates age 45 or older had the highest rate of AIDS- related deaths (23 per 100,000), 4½ times the rate among inmates age 25 to 34 (5 per 100,000). HIV/AIDS reported by prison inmates in personal interviews The 2004 Survey of Inmates in State and Federal Correctional Facilities asked inmates if they had ever been tested for HIV, if they had been tested since admission, and whether they were HIV positive. (See Methodology for further detail.) Though some inmates may refuse to report that they are HIV positive and others may not know, the survey provided a means to track HIV infection among demographic and "high-risk" groups. Of inmates who reported being tested since admission and reported a result, 1.9% in State prison and 1.1% in Federal prison reported being HIV positive. Among State prisoners who were tested for HIV, female inmates (1.9%) were more likely than male inmates (1.6%) to be HIV positive. Black non-Hispanic inmates (2.0%) and Hispanic inmates (1.8%) were about twice as likely as white non-Hispanic inmates (1.0%) to report being HIV positive. Among male inmates, 1.9% of black non-Hispanics, 1.8% of Hispanic, and 1.1% of white non- Hispanics said they were HIV positive. Among female inmates, black non-Hispanics (3.4%) and Hispanics (2.7%) were about 6 times as likely as white non-hispanic inmates (.5%) to be HIV positive. In Federal prisons 1.0% of male inmates and 1.4% of female inmates reported HIV infection. HIV-positive rates were highest among black non-Hispanic female inmates (2.6%). In both State and Federal prisons, inmates age 34 or younger had the lowest rates of HIV infection. The highest HIV-positive rates in State prisons were among those age 45 or older and in Federal prisons among those age 35-44 (1.9%). In both State and Federal prisons, inmates with less than a high school education were more likely than those with a high school education to be HIV positive. Among prisoners property offenders reported the highest prevalence of HIV Inmates held on a property offense in State and Federal prisons had the highest HIV-positive rate (both 2.6%). Among State inmates, public-order offenders (0.9%) were least likely to report being HIV positive; among Federal prisoners, drug offenders (0.7%) were least likely to report being HIV positive. The percentage of State and Federal prison inmates reporting that they were HIV positive varied by degree of involvement in prior drug use. The percentage of State prison inmates who were HIV positive was — * 1.3% of those who never used drugs * 1.7% of those who had ever used drugs * 1.9% of those who used drugs in the month before their current offense * 2.8% of those who had used a needle to inject drugs * 5.1% of those who had shared a needle. Like State inmates, Federal inmates who used a needle and shared a needle had higher rates of HIV infection than those inmates who reported ever using drugs or using drugs in the month before their current offense. Methodology National Prisoner Statistics The National Prisoner Statistics series(NPS-1)includes yearend counts of prisoners by jurisdiction, gender, race, Hispanic origin, and admissions and releases during the year. The series consists of reports from the depart-ments of corrections in the 50 States and the Federal Bureau of Prisons. Since 1991 respondents have indicated the circumstances under which inmates are tested for HIV and have provided the number of HIV-infected inmates in their custody. Surveys of Inmates in State and Federal Correctional Facilities The Survey of Inmates in State and Federal Correctional Facilities, 2004, is comprised of two separate surveys: one in State adult correctional facilities and one in Federal correctional facilities. The surveys provide nationally representative data on State prison inmates and sentenced Federal inmates. Both surveys used the same questionnaire and a stratified two-stage sample design where facilities were selected in the first stage and inmates to be interviewed in the second stage. The State prison sample was selected from a universe of 1,585 facilities that were enumerated in the 2000 Census of State and Federal Correctional Facilities, or had opened between the completion of the Census and May 31, 2003. A total of 287 State prisons participated in the survey; 2 refused, 11 were closed or had no inmates to survey, and 1 was erroneously included in the universe. The Federal prison sample was selected from 148 Federal prisons and satellite facilities holding inmates on January 4, 2003. Thirty-nine of the 40 Federal prisons selected participated in the survey. A total of 14,499 inmates in the State facilities were interviewed; 1,653 inmates refused to participate, resulting in a second-stage nonresponse rate of 10.2%. In the Federal survey, after the initial sample of inmates, a secondary sample of 1 in 3 drug offenders was selected for participation in the survey. A total of 3,686 inmates in Federal facilities were interviewed and 567 refused to participate, for a second-stage nonresponse rate of 13.3%. The accuracy of the 2004 Survey of Inmates in State and Federal Correctional Facilities depends on sampling and measurement errors. Sampling errors occur by chance because a sample rather than a complete enumeration of the population was conducted. Measurement error can be attributed to many sources, such as nonresponse, recall difficulties, differences in the interpretation of questions among inmates, and processing errors. The sampling error, as measured by an estimated standard error, varies by the size of the estimate and the size of the base population. Estimates for the percentage of inmates ever tested for HIV and the percentage who tested HIV positive have been calculated. These standard errors may be used to construct confidence intervals around percentages. For example, the 95- percent confidence interval around the percentage of males in State prisons who were HIV positive is approximately 1.6% plus or minus 1.96 times .20% (or 1.2% to 2.0%). Detailed descriptions of the methodology for each of these surveys, including standard error tables and links to other reports or findings from these surveys, are available on the BJS Website . AIDS in the U.S. resident population The number of persons with confirmed AIDS in the U.S. general population (age 13 and over) was derived from the Centers for Disease Control and Prevention (CDC), HIV/AIDS Surveillance Report, yearend editions 1995-2004. For each year the number of active AIDS cases in the United States was calculated by subtracting the number of cumulative AIDS deaths for people age 15 or older at yearend from the cumulative number of total AIDS cases for people age 13 or older at yearend as listed in the HIV/AIDS Surveillance Report. The rate of confirmed AIDS cases in the U.S. general population was calculated by dividing the annual totals for individuals with AIDS by the population estimates for the U.S. general population of individuals 13 or older prior to 2000 and 15 or older for 2000 and beyond. 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. Deaths in the U.S. population for persons age 15-54 were taken from the CDC, Monthly Vital Statistics Report, Vol. 42, No. 2(S); Vol. 43, No. 12; Vol. 43, No. 6(S); Vol. 45, No. 3(S); and Vol. 45, No. 11(S); and from CDC, National Vital Statistics Report, Vol. 47, No. 9; Vol. 47, No. 25; Vol. 48, No. 11; Vol. 49, No. 8; Vol. 50, No. 15; and Vol. 53, No. 15. 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 by the national mortality estimates of persons age 15-54 in a given year. BJS Deaths in Custody Reporting Program To implement the Death in Custody Reporting Act of 2000 (PL 106-297), BJS developed four quarterly data collections of death records: local jails(begun in 2000), State prisons (2001), State juvenile correctional agencies(2002), and State and local law enforcement agencies (2003). Records include data on the deceased's characteristics(such as age, gender, and race/Hispanic origin), criminal background (such as legal status, offenses, and time in custody), and the death itself (such as cause, time, location, and medical conditions and treatment). --------------------------------------------- The Bureau of Justice Statistics is the statistical agency of the U.S. Department of Justice. Jeffrey L. Sedgwick is director. Laura M. Maruschak wrote this report, under the supervision of Allen J. Beck. Todd D. Minton provided statistical review. Tina Dorsey and Marianne Zawitz edited the report. Jayne Robinson prepared the report for final printing. November 2006, NCJ 213897 ----------------------------------------------- ------------------------------------------------ This report in portable document format and in ASCII and its related statistical data and tables including five appendix tables are available at the BJS World Wide Web Internet site: ------------------------------------------------ End of file 10/19/06 ih