U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics ------------------------------------------------------ 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 on BJS website at https://www.bjs.gov/index.cfm?ty=pbdetail&iid=6026 This reports is one in a series. More recent editions may be available. To view a list of all reports in the series go to https://www.bjs.gov/index.cfm?ty=pbse&sid=7 ------------------------------------------------------ ********************************************** HIV in Prisons, 2015 - Statistical Tables ********************************************** ****************************************************** Laura M. Maruschak and Jennifer Bronson, Ph.D., BJS Statisticians ****************************************************** At yearend 2015, an estimated 17,150 prisoners in the custody of state and federal correctional authorities were known to be living with HIV (human immunodeficiency virus), down from about 17,740 at yearend 2014 (figure 1).***Footnote 1 Includes those who were HIV-positive or had confirmed AIDS (acquired immunodeficiency syndrome).*** This was the first year that the total number of state and federal prisoners who had HIV fell below the estimated number in 1991 (17,680), when HIV data were first collected by the Bureau of Justice Statistics (BJS). The decrease continued an annual downward trend in the number of prisoners who had HIV that began more than 15 years ago. In 1998, the year in which the number of prisoners who had HIV peaked, an estimated 25,980 state and federal prisoners had HIV. From 1998 to 2015, the decline in estimated HIV cases between single years ranged from 0.1% to almost 7%. The decline observed in HIV among prisoners since 1998 was driven by the consistent year-to-year decline in the number of state prisoners who had HIV. Between 1998 and 2015, the estimated number of state prisoners who had HIV declined from 24,910 to 15,610 (down 9,300). During the same period, the federal prison population who had HIV grew from 1,066 to 1,536. In 2015, federal prisons held 906 more prisoners who had HIV than in 1991, while state prisons held an estimated 1,440 fewer prisoners who had HIV. The rate of HIV per 100,000 persons in the custody of state and federal correctional authorities was 2,231 in 1991. The rate of prisoners who had HIV peaked the following year at 2,471 per 100,000 before beginning a largely downward trend. In 2015, the rate of HIV among prisoners was 1,297 per 100,000 state and federal prisoners, the lowest rate observed during the 25-year period in which BJS has collected HIV data. ***************** List of tables ***************** Table 1. Estimated number of prisoners who had HIV in the custody of state and federal correctional authorities, by sex, 2010–2015 Table 2. AIDS-related deaths among prisoners in the custody of state correctional authorities, by demographic characteristics, 2010–2015 Table 3. Number of jurisdictions that tested for HIV and percent of all prison admissions, by HIV testing practices during the intake process, 2011 and 2015 Table 4. Number of jurisdictions that tested prisoners for HIV while in custody, by HIV testing practices, 2011 and 2015 Table 5. Number of jurisdictions that tested for HIV and percent of all prison releases, by HIV testing practices during discharge planning, 2011 and 2015 *********************************************************** ************************** List of appendix tables ************************** Appendix Table 1. Estimated numbers for figure 1: Number of prisoners who had HIV and rate of HIV per 100,000 in the custody of state and federal correctional authorities, 1991– 2015 Appendix Table 2. Numbers for figure 2: Number of AIDS-related deaths and mortality rate among state prisoners, 1991–2015 Appendix Table 3. Estimated number of prisoners who had HIV in the custody of state and federal correctional authorities, by jurisdiction, 2010–2015 Appendix Table 4. Estimated number of prisoners who had HIV in the custody of state and federal correctional authorities, by sex and jurisdiction, 2010–2015 Appendix Table 5. HIV testing and consent practices for state and federal prisoners during the intake process, by jurisdiction, 2011 Appendix Table 6. HIV testing and consent practices for state and federal prisoners during the intake process, by jurisdiction, 2015 Appendix Table 7. HIV testing practices for state and federal prisoners while in custody, by jurisdiction, 2011 Appendix Table 8. HIV testing practices for state and federal prisoners while in custody, by jurisdiction, 2015 Appendix Table 9. Appendix Table 1. HIV testing practices for state and federal prisoners during discharge planning, by jurisdiction, 2011 Appendix Table 10. HIV testing practices for state and federal prisoners during discharge planning, by jurisdiction, 2015 Appendix Table 11. Number of prisoners in the custody of state and federal correctional authorities, by sex, 2010– 2015 ************************************************************ In 1991, a total of 520 state prisoners died from AIDS- related causes. This grew to 1,010 in 1995 (figure 2). Since 1995, the number of AIDS-related deaths in state prison has declined overall, with a few upward fluctuations. In 2015, state prisons reported a preliminary count of 45 AIDS- related deaths, the lowest number since data collection began in 1991. The AIDS-related mortality rate among state prisoners followed a similar trend in the number of AIDS- related deaths among state prisoners. In 1999, the first year in which BJS obtained federal death data, 16 AIDS-related deaths were reported among federal prisoners. Preliminary data indicate that one federal prisoner died in 2015 from AIDS-related causes (not shown). While the number of AIDS-related deaths among federal prisoners declined overall between 1999 and 2015, the number fluctuated during this period, from a high of 27 in 2005 to a low of zero in 2014. Findings in this report are based on data collected from 51 jurisdictions, which include 50 states and the Federal Bureau of Prisons (BOP), through BJS’s National Prisoner Statistics (NPS) program. The NPS annually collects data on prisoner counts, characteristics, admissions, and releases. This report also includes data from the Deaths in Custody Reporting Program (DCRP), which collects individual-level data on cause of death and characteristics of those who died. Statistical tables provide national- and jurisdiction- level data on the total number and sex of persons living with HIV who are in the custody of state and federal correctional authorities. Rates of HIV among prisoners and the number and rate of AIDS-related deaths that occurred in state prison by demographic characteristics are also presented. ************************************************************ *********************************************** Center for Disease Control and Prevention's HIV testing guidelines and testing measures *********************************************** The correctional setting presents an opportunity to test people for HIV who may be at high risk for contracting the virus and who are unaware of their HIV status. Since 2009, the Centers for Disease Control and Prevention has recommended opt-out HIV screening at the time of admission for prisoners entering a correctional facility.***Footnote 2 Center for Disease Control and Prevention. (2009). HIV Testing Implementation Guidance for Correctional Settings. Retrieved from https://www.cdc.gov/hiv/pdf/group/cdc-hiv-correctional- settings-guidelines.pdf*** In an opt-out HIV screening protocol, the prisoner is informed that an HIV test will be performed and the test is given unless they declined to take the test. In 2011, the HIV testing questions in the National Prisoner Statistics (NPS) instrument were enhanced to further assess HIV testing practices in prisons. A series of questions regarding a jurisdiction’s HIV testing practices for prisoners entering their facilities was added. Each state and the Federal Bureau of Prisons were asked to select the statement that best described their system's HIV testing practices at admission: * all inmates were tested for HIV, regardless of whether the inmate agreed * all inmates were told that an HIV test would be performed, and the test was given unless the inmate declined * all inmates were told that HIV testing was available, and the inmate must have requested a test * inmates were only tested based upon an assessment of high- risk behavior, medical history, or other clinical evaluation * not all inmates were told that an HIV test was available, but were tested if they requested one * other * did not provide HIV testing. Questions on testing during discharge planning were also added to the NPS, and questions regarding HIV testing for prisoners while in custody were modified. The NPS does not measure the type of HIV test used in a given jurisdiction, and this report does not detail the type(s) of HIV screening and tests that may be used by correctional facilities to diagnose inmates who had HIV. Many factors, such as financial resources, staff hours, availability of confidential testing space, and laboratory processing times, may influence the testing practices adopted by a jurisdiction. ************************************************************ While BJS has collected HIV data since 1991, the highlights reported here focus on changes in HIV infection and AIDS- related deaths during the past 5 years. Findings related to HIV testing practices covered 2011 to 2015. BJS expanded the HIV testing section of the NPS to include intake and discharge testing practice in 2011. ************************************** HIV among state and federal prisoners ************************************** * In 2015, the total number of prisoners who had HIV in the custody of state and federal correctional authorities was 17,150, a decline from 17,740 in 2014 (figure 1; appendix table 1). * The number of state prisoners who had HIV declined by 560, from an estimated 16,170 in 2014 to 15,610 in 2015. * The number of federal prisoners who had HIV declined by 28, from 1,564 at yearend 2014 to 1,536 at yearend 2015. * The rate of HIV among state and federal prisoners declined from 1,313 per 100,000 prisoners at yearend 2014 to 1,297 per 100,000 at yearend 2015. * During the most recent 5-year period, the number of state prisoners who had HIV declined each year, while the number of federal prisoners fluctuated. * Overall, 3,100 fewer state prisoners and 42 fewer federal prisoners had HIV in 2015 than in 2010. ************************************************ HIV among state and federal prisoners by sex ************************************************ * An estimated 15,920 male prisoners and 1,220 female prisoners had HIV at yearend 2015, both down from 2014 (16,410 males and 1,330 females) (table 1). * From yearend 2010 to yearend 2015, the number of male prisoners who had HIV declined from 18,510 to 15,920 (down 2,590), and the number of females who had HIV declined from 1,780 to 1,220 (down 560). * From 2010 to 2015, the number of males who had HIV declined by 14%, while the number of females who had HIV declined by 31%. * In 2010, 1% of male prisoners had HIV, compared to 2% of females. By yearend 2015, about 1% of both male and female prisoners had HIV. ********************************** AIDS-related deaths among state and federal prisoners ********************************** * The number of AIDS-related deaths among state prisoners fluctuated from 2010 to 2015. Most recently, the number decreased from 64 deaths in 2014 to a preliminary count of 45 deaths in 2015 (table 2). * From 2010 to 2015, the AIDS-related mortality rate among state prisoners ranged from about 4 to 6 deaths per 100,000 persons in the custody of state prison authorities. * The number of AIDS-related deaths among federal prisoners was less than 10 each year from 2010 to 2015. In 2015 there was one death, and in 2014 there were no deaths (not shown). * Among federal prisoners, the AIDS-related mortality rate between 2010 and 2015 ranged from none to 4 deaths per 100,000 persons in the custody of federal authorities. ****************************************** AIDS-related deaths of state prisoners by sex, race, Hispanic origin, and age ****************************************** Sex ****** * Among state prisoners, 44 males and 1 female died from AIDS-related causes in 2015, down from 61 males and 3 females in 2014. * Between 2010 and 2015, males accounted for the majority of AIDS-related deaths among state prisoners, ranging from 44 in 2015 to 71 in 2012. * Between 2010 and 2015, three or fewer AIDS-related deaths occurred among female state prisoners each year. * Between 2010 and 2015, the AIDS-related mortality rate in state prisons ranged from about 4 to 6 deaths per 100,000 male prisoners and 1 to 3 deaths per 100,000 female prisoners. Race and Hispanic origin *************************** * In 2015, 23 non-Hispanic black, 18 non-Hispanic white, and 2 Hispanic state prisoners died from AIDS-related causes. In comparison, 38 black, 21 white, and 3 Hispanic state prisoners died from AIDS-related causes in 2014. * Between 2010 and 2015, the number of AIDS-related deaths among black prisoners in the custody of state authorities fluctuated, from a high of 44 (2010) to a low of 23 deaths (2015). * In 2015, the AIDS-related mortality rate among black state prisoners was about 5 per 100,000 black prisoners in the custody of state authorities, the lowest rate observed among black prisoners between 2010 and 2015. * In 2015, the AIDS-related mortality rate among white state prisoners was about 4 per 100,000 white persons in the custody of state prison authorities. Among Hispanic state prisoners, the AIDS-related mortality rate was 1 per 100,000 Hispanic prisoners. Age ****** * In 2015, 64% (29) of AIDS-related deaths occurred among state prisoners age 45 or older, up from 52% (38) in 2010. * The AIDS-related mortality rate in 2015 among those age 55 and older was higher (11 per 100,000 persons in the custody of state prison authorities) than among those ages 45 to 54 (6 per 100,000). ******************************************** HIV testing practices in state and federal prison systems ******************************************** During intake process ************************ * In 2015, as part of the prison intake process, 15 states reported that they tested all prisoners for HIV (i.e., mandatory testing) and 17 states reported that they offered opt-out HIV testing (i.e., all prisoners were offered the test and the test was given unless the prisoner declined). This was up from 14 states that tested all prisoners and 13 that had opt-out HIV testing in 2011 (table 3). * Among prison admissions in 2015, about a third (34%) were admitted in states that conducted mandatory HIV testing and an additional 31% were admitted in states with opt-out HIV testing during intake. * Overall, a larger percentage of persons admitted to prison in 2015 (66%) than in 2011 (62%) were admitted in states that conducted either mandatory or opt-out HIV testing during intake. * In 2015, eight states offered an HIV test to all incoming prisoners, but the prisoner had to opt-in or request the test to receive it. These eight states received about 13% of all newly admitted prisoners. * The BOP reported offering an HIV test to all sentenced prisoners during the intake process in 2011. In 2015 the BOP specified that they provided opt-out testing to all sentenced prisoners. While in custody ******************* * In 2015, a total of 41 states and the BOP reported testing those in custody for HIV upon request by the prisoner, down from 43 states and the BOP in 2011 (table 4). * HIV testing upon clinical indication, the second most commonly reported testing practice for prisoners while in custody, was reported by 40 states in 2015, up from 39 in 2011. The BOP reported testing based on clinical indication in both years. * Thirty-seven states and the BOP in 2015 (up from 33 states and the BOP in 2011) reported testing prisoners for HIV after they were involved in an incident, such as an accident. * Eighteen states offered HIV tests during routine medical exams in 2015, up from 14 states and the BOP in 2011. * In 2015, all reporting jurisdictions (49) said that they offered an HIV test to prisoners while in custody. During discharge process ************************** * In 2011 and 2015, HIV testing upon prisoner request (24 states and the BOP in 2011 and 20 states and the BOP in 2015) was the most commonly reported testing practice during the discharge process (table 5). * Approximately 41% of prisoners released in 2015 were in one of the 21 jurisdictions that offered HIV testing upon request by prisoners. * About 2 in 10 persons released from prison in 2015 (21%) and 2011 (22%) were released from states that offered all prisoners an HIV test as part of discharge planning. * In 2015, the six states that did not provide HIV testing upon discharge accounted for 8% of all releases, up from 5% in 2011. *************** Methodology *************** National Prisoner Statistics ****************************** Started in 1926, the National Prisoner Statistics (NPS) Program collects annual data on prisoners at yearend. The series comprises reports from the departments of corrections in the 50 states and the Federal Bureau of Prisons. The NPS includes yearend counts of prisoners by jurisdiction, sex, race, Hispanic origin, and admissions and releases during the year. In 1991, the Bureau of Justice Statistics (BJS) began using the NPS to collect data on the number of prisoners who had HIV and confirmed AIDS cases. NPS respondents also indicated the circumstances under which prisoners were tested for HIV. Through 2007, respondents provided the number of deaths among prisoners under the jurisdiction of state prisons disaggregated by cause of death, including those that were AIDS-related. In 2001, BJS began collecting deaths among prisoners in the custody of state authorities through the Deaths in Custody Reporting Program (DCRP). In this report, yearend custody counts provided by jurisdictions have been used as the denominator when calculating the rates of HIV. Estimating counts for nonreporting states ******************************************* State and national totals of the number of prisoners who had HIV include estimates in-- * Alaska (1993, 1994, 2000, 2003-2006, and 2010-2015) * Delaware (1996) * District of Columbia (1991-1995) * Idaho (2011 and 2013) * Illinois (2006-2007 and 2012) * Indiana (1992-2015) * Kentucky (2002-2003) * Maine (1997 and 2002) * Mississippi (1992) * Montana (2015) * Nevada (2013-2015) * Oklahoma (1998) * Oregon (2003-2007) * South Dakota (1991-1993) * Virginia (1997). Since HIV data collection began in the NPS, completeness of reporting HIV has ranged from one missing jurisdiction to four missing jurisdictions in any given year. To produce national and state totals of the number of prisoners who had HIV, estimates were made for nonreporting jurisdictions. Nonreporting jurisdictions fell into four categories: missing data at either end of the collection period (1991- 2015), missing data in all years except the first year of data collection (1991), missing data in the most recent reporting year (2015), and missing data that fell in between years in which data were reported. Three states (Alaska, Nevada, and South Dakota) and the District of Columbia were missing data for a number of years on either end of the collection period (1991-2015). Estimates were made by applying the annual change in the rate of HIV observed in reporting jurisdictions to the last reported rate for each jurisdiction. For subsequent or earlier years of missing data, the annual change observed in the HIV rate of reporting jurisdictions was applied to the last estimated rate produced. The estimated rate for the missing year was then multiplied by the custody population of the jurisdiction in the year for which data were missing and divided by 100,000 in order to produce a count. In Indiana, the one state in which data were missing in all years except 1991, estimates on the number of persons in prison living with HIV were made based on the change in the HIV rate for states with similar HIV rates in the general population in 2013 (the most recent year for which data are available) and in the prison population in 1991. Estimates were made by applying the annual change in the HIV rate in similar states to the rate of HIV among prisoners in Indiana in 1991. For each year, the annual change in rates was applied to the last estimated rate of HIV infection. To produce the count in each year, the newly estimated rate was multiplied by the custody population for the given year and divided by 100,000. In Montana, the one state where data were only missing in 2015, an estimate of the HIV count was made by assuming the change observed in the previous year occurred in the most recent year. The percentage change between the 2013 and 2014 counts was multiplied by the 2014 count and then added to the 2014 count to produce the estimated 2015 count. For states with missing data that fell between reporting years (Alaska, Delaware, Idaho, Illinois, Kentucky, Maine, Mississippi, Oklahoma, Oregon, and Virginia), missing data were estimated by using observed data points that were closest in time to the missing data. The missing value was assumed to fall on a straight line plotted between the two known data points. Rate of HIV among prisoners ****************************** To calculate the estimated rate of HIV per 100,000 state and federal prisoners, the estimated yearend count of prisoners who had HIV was divided by the yearend custody population for each year and multiplied by 100,000. The yearend jurisdiction count for New Mexico was used because New Mexico reported the number of prisoners who had HIV under their jurisdiction. Jurisdiction refers to the legal authority of state or federal correctional officials over a prisoner, regardless of where the prisoner is held. To have custody of a prisoner, a state or federal prison must physically hold that prisoner in one of its facilities. Custody counts do not include those held in private facilities or local jails. AIDS-related mortality rate in prison ************************************** For this report, BJS presents data on AIDS-related deaths reported in NPS from 1991 to 2000 and in DCRP from 2001 to 2015. The AIDS-related mortality rates were calculated for 1991 to 2000 using the midyear jurisdiction population as the denominator because number of deaths were based on those under the jurisdiction of correctional authorities. For 2001 to 2010, the AIDS-related mortality rate for state prisoners was calculated as the number of deaths per year divided by the midyear state prison population in custody multiplied by 100,000. Starting in 2011, the rate was calculated using yearend custody counts because midyear populations were no longer available. The Bureau of Justice Statistics of the U.S. Department of Justice is the principal federal agency responsible for measuring crime, criminal victimization, criminal offenders, victims of crime, correlates of crime, and the operation of criminal and civil justice systems at the federal, state, tribal, and local levels. BJS collects, analyzes, and disseminates reliable and valid statistics on crime and justice systems in the United States, supports improvements to state and local criminal justice information systems, and participates with national and international organizations to develop and recommend national standards for justice statistics. Jeri M. Mulrow is acting director. This report was written by Laura M. Maruschak and Jennifer Bronson. Todd Minton and Mary Cowhig verified the report. Monika Potemra and Jill Thomas edited the report. Steve Grudziecki produced the report. August 2017, NCJ 250641 *************************************************************** Office of Justice Programs Building Solutions • Supporting Communities • Advancing Justice www.ojp.usdoj.gov *************************************************************** 7/28/2017 JER