U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics Bulletin HIV in Prisons, 2005 September 2007, NCJ 218915 --------------------------------------------------------- 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 are available from: http://www.ojp.usdoj.gov/bjs/abstract/hivp05.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 On December 31, 2005, correctional authorities reported that 20,888 State inmates (1.8%) and 1,592 Federal inmates (1.0%) were infected with the human immunodeficiency virus (HIV) or had confirmed AIDS. This was a total of 22,480 inmates, a slight decrease from 22,936 inmates in 2004. Half of the HIV/AIDS cases were in the South, nearly a third in the Northeast, and about a tenth in both the Midwest and the West. The Northeast reported the highest percentage of HIV/AIDS cases based on its custody population (3.9%). At yearend 2005, three states New York (4,440), Florida (3,396), and Texas (2,400) housed nearly half (49%) of all HIV/AIDS cases in State prisons. At yearend 2005, an estimated 18,953 males (1.8%) and 1,935 females (2.4%) in State prisons were HIV-infected or had confirmed AIDS. The number of cases for both males and females were down from 2004. At yearend 2005, five States reported no female HIV/AIDS cases: New Hampshire, North Dakota, West Virginia, Hawaii, and Montana. Among Federal inmates, 1,491 men (1.0%) and 101 women (0.9%) were HIV-infected or had confirmed AIDS. An estimated 5,620 inmates had confirmed AIDS, down from 5,969 in 2004. Of the confirmed cases, 5,026 were in State prisons and 594 were in Federal prisons. Four States accounted for nearly half (47%) of all confirmed AIDS cases: Texas (894), New York (700), Florida (645), and Maryland (408). Maryland (1.8%) had the highest percentage of confirmed AIDS cases among its custody population, followed by Connecticut, New York, and Delaware (1.1% each). Five States (New Hampshire, Indiana, North Dakota, Idaho, and Wyoming) reported having no confirmed AIDS cases. During 2005 an estimated 176 State inmates died from AIDS-related causes, down from 185 in 2004. For every 100,000 State inmates, 13 died from AIDS-related causes. AIDS-related deaths accounted for nearly 1 in 20 deaths reported in State prisons. New York reported the largest number of AIDS-related deaths (19), followed by Florida (17) and California (14). Relative to the number of inmates in custody, the Northeast reported the highest rate of AIDS-related deaths (28 per 100,000 inmates), followed by the South (13 per 100,000 inmates). Among Federal inmates, 27 died from AIDS-related causes in 2005, up from 18 in 2004. For every 100,000 Federal inmates, 15 died from AIDS-related causes. AIDS-related deaths accounted for 7% of all deaths in Federal prisons. State-level data and other detailed information are available in appendix tables on the BJS website at . HIV/AIDS cases in State and Federal prisons steadily declining since 1999 The Bureau of Justice Statistics (BJS) began collecting official data on HIV infection in State and Federal prisons in 1991 (see Methodology). At that time, 17,551 State and Federal inmates were HIV-infected or had confirmed AIDS (figure 1). This number steadily increased through yearend 1995, but fluctuated thereafter until reaching a high of 25,807 at yearend 1999. Since then, the number of HIV/AIDS cases has steadily declined, reaching 22,480 at yearend 2005. New York accounted for more than three-quarters of the decline in HIV/AIDS cases between 1999 and 2005 Between 1999 and 2005, the number of inmates who were HIV-infected or had confirmed AIDS increased in 18 States and the Federal system, while the number decreased in 27 States (table 1). The remaining five States and the District of Columbia either reported no change or did not report data for 1999 or 2005. The largest increases were reported in Florida (up 763), the Federal system (up 436), Georgia (up 196), and North Carolina (up 164). New York reported the largest decrease, with 2,560 fewer --HIV-infected or confirmed AIDS inmates, followed by New Jersey (down 329), and California (down 321). New York alone accounted for more than three-quarters (83%) of the total reported decrease in comparable HIV/AIDS cases. ***Footnote 1: New York estimates the number of HIV/AIDS cases based on data obtained through blind sero-prevalence studies conducted biennially by the New York State Department of Health. See Methodology for details on the estimation procedures.*** Number of confirmed AIDS cases fluctuated between 1999 and 2005 Between 1999 and 2005, the estimated number of confirmed AIDS cases in State and Federal prisons fluctuated, reaching a high of 7,039 in 1999 and a low of 5,607 in 2002 (table 2). Overall, the estimated number of confirmed cases decreased by 1,419 cases between 1999 and 2005. Since 2000, the estimated confirmed AIDS cases as a percent of all HIV/AIDS cases have remained stable at about 25%. The number of confirmed AIDS cases was estimated because not all States reported counts in every year during the 7-year period between 1999 and 2005. For States that reported counts, the number of confirmed AIDS cases ranged between 6,642 in 1999 and 4,862 in 2002. A total of 31 States and the Federal system provided data in all 7 years (see comparable column in table 2). The pattern of change in confirmed AIDS cases was similar across the three measures --estimated, reported, and comparable confirmed AIDS cases. The number fluctuated but decreased overall during the period. Difference between the rate of confirmed AIDS cases in prisons and the general population shrinking In each year since 1991, the rate of confirmed AIDS has been higher among prison inmates than in the U.S. general population, but the gap has been narrowing. At yearend 2005, the estimated rate of confirmed AIDS in State and Federal prisons was more than 2« times higher than in the general population (table 3). In 1999 it was nearly 5 times higher. The shrinking difference between the rate of confirmed AIDS cases in prisons and the general population between 1999 and 2005 resulted from a decrease in the number of confirmed AIDS cases in prisons (down 20%) and an increase in cases (up 44%) among the general population. HIV/AIDS cases among both male and female State inmates declining, but at a faster rate for females Since 1999 the estimated number of both male and female inmates who had HIV infection or confirmed AIDS has decreased. Among men, HIV/AIDS dropped from 22,175 cases to 18,953 between 1999 and 2005 (table 4). For women, the number of cases dropped from 2,402 to 1,935. The percentage of male inmates who were HIV positive or had confirmed AIDS decreased from 2.2% to 1.8%; the percentage for female inmates fell from 3.4% to 2.4%. While both groups experienced a decrease in the number of HIV/AIDS cases, females had a larger decrease in the percentage of HIV/AIDS cases. This can be explained by the faster growing female population in prisons and a larger decrease in the number of HIV/AIDS cases among women. ------------------------------------------------------- Inmate survey data support decline in HIV infection in 1997 and 2004 Data reported by inmates in personal interviews, collected in the BJS Survey of Inmates in State Correctional Facilities, were consistent with the decline in HIV infection observed in National Prisoner Statistics (NPS-1) official records. Personal interview data are obtained every 5 to 6 years. The most recent data collections were in 1997 and 2004. In each year, inmates were asked if they had been tested for HIV at admission or had ever been tested and the results of the test. In 2004, 1.6% of tested State inmates reported being HIV positive, down from 2.2% in 1997. Decreases found in the percent of HIV positive among male and female inmates and inmates ages 25 to 34 The inmate survey data provide a broad range of individual characteristics, including gender, race, age, current offense, and prior drug use, that can be used to describe trends. Despite apparent declines within each category, not all declines were statistically significant (see table footnote "a" for statistically significant items). Overall, the percentage of State inmates reporting HIV infection in 2004 was down from 1997. Both male and female inmates were less likely to report being HIV positive in 2004 than in 1997. In 2004, 1.6% of male inmates, compared to 2.2% in 1997, were HIV positive. For female inmates, 1.9% in 1997, down from 3.4% in 2004, reported being HIV positive. Among State inmates ages 25 to 34, there was a sharp decline in the number who reported being HIV positive between 1997 and 2004 (2.3% compared to 0.8%). Over the same time period, inmates in each of the other age categories were equally likely to report being HIV positive. Decrease in HIV infection found among drug offenders and inmates who reported prior drug involvement Drug offenders were less likely in 2004 to report being HIV positive than in 1997. In 2004, 1.8% of drug offenders reported being HIV positive, down from 2.9% in 1997. Between 1997 and 2004, significant decreases in the percentage of inmates who reported being HIV positive were found among inmates who ever used drugs, used drugs in the month before arrest, and used needles to inject drugs. Among inmates who reported ever using drugs, 1.7% reported being HIV positive in 2004, down from 2.3% in 1997. Inmates who used drugs in the month before arrest were less likely to report being HIV positive in 2004 (1.9%) than in 1997 (2.7%). Among inmates who said they had used a needle to inject drugs, 2.8% reported being HIV positive in 2004, down from 4.6% in 1997. ------------------------------------------------------- Number of AIDS-related deaths declined dramatically between 1995 and 2000 The number of State inmates who died of AIDS-related diseases, such as Pneumocystis carinii pneumonia and Kaposi's sarcoma, ***Footnote 2: Center for Disease Control, 1993, Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults. MMWR 1992; 41(RR-17).*** peaked in 1995 at 1,010 deaths and declined through 2000 to 185 deaths. In 2001 the number of AIDS-related deaths reported in the NPS-1 increased to 256 and has steadily declined since (figure 2). In 2001 BJS began collecting individual-level information about deaths in State prisons, under the Death in Custody Reporting Program (DCRP). ***Footnote 3: In 2001 BJS began to estimate the number of AIDS-related deaths using data from the NPS-1 and the DCRP. The most complete data for each State's number of deaths were used to calculate the estimated number of AIDS-related deaths. See Methodology.*** The estimated number of AIDS-related deaths calculated using data from both the NPS-1 and the DCRP followed the same downward trend between 2001 and 2005 that was found using data from NPS-1 only. The estimated number of AIDS-related deaths was 176 in 2005, down from 311 in 2001. Between 1995 and 2000, New York reported the largest decline in AIDS-related deaths (down 250), followed by Florida (down 102) and California (down 68). These three States combined accounted for more than half of the total decline (825) in the number of AIDS-related deaths. New Jersey (down 46) and Georgia (down 42) also had large declines. Almost all of the decrease in AIDS-related deaths attributed to male inmates Using the individual records collected under the DCRP, estimates of AIDS-related deaths by gender, age, and race were calculated by applying the percentages in DCRP in each year to the estimated total number of deaths. The number of AIDS-related deaths decreased across gender, age, race and Hispanic origin. Between 2001 and 2005, male inmates, inmates ages 35 to 44, and black non-Hispanic inmates accounted for most of the decrease (table 5). In 2005, 166 male inmates died from AIDS-related causes, down from 295 in 2001. This decrease of 129 AIDS-related deaths among male inmates was almost all (96%) of the total decrease of 135 deaths among all inmates. Between 2001 and 2005, inmates ages 35 to 44 accounted for half of the decrease (down 68) in the total number of AIDS-related deaths. AIDS-related deaths of black non-Hispanic inmates accounted for 65% of the total decline of 88 AIDS-related deaths reported between 2001 and 2005 (down from 208 to 120). AIDS-related deaths as a percent of all deaths decreasing more rapidly in State prison than in the general population AIDS-related deaths as a percent of total deaths in State prisons also decreased significantly between 1995 and 2000, from 34.2% to 5.3% (table 6). Over a slightly different time period (1995 to 2004, the most recent year for which data are available), AIDS-related deaths among the general population ages 15 to 54 decreased 68%, from 44,233 to 14,315. AIDS-related deaths as a percent of all deaths in the general population declined from 12.9% to 4.3% during the period. Between 2001 and 2004, the rate of AIDS-related deaths among prison inmates as a percent of all deaths in the prison population was nearly cut in half (from 10.3% to 5.6%). However, the rate in the general population remained stable at about 4.3%. Rate of AIDS-relate deaths declining in prisons, stabilizing in the general population Between 1995 and 2001, the rate of AIDS-related deaths declined from 100 deaths per 100,000 inmates to 25 per 100,000 (table 7). In the general population the rate dropped from 29 per 100,000 to 9 per 100,000. After 2001, while the rate of AIDS-related deaths in the State prison population continued to decline, from 25 to 13 per 100,000 inmates, the rate in the general population ages 15 to 54 remained stable between 8 and 9 deaths per 100,000 persons. Older persons in State prisons had a higher rate of AIDS-related deaths than those in the general population Older inmates were more likely to die from AIDS-related causes than persons in the same age group in the general population. In 2005, inmates ages 35 to 44 were almost twice as likely to die from AIDS-related causes (21 per 100,000 State inmates) than their counterparts in the general population (12 per 100,000 persons) (table 8). Among persons ages 45 to 54, State inmates were more than twice as likely as those in the general population to die from AIDS-related causes (31 per 100,000 compared to 14 per 100,000). Methodology National Prisoner Statistics The National Prisoner Statistics collection (NPS-1), which primarily measures prison population movement, began in 1926. The 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 departments of corrections in the 50 States and the Federal Bureau of Prisons. In 1991 BJS began collecting data on HIV/AIDS in prisons in NPS-1. BJS 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 Correctional Facilities The Survey of Inmates in State Correctional Facilities provides nationally representative data on State prison inmates. The 1997 and 2004 surveys used the same questionnaire and a stratified two-stage sample design. Facilities were selected in the first stage and inmates were selected for interviews in the second stage. Detailed descriptions of each survey's methodology and links to other reports or findings are available on the BJS Website . Accuracy of the survey estimates The accuracy of the estimates in this report depends on two types of error: sampling and nonsampling. Sampling error is the variation that may occur by chance because a sample rather than a complete enumeration of the population was conducted. Nonsampling error can be attributed to many sources, such as nonresponses, differences in the interpretation of questions among inmates, recall difficulties, and processing errors. In any survey the full extent of the nonsampling error is never known. The sampling error, as measured by an estimated standard error, varies by the size of the estimate and the size of the base population. Testing for differences in the proportions of inmates reporting that they were HIV positive within subgroups in the 1997 and 2004 surveys compared a calculated z-value against the critical value of 1.645 (the 95% level for a one-tail test). Given the overall declines in HIV cases reported in the administrative data, a one-tail test showed that the difference in proportions was less than zero. The z-value was calculated by taking the ratio of the estimated difference in proportions to the square root of the pooled variances of the two samples. (See standard errors in appendix table 7 at .) 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 from 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). Estimation of HIV/AIDS cases in New York State New York estimates the number of HIV/AIDS cases based on data from blind sero-prevalence studies conducted biennially by the New York State Department of Health. Blood samples are taken from all inmates entering New York State prisons. Every other year an extra sample from 1,000 sequential admissions at reception in four reception centers is tested for various diseases, including HIV. The percentage with HIV infection is applied to the total inmate population, then adjusted for length of stay and data from other studies. Projections for interim years are made without blind studies. AIDS in the U.S. resident population The number of persons with confirmed AIDS in the U.S. general population (age 13 and older) was derived from the Centers for Disease Control and Prevention (CDC), HIV/AIDS Surveillance Report, yearend editions 1995-2005. For each year the number of active AIDS cases in the United States was calculated by taking the-- * cumulative number of total AIDS cases for persons age 13 or older at yearend (from the HIV/AIDS Surveillance Report), minus estimated confirmed AIDS cases in State and Federal prisons, and subtracting the * cumulative number of AIDS deaths for people age 15 or older at yearend, minus estimated number of AIDS-related deaths in State and Federal prisons. The rate of confirmed AIDS cases in the U.S. general population was calculated by * dividing the annual total number of individuals with AIDS by the estimated U.S. general population (age 13 or older before 2000; age 15 or older since 2000) minus the State and Federal custody population. AIDS-related deaths in the United States The number of AIDS-related deaths for persons ages 15 to 54 was based on the CDC, HIV/AIDS Surveillance Report, yearend editions. Deaths in the U.S. population for persons ages 15 to 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). Also deaths were taken from the 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; Vol. 53, No. 15; and Vol. 54, No. 19. For 2001 to 2005, AIDS-related deaths were calculated as a percent of all deaths among persons ages 15 to 54 in the U.S. general population. The difference of the national estimate of AIDS deaths of persons ages 15 to 54 minus AIDS-related deaths of persons ages 15 to 54 in State prison was divided by the national mortality estimates of persons ages 15 to 54 minus total deaths in State prisons. For 2001 through 2005, the rates of AIDS-related deaths in the general population were calculated by taking the difference of the national estimate of AIDS-related deaths for persons ages 15 to 54 minus AIDS-related deaths for those ages 15 to 54 in State prisons and dividing it by the U.S. general population estimate minus the State prison population ages 15 to 54. Because data on AIDS-related deaths by age in State prisons were not collected prior to 2001, the total number of AIDS-related deaths in State prison were subtracted from the national estimate of AIDS-related deaths for the 1995 rate calculations. ------------------------------------------------------- The Bureau of Justice Statistics is the statistical agency of the U.S. Department of Justice. Jeffrey L. Sedgwick is the director. BJS Bulletins present the first release of findings from permanent data collection programs. This Bulletin was written by Laura M. Maruschak. Margaret Noonan and Heather Couture verified the report. Theresa M. Reitz carried out the data collection and processing under the supervision of Charlene M. Sebold, Governments Division, Census Bureau, U.S. Department of Commerce. Duane H. Cavanaugh and Diron J. Gaskins provided technical assistance. Tina Dorsey and Carolyn C. Williams edited the report and Jayne Robinson prepared it for final printing, under the supervision of Doris J. James. September 2007, NCJ 218915 ------------------------------------------------------- ------------------------------------------------------- This report in portable document format and in ASCII and its related statistical data and tables are available at the BJS World Wide Web Internet site: . ------------------------------------------------------- End of file 09/27/07 td