HIV in Prisons 1997 US Department of Justice Office of Justice Programs Bureau of Justice Statistics Bulletin November 1999 NCJ 178284 Revised 12/9/99 th --------------------------------------------------------- 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 At yearend 1997, 2.1% of all State and Federal prison inmates were known to be infected with the human immunodeficiency virus (HIV). The infection rate was down from 2.2% in 1996. In 1997 a total of 23,548 prison inmates were HIV positive (1,030 Federal and 22,518 State). HIV-positive inmates made up 1.0% of Federal prison inmates and 2.2% of State prison inmates. Of those known to be HIV positive in all U.S. prisons, 6,184 were confirmed AIDS cases, while the remaining 16,508 either showed symptoms of HIV infection or were asymptomatic. -------------- Highlights -------------- HIV-positive State and Federal prison inmates Percent of custody Year Number population 1991 17,551 2.2% 1992 20,651 2.5 1993 21,475 2.4 1994 22,717 2.4 1995 24,256 2.3 1996 23,881 2.2 1997 23,548 2.1 *Between 1991 and 1997 the number of HIV-positive prisoners grew at a slower rate (34%) than the overall prison population (49%). *At yearend 1997, 3.5% of all female State prison inmates were HIV positive, compared to 2.2% of male State prisoners. HIV-positive prison inmates Percent of custody Jurisdiction Number population New York 7,500 10.8% Florida 2,325 3.6 Texas 2,126 1.5 California 1,328 0.9 Federal system 1,030 1.0 New Jersey 867 3.4 Georgia 861 2.4 Connecticut 798 5.1 Maryland 766 3.5 Based on jurisdictions with more than 700 HIV-positive inmates. *New York held about a third of all inmates (7,500 inmates) known to be HIV positive at yearend 1997. *Of all HIV-positive prison inmates, 26% were confirmed AIDS cases. In State prisons 26% of HIV-positive inmates had AIDS; in Federal prisons, 36%. *The overall rate of confirmed AIDS among the Nation's prison population (0.55%) was more than 5 times the rate in the U.S. population (0.10%). *The number of AIDS-related deaths among prison inmates decreased from 907 in 1996 to 538 in 1997. *Of all State prison inmates, 2.8% of black inmates and 2.5% of Hispanic inmates, compared to 1.4% of white inmates reported to survey interview- ers that they were HIV positive. Tested inmates who reported results Percent Number HIV positive All inmates 790,128 2.2% Male 734,327 2.2 Female 55,800 3.4 White 257,919 1.4% Black 384,870 2.8 Hispanic 123,725 2.5 Age 24 or younger 154,181 0.5% 25-34 310,161 2.3 35-44 232,835 3.1 45 or older 92,168 2.7 Ever used drugs 665,977 2.3% Used in month before offense 460,685 2.7 From the 1997 Survey of Inmates in State Correctional Facilities. In 1997 there were 538 AIDS-related deaths in State prisons, down from 907 in 1996. For every 100,000 State prison inmates in 1997, 48 died of AIDS-related causes. Between 1991 and 1996, about 1 in 3 State prison inmate deaths were attributed to AIDS-related causes; in 1997 about 1 in 5. Data based on personal interviews from the 1997 Survey of Inmates in State Correctional Facilities show that 75% of State inmates were ever tested for HIV. Of those who were ever tested and reported results, 2.2% were HIV positive -- 2.2% of males and 3.4% of females. As level of prior involvement in drug use increased, so did the percentage of HIV-positive inmates: 2.3% of those who said they had ever used drugs, 2.7% of those who used drugs in the month before the current offense, 4.6% of those who injected drugs, and 7.7% of those who ever shared a needle were HIV positive. Data based on official records and prisoner interviews Departments of corrections in 50 States and the District of Columbia as well as the Federal Bureau of Prisons provided data on HIV/AIDS among inmates. 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. (See questionnaire items in figure 1, page 10.) Respondents have also reported for each year the number of inmate deaths from HIV-related infections and other causes. Data on HIV/AIDS and demographics for prison inmates were calculated from the 1997 Surveys of Inmates in State and Federal Correctional Facilities. Through personal interviews, inmates held in prisons were questioned about current offenses, prior drug use and treatment, personal characteristics and other aspects of their life. Questions on whether inmates had ever been tested for HIV and the results of the test were included in the interviews. States report a small decrease in the number of HIV-infected inmates during 1997 At yearend 1997, 23,548 inmates in State and Federal prisons were known to be infected with the human immunodeficiency virus (HIV) (table 1). Inmates in custody of State or Federal prison authorities and known to be positive for the human immunodeficiency virus, 1995-97 HIV/AIDS cases as a percent of Total known to be HIV positive total custody population/a Jurisdiction 1995 1996 1997 1995 1996 1997 U.S. total/b 24,256 23,881 23,548 2.3% 2.2% 2.1% Federal 822 947 1,030 0.9 1.0 1.0 State 23,434 22,934 22,518 2.4 2.3 2.2 Northeast 12,262 11,090 10,394 7.8% 6.9% 6.4% Connecticut 755 690 798 5.1 4.6 5.1 Maine 4 4 -- 0.3 0.3 -- Massachusetts 409 393 402 3.9 3.6 3.7 New Hampshire 31 18 17 1.5 0.9 0.8 New Jersey 847 705 867 3.7 3.0 3.4 New York 9,500 8,500 7,500 13.9 12.2 10.8 Pennsylvania 590 652 697 1.8 1.9 2.0 Rhode Island 126 125 107 4.4 3.9 3.2 Vermont 0.0 3.0 6.0 0.0 0.3 0.5 Midwest 1,667 1,874 1,849 0.9% 1.0% 0.9% Illinois 583 634 655 1.5 1.6 1.6 Indiana -- -- -- -- -- -- Iowa 20 24 34 0.3 0.4 0.5 Kansas 24 16 4 0.3 0.2 0.1 Michigan 379 528 419 0.9 1.2 0.9 Minnesota 46 24 31 1.0 0.5 0.6 Missouri 173 190 227 0.9 0.9 0.9 Nebraska 19 17 22 0.6 0.5 0.7 North Dakota 2 3 7 0.3 0.4 0.9 Ohio 346 343 365 0.8 0.7 0.8 South Dakota 3 4 1 0.2 0.2 0.0 Wisconsin 72 91 84 0.6 0.7 0.6 South 7,870 8,162 8,291 1.9% 1.9% 2.0% Alabama 222 234 212 1.1 1.1 1.0 Arkansas 83 77 86 1.0 0.9 1.0 Delaware 122 -- -- 2.5 -- -- District of Columbia -- -- 75 -- -- 1.1 Florida 2,193 2,152 2,325 3.4 3.4 3.6 Georgia 858 814 861 2.5 2.3 2.4 Kentucky 41 55 55 0.4 0.5 0.5 Louisiana 314 347 397 1.8 2.0 2.1 Maryland 724 832 766 3.4 3.8 3.5 Mississippi 138 135 189 1.4 1.3 1.8 North Carolina 526 589 519 1.9 2.0 1.7 Oklahoma 115 108 107 0.8 0.7 0.7 South Carolina 380 422 432 2.0 2.1 2.1 Tennessee 120 131 131 0.9 1.0 0.9 Texas 1,890 1,876 2,126 1.5 1.4 1.5 Virginia 134 383 -- 0.6 1.5 -- West Virginia 10 7 10 0.4 0.3 0.4 West 1,635 1,808 1,984 0.8% 0.8% 0.8% Alaska 5 10 10 0.2 0.3 0.3 Arizona 140 205 105 0.7 0.9 0.4 California 1,042 1,136 1,328 0.8 0.8 0.9 Colorado 93 94 110 1.0 0.9 1.0 Hawaii 12 23 16 0.4 0.7 0.4 Idaho 11 17 10 0.4 0.5 0.3 Montana 4 6 8 0.2 0.4 0.4 Nevada 147 133 139 1.9 1.6 1.6 New Mexico 24 11 23 0.6 0.2 0.6 Oregon 29 39 54 0.4 0.5 0.7 Utah 31 31 60 0.8 0.7 1.2 Washington 92 99 119 0.8 0.8 0.9 Wyoming 5 4 2 0.4 0.3 0.1 --Not reported. a/The custody population includes only those inmates housed in a jurisdiction's facilities. b/Totals exclude those inmates in jurisdictions that did not report data on HIV/AID. Counts may differ from previous reports. Percentages for all years are based on yearend custody counts. Although the number of reported HIV-positive imates was down from the total reported at yearend 1996 (23,881), Virginia and Maine (with 383 and 4 cases, respectively, in 1996) did not report data in 1997. The District of Columbia (with 75 cases in 1997) had not reported data in 1996. Based on comparable reporting jurisdictions in both years, the number of HIV- positive inmates decreased slightly in State prisons (down 104) and increased in Federal prisons (up 83). From 1991, when BJS began collecting data annually on HIV/AIDS, to 1997, the number of inmates reported to be HIV positive increased at about the same rate as the overall prison population. HIV-positive inmates comprised 2.2% of the State prison population in 1997, down from 2.3% in 1991. Infected inmates were 1.0% of Federal prisoners in 1997, unchanged from 1991. HIV-infected inmates were concentrated in a small number of States. New York and Florida housed the largest number of HIV-positive inmates (7,500 and 2,325, respectively). In 1997 these two States housed more than 40% of all HIV-infected inmates in State prisons. Percent of custody populati known to be HIV positive Year State Federal 1991 2.3% 1.0% 1992 2.6 1.2 1993 2.6 1.2 1994 2.5 1.1 1995 2.4 0.9 1996 2.4 1.0 1997 2.2 1.0 Northeast prisons held the largest number of HIV-infected inmates Nearly half the State prison inmates known to be HIV positive were in the Northeast. Within the Northeast, 6.4% of the prison population were HIV positive, followed by 2.0% in the South, 0.9% in the Midwest, and 0.8% in the West. New York had the highest percentage of inmates known to be HIV positive (10.8%), followed by Connecticut (5.1%) and Massachusetts (3.7%). Nine States (Alaska, Idaho, Kansas, Montana, North Dakota, South Dakota, Vermont, West Virginia, and Wyoming) reported 10 or fewer cases of HIV-positive inmates in their prisons. Of the 46 States that reported information in 1997, each reported having at least one HIV-positive inmates. Ten States reported that fewer than 0.5% of their inmate population were HIV positive. Between 1996 and 1997, 15 States reported a decreased number of HIV-positive inmates. The largest decrease (1,000 cases) was reported in New York--7,500 in 1997, down from 8,500 in 1996. Michigan (down 109), Arizona (down 100), North Carolina (down 70), and Louisiana (down 66) also reported large decreases. Twenty-eight States reported an increased number of HIV cases. Texas reported the largest increase (up 250) during 1997, followed by California (up 192) and Connecticut (up 108). Confirmed AIDS cases in prison more than tripled from 1991 to 1997 At the end of 1997, 6,184 inmates had confirmed AIDS: 5,816 were State inmates and 368 were Federal inmates (table 2). Inmates in custody of State and Federal prison authorities, by type of HIV infection or confirmed AIDS, yearend 1997 Confirmed AIDS cases Cases of HIV or confirmed AIDS as a percent of Asymp- Symptom- Confirmed Total HIV Custody Jurisdiction Total/a tomatic/b atic/c AIDS cases population U.S. total 23,548 13,532 2,971 6,184 26.3% 0.5% Federal 1,030 662 -- 368 35.7 0.4 State 22,518 12,870 2,971 5,816 25.8 0.6 Northeast 10,394 7053.0 1,122 2,219 21.3% 1.4% Connecticut 798 171.0 425 202 25.3 1.3 Maine -- -- -- -- -- -- Massachusetts 402 51 214 137 34.1 1.3 New Hampshire 17 3 7 7 41.2 0.3 New Jersey 867 565 -- 302 34.8 1.2 New York 7,500 5,926 273 1,301 17.3 1.9 Pennsylvania 697 323 153 221 31.7 0.6 Rhode Island 107 11 50 46 43 1.4 Vermont 6 3 0 3 ** 0.2 Midwest 1,849 910 365 574 31.0% 0.3% Illinois 655 418 36 201 30.7 0.5 Indiana -- -- -- -- -- -- Iowa 34 26 -- 8 23.5 0.1 Kansas 4 3 -- 1 ** + Michigan 419 216 -- 203 48.4 0.5 Minnesota 31 26 0 5 16.1 0.1 Missouri 227 -- 190 37 16.3 0.2 Nebraska 22 18 1 3 13.6 0.1 North Dakota 7 0 6 1 ** 0.1 Ohio 365 155 119 91 24.9 0.2 South Dakota 1 0 0 1 ** + Wisconsin 84 48 13 23 27.4 0.2 South 8,291 3,669 1,147 2,614 31.5% 0.6% Alabama 212 58 103 51 24.1 0.2 Arkansas 86 46 26 14 16.3 0.2 Delaware -- -- -- -- -- -- District of Columbia 75 -- -- 75 100 1.1 Florida 2,325 1,499 -- 826 35.5 1.3 Georgia 861 -- -- -- -- -- Kentucky 55 27 17 11 20 0.1 Louisiana 397 -- 290 107 27 0.6 Maryland 766 272 220 274 35.8 1.3 Mississippi 189 151 -- 38 20.1 0.4 North Carolina 519 349 -- 170 32.8 0.5 Oklahoma 107 103 -- 4 3.7 + South Carolina 432 64 197 171 39.6 0.8 Tennessee 131 -- 89 42 32.1 0.3 Texas 2,126 1,092 205 829 39 0.6 Virginia -- -- -- -- -- -- West Virginia 10 8 0 2 ** 0.1 West 1,984 1,238 337 409 20.6% 0.2% Alaska 10 0 10 0 ** 0 Arizona 105 59 -- 46 43.8 + California 1,328 974 197 157 11.8 0.1 Colorado 110 37 42 31 28.2 0.3 Hawaii 16 3 9 4 25 0.1 Idaho 10 5 2 3 ** 0.1 Montana 8 1 0 7 ** 0.4 Nevada 139 67 29 43 30.9 0.5 New Mexico 23 20 0 3 13 0.1 Oregon 54 33 14 7 13 0.1 Utah 60 10 34 16 26.7 0.3 Washington 119 27 -- 92 77.3 0.7 Wyoming 2 2 0 0 ** 0 Note: Totals and percentages exclude inmates in jurisdictions that did not report data on type of HIV/AIDS infection. The custody population includes only inmates housed at the end of 1997. --Not reported. **Not calculated for 10 or fewer cases. +Less than .05%. a/Georgia reported the total of HIV-positive cases but not the type of HIV infection. b/Includes all inmates who had tested positive for the HIV antibody but had no HIV-related symptoms. c/Includes inmates with symptoms of HIV infection but without a confimed AIDS diagnosis. Of the remaining HIV-positive inmates, 2,971 showed symptoms of AIDS (symptomatic), while 13,532 were HIV positive but showed no symptoms of AIDS (asymptomatic). Confirmed AIDS cases made up 0.5% of all inmates in State and Federal prisons. Of those known to be HIV-positive inmates, over a quarter had confirmed AIDS. HIV-positive State and Federal inmates 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 1995 5,099 18,165 1996 5,847 16,656 1997 6,184 16,503 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 classifica- tion system and expanded the surveil lance 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. During 1997 the number of confirmed AIDS cases increased by 337. Overall, after 1991 the number of confirmed AIDS cases increased 4,502 -- an annual average increase of 24.2%. While the number of confirmed AIDS cases increased, the number of inmates with lesser or no symptoms of HIV infection decreased from 18,165 in 1995 to 16,503 in 1997. The States with the largest number of confirmed AIDS cases were New York (1,301), Texas (829), and Florida (826). Combined, these States made up 51% of all confirmed AIDS cases in State prisons. Seventeen States reported having fewer than 10 confirmed AIDS cases in their prison. The highest percentage of the State prison population having confirmed AIDS was in New York (1.9%), followed by Rhode Island (1.4%), Connecticut (1.3%), Florida (1.3%), and Maryland (1.3%). In 17 States, confirmed AIDS cases comprised 0.1% or less of State inmates. The rate of AIDS in prison at least 5 times the rate in the general population At the end of 1997, the rate of confirmed AIDS in State and Federal prisons was 5« times higher than in the total U.S. population. About 55 per 10,000 prison inmates had confirmed AIDS, compared to 10 per 10,000 persons in the U.S. population. Percent of population with confirmed AIDS U.S. Inmates in general State and Year population Federal prisons 1991 0.03% 0.21% 1992 0.03 0.33 1993 0.06 0.50 1994 0.07 0.52 1995 0.08 0.51 1996 0.09 0.54 1997 0.10 0.55 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 In every year since 1991, the rate of confirmed AIDS has been higher among prison inmates than in the general population. In 1992 the rate of AIDS was 10 times higher for prisoners than the general population. In 1993, following a revision of the HIV classification system and an expansion of the case definition for AIDS, the rate of confirmed AIDS increased 1« times among prisoners and doubled in the general population. After the adoption of these new measures, the incidence of AIDS grew somewhat faster in the general population. A greater percent of females than males reported HIV infection At yearend 1997, 20,153 male inmates and 2,185 female inmates were known to be HIV positive (table 3). State prison inmates known to be positive for the human immunodeficiency virus, by gender, yearend 1997 Male HIV cases Female HIV cases Percent of Percent of Jurisdiction Number population Number population Total 20,153 2.2% 2,185 3.5% Northeast 9,322 6.0 1,072 12.7 Connecticut 659 4.6 139 13.1 Maine -- -- -- -- Massachusetts 344 3.4 58 8.2 New Hampshire 15 0.8 2 1.5 New Jersey 796 3.3 71 5.5 New York 6,755 10.3 745 20.7 Pennsylvania 653 1.9 44 3.1 Rhode Island 95 3.1 12 6.1 Vermont 5 0.4 1 1.9 Midwest 1,708 0.9% 141 1.2% Illinois 591 1.5 64 2.6 Indiana -- -- -- -- Iowa 27 0.4 7 1.3 Kansas 4 0.1 0 0 Michigan 398 0.9 21 1 Minnesota 31 0.6 0 0 Missouri 212 0.9 15 0.9 Nebraska 20 0.6 2 0.9 North Dakota 5 0.7 2 3 Ohio 340 0.8 25 0.9 South Dakota 1 0 0 0 Wisconsin 79 0.6 5 0.7 South 7,385 1.9% 831 3.1% Alabama 197 1 15 1.1 Arkansas 81 1 5 0.8 Delaware -- -- -- -- District of Columbia -- -- -- -- Florida 2,082 3.4 243 7.1 Georgia 765 2.2 96 4.2 Kentucky 50 0.5 5 0.8 Louisiana 372 2.1 25 2.7 Maryland 682 3.3 84 7.6 Mississippi 171 1.8 18 2 North Carolina 455 1.6 64 3.6 Oklahoma 97 0.7 10 0.8 South Carolina 409 2.1 23 1.8 Tennessee 127 0.9 4 0.7 Texas 1,887 1.5 239 2.3 Virginia -- -- -- -- West Virginia 10 0.4 0 0 West 1,738 0.9% 141 0.9% Alaska 6 0.2 4 1.9 Arizona -- -- -- -- California 1,248 0.9 80 0.7 Colorado 102 1 8 1 Hawaii 16 0.4 0 0 Idaho 10 0.3 0 0 Montana 7 0.4 1 1.2 Nevada 108 1.4 31 4.9 New Mexico 22 0.7 1 0.3 Oregon 51 0.7 3 0.7 Utah 57 1.2 3 1.1 Washington 109 0.9 10 1.1 Wyoming 2 0.2 0 0 -Not reported. Those known to be HIV positive were 2.2% of male inmates and 3.5% of female inmates. In most States and in all regions except the West, female inmates had a higher HIV-positive infection rate than male inmates. State prison inmates Percent HIV- positive in Year Number of custody popula- HIV-positive tion of reporting Males inmates States 1991 16,150 2.2% 1992 18,266 2.6 1993 18,218 2.5 1994 19,762 2.4 1995 20,690 2.3 1996 21,799 2.3 1997 20,153 2.2 Annual average change, 1991-97* 3.8% Females 1991 1,159 3.0% 1992 1,598 4.0 1993 1,796 4.2 1994 1,953 3.9 1995 2,182 4.0 1996 2,135 3.5 1997 2,185 3.5 Annual average change, 1991-97* 11.1% *In 1991 North Carolina, South Dakota, and the District of Columbia did not report data by gender. In 1997 Maine, Delaware, Indiana, Virginia, Arizona, and the District of Columbia did not report data by gender. Following a decrease in 1996, the number of HIV-infected females increased during 1997 (from 2,135 to 2,185). The number of infected male inmates decreased 7.6% (from 21,799 in 1996 to 20,153 in 1997). Among State prisoners, the average annual rates of increased from 1991 to 1997 of those infected with HIV were 3.8% for males and 11.1% for females. States in the Northeast reported the largest number of HIV-positive male and female inmates (9,322 and 1,072, respectively). In seven States, more than 5% of all female inmates were known to be HIV positive. In New York (20.7%) and Connecticut (13.1%) over 10% of female inmates were known to be HIV-positive. New York (10.3%) was the only State in which more than 10% of all male inmates were HIV-positive. New York also reported the largest number of male and female HIV-positive inmates (6,755 and 745, respectively). The second largest numbers of HIV-positive male and female inmates were in Florida (2,082 and 243, respectively), followed by Texas (1,887 and 239, respectively). Seven States reported no female HIV-positive inmates. Every State reported at least one male inmate as HIV positive. AIDS-related deaths in State prisons dropped 41% during 1997 The number of State inmates who died of Pneumocystis carinii pneumonia, Kaposis's sarcoma, or other AIDS-related diseases decreased from 907 in 1996 to 538 in 1997 (table 4). Number of inmate deaths in State prisons, by cause, 1995-97 1995 1996 1997 Rate of Rate of Rate of death per death per death per 100,000 100,000 100,000 Cause of death Number inmates Number inmates Number inmates Total 3,133 311 3,095 308 2,872 255 Natural causes other than AIDS 1,569 156 1,715 170 1,859 165 AIDS 1,010 100 907 90 538 48 Suicide 160 16 154 15 159 14 Accident 48 5 43 4 37 3 Execution 56 6 45 4 74 7 By another person 86 9 65 6 75 7 Other/unspecified 204 20 166 16 130 12 Note: To calculate the rate of death, the number of inmates under State jurisdiction on June 30 of each year was used as an approximation of the average population exposed to the risk of death during the year. These AIDS deaths accounted for 19% of all deaths among State prisoners, down from 29% in 1996. Even with a sharp decline, AIDS-related illnesses were still the second leading cause of death in State prisons behind natural causes other than AIDS. In 1997 for every 100,000 inmates, 48 died from AIDS-related causes (table 5). AIDS-related deaths of sentenced prisoners under State jurisdiction, 1997 Deaths from all causes in State prisons AIDS-related deaths Rate per Rate per As a percent of Jurisdiction Total 100,000 inmates/a Total 100,000 inmate all deaths/b Total 2,872 255 538 48 18.7% Northeast 501 295 136 80 27.1 Connecticut 33 191 13 75 39.4 Maine 1 62 0 0 ** Massachusetts 24 201 2 17 8.3 New Hampshire 5 231 0 0 ** New Jersey 101 356 41 145 40.6 New York 221 320 60 87 27.1 Pennsylvania 109 312 19 54 17.4 Rhode Island 6 178 1 30 ** Vermont 100.0% 79 0 0 ** Midwest 488 223 50 23 10.2% Illinois 101 248 16 39 15.8 Indiana 45 251 1 6 2.2 Iowa 9 130 0 0 ** Kansas 24 303 1 13 4.2 Michigan 99 221 18 40 18.2 Minnesota 6 113 1 19 ** Missouri 48 200 6 25 12.5 Nebraska 10 294 0 0 ** North Dakota 1 125 0 0 ** Ohio 117 244 6 12 5.1 South Dakota 6 268 0 0 ** Wisconsin 22 135 1 6 4.5 South 1,415 288 309 64 21.8% Alabama 91 408 14 63 15.4 Arkansas 31 309 0 0 0 Delaware 12 221 0 0 0 District of Columbia 25 267 -- -- -- Florida 242 374 108 167 44.6 Georgia 114 312 41 112 36 Kentucky 28 192 0 0 0 Louisiana 80 273 17 58 21.3 Maryland 54 243 12 54 22.2 Mississippi 47 329 4 28 8.5 North Carolina 56 177 8 25 14.3 Oklahoma 68 331 3 15 4.4 South Carolina 55 260 19 90 34.5 Tennessee 70 420 13 78 18.6 Texas 341 243 56 40 16.4 Virginia 92 324 14 49 15.2 West Virginia 9 286 0 0 ** West 468 188 43 17 9.2% Alaska 4 96 0 0 ** Arziona 61 260 0 0 0 California 268 172 36 23 13.4 Corado 34 253 0 0 0 Hawaii 8 161 1 20 ** Idaho 10 256 2 51 20 Montana 4 159 0 0 ** Nevada 25 277 3 33 12 New Mexico 7 149 0 0 ** Oregon 19 238 0 0 0 Utah 3 70 0 0 ** Washington 23 174 1 8 4.3 Wyoming 2 129 0 0 ** --Not reported. **Not calculated for 10 or fewer deaths. a/Based on the number of inmates under State jurisdiction on June 30, 1997, with a sentence of more than 1 year. b/National and regional totals exclude inmates in jurisdictions that did not report data on cause of death. Between 1995 and 1997, the number of AIDS-related deaths in State prisons decreased 47%. This decrease may reflect improvement in the effectiveness of HIV/AIDS care, following the introduction of protease inhibitors and combination antiretroviral therapies. AIDS death rate in State prison at least 3 times the rate in the general population In 1997 the rate of death because of AIDS was over 3 times higher in the prison population than in the total U.S. population age 15-54. About 1 in every 5 prisoner deaths were attributable to AIDS-related causes. In 1996 about 1 in 10 deaths in the general population were AIDS related. AIDS-related deaths as a percent of all deaths U.S. general State population and prison Year 15-54* inmates 1991 10.4% 28.0% 1992 11.7 35.2 1993 11.9 33.2 1994 12.7 35.1 1995 13.1 34.2 1996 10.1 29.3 1997 5.8 18.7 *See Methodology for source of data. AIDS-related deaths accounted for more than a third of all inmate deaths in Florida (45%), New Jersey (41%), Connecticut (39%), and South Carolina (35%) (table 5). Prison officials in the South reported the most AIDS-related deaths (309); Florida accounted for 108 of those deaths. Nineteen States reported having no AIDS-related deaths, and 7 States reported 1 AIDS- related death. Eighteen States tested all inmates for HIV either at admission or while in prison Prison officials report data on HIV and AIDS in the National Prisoners Statistics series (NPS-1). The quality of the reporting may vary by the nature and extent of testing in each jurisdiction. Testing policies range from testing all inmates to testing only upon inmate request. In 1997 all States, the District of Columbia, and the Federal Bureau of Prisons tested their inmates for HIV based on certain criteria (table 6). Prison system testing policies for the antibody to the human immunodeficiency virus, by jurisdiction, 1997 All inmates High Upon Clinical Involve- In At risk inmate indica- mentin Random Entering custody release group request tion incident sample Other Federal* X X X Northeast Connecticut X X X X Maine X Massachusetts X New Hampshire X New Jersey X X X New York X X X X X Pennsylvania X Rhode Island X X X X X Vermont X X X Midwest Illinois X X X X Indiana X X X Iowa X Kansas X X X Michigan X X X X Minnesota X X X X Missouri X X X X X Nebraska X X X North Dakota X Ohio X X X X X South Dakota X Wisconsin X X South Alabama X X X Arkansas X X X X X X Delaware X X X District of Columbia X Florida X X X Georgia X X X Kentucky X X X X Louisiana X X X Maryland X X X Mississippi X North Carolina X X X Oklahoma X X X X South Carolina X X X X Tennessee X X X X X Texas X X X X Virginia X X X X X X West Virginia X X West Alaska X Arizona X X X X California X X X Colorado X X X X X Hawaii X X Idaho X Montana X X X X Nevada X X X X X New Mexico X X Oregon X Utah X Washington X X X Wyoming X *The Bureau of Prisons tests a random sample of inmates on alternate years. Most jurisdictions (44 out of 52) tested inmates if they had HIV- related symptoms or if the inmates requested a test. Twenty-nine States tested inmates after they were involved in an incident, and 15 States tested inmates who belonged to specific "high-risk groups." Of the 18 States that tested all entering inmates, 4 States (Alabama, Missouri, Nevada, and Virginia) and the Federal Bureau of Prisons tested inmates at release. Arkansas, Rhode Island, and Virginia tested all inmates currently in custody. New York was the only State that tested inmates selected at random. Number of Testing policy jurisdictions Upon inmate request 40 Upon clinical indication of need 37 Upon involvement in an incident 29 All incoming inmates 18 High-risk groups 15 All inmates at time of release 5 All inmates currently in custody 3 Random sample 1 Note: Detail adds to more than 52 because a jurisdiction may have more than one testing policy. HIV/AIDS reported in personal interviews Data based on reports from correctional authorities are limited in detail and may understate the number of inmates infected with HIV. Additional information may be obtained through personal interviews of prisoners. Though some inmates may be reluctant to report that they are HIV positive and others may not know, surveys provide a means to track HIV infection among demographic and "high-risk" groups not identified in official records. The 1997 Surveys of State and Federal Correctional Facilities asked inmates if they had ever been tested, if they had been tested since admission, and whether they were HIV positive. (See Methodology for further detail.) Key National P rison Statistics Program-1 items on HIV/AIDS HIV testing, Jan. 1 - Dec. 31, 1997 During 1997 were any inmates tested for the antibody to the Immunodeficiency Virus (HIV) that causes AIDS? - Yes - No Which inmates were tested during 1997? Mark (X) all that app -All incoming inmates -All inmates currently in custody -All inmates at time of release -Certain inmates (Complete next item) Who were the certain inmates tested? Mark (X) all that appl -High-risk groups - Specify ---------------------- -Upon inmate request -Upon clinical indication of need -Upon involvement in incident -Random sample -Other - Specify ---------------------- HIV infection/AIDS cases in custody on Dec. 31, 1997 Inmates who were asymptomatic HIV positive Total _____ Male _____ Female _____ Inmates with lesser forms of symptomatic HIV disease Total _____ Male _____ Female _____ Inmates with confirmed AIDS Total _____ Male _____ Female _____ Total number of inmates who were HIV positive or confirmed A Total _____ Male _____ Female _____ Rate of HIV infection higher among State inmates than Federal inmates Of inmates who reported being tested since admission, 2.6% in State prison and 0.7% in Federal prison reported being HIV positive (table 7). Inmates ever tested or tested since admission for the human immunodeficiency virus and test results, 1997 Percent of tested inmates who reported results State Federal Inmate characteristic prisons prisons Ever tested 74.6% 79.6% HIV positive 2.2 0.6 Tested since admission 59.1% 69.7% HIV positive 2.6 0.7 Note: Data are from the 1997 Surveys of Inmates in State and Federal Correctional Facilities. Among State prisoners who were tested for HIV, female inmates (3.4%) were more likely than male inmates (2.2%) to be HIV positive (table 8). Inmates ever tested for the human immunodeficiency virus and results, by selected characteristics, 1997 Tested inmates who reported results State prisons Federal prisons Percent Percent HIV Characteristic Number HIV postive Number positive All inmates 790,128 2.2% 70,902 0.6% Gender Male 734,327 2.2% 65,723 0.6% Female 55,800 3.4 5,179 0.6 Race/Hispanic origin White non-Hispanic 257,919 1.4% 21,128 0.3% Male 239,687 1.4 19,565 0.3 Female 18,232 2.3 1,563 0.3 Black non-Hispanic 384,870 2.8 28,178 0.8 Male 357,736 2.7 26,387 0.8 Female 27,135 3.9 1,791 1.3 Hispanic 123,725 2.5 18,466 0.7 Male 115,344 2.4 16,892 0.7 Female 8,382 4.2 1,573 0 Age 17-24 154,181 0.5% 5,528 0.1% 25-34 310,161 2.3 26,262 0.5 35-44 232,835 3.1 22,228 0.4 45 or older 92,168 2.7 16,884 1.2 Marital status Married 128,834 1.7% 21,545 0.5% Widowed/divorced 161,468 2.0 16,331 0.4 Separated 45,435 2.9 3,884 0 Never married 453,664 2.4 29,045 0.8 Education Less than high school 302,437 2.7% 17,226 0.8% GED 231,714 1.4 16,389 0.6 High school or more 254,975 2.4 37,237 0.5 Note: Data are from the 1997 Surveys of Inmates in State and Federal Correctional Facilities. Black non-Hispanic inmates (2.8%) were twice as likely as white non-Hispanic inmates (1.4%) to report being HIV positive. Among male inmates, black non-Hispanics (2.7%) were nearly twice as likely as white non-Hispanics (1.4%) to be HIV positive. Because of the small number of inmates interviewed, the rates of HIV infection among female inmates were not significantly different between white non-Hispanics (2.3%), black non- Hispanics (3.9%), and Hispanics (4.2%). In Federal prisons 0.6% of males and of females reported an HIV infection. HIV-positive rates were lowest for white non-Hispanic inmates (0.3%). In both State and Federal prisons, inmates age 17-24 had the lowest rates (0.5% and 0.1%, respectively). In State prisons, inmates age 35-44 had the highest HIV-positive rate (3.1%). Those inmates age 25 or older were more likely to be HIV positive than those who were 24 or younger. In Federal prisons, inmates age 45 or older had the highest rate of HIV infection (1.2%). Among State prisoners drug offenders reported a higher prevalence of HIV infection Those inmates held on a drug offense in State prisons had the highest HIV- positive rate (2.9% ) (table 9). Inmates ever tested for the human immunodeficiency virus and results, by offense and prior drug use, 1997 Tested inmates who reported results State prisons Federal prisons Percent Percent Characteristic Number HIV positive Number HIV positive Current offense Violent 360,370 1.9% 10,681 1.0% Property 178,601 2.4 4,660 1.0 Drug 164,256 290.0% 43,815 0.4 Public-order 77,049 1.9 10,029 1.0 Prior drug use Never 123,049 1.7% 18,917 0.3% Ever 665,977 2.3 51,847 0.7 In the month before offense 460,685 2.7 32113 0.3 Used needle to inject drugs 168,446 4.6 9,443 1.3 Ever shared a needle 74,393 7.7 4,022 2.1 Note: Data are from the 1997 Surveys of Inmates in State and Federal Correctional Facilities. Of property offenders, 2.4% reported being HIV positive. Rates were slightly lower for violent and public-order offenders (1.9% each). Of Federal prison inmates, 1.0% of violent offenders, property offenders, and public-order offenders reported being HIV positive. The percentage of State and Federal prison inmates reporting that they were HIV positive varied by level of prior drug use. Of State prison inmates who reported never using drugs, 1.7% were HIV positive. An estimated 2.3% of inmates who had ever used drugs, 2.7% of those who used drugs in the month before their current offense, 4.6% of those who had used a needle to inject drugs, and 7.7% of those who had shared a needle reported being HIV positive. Like State inmates, Federal inmates who used a needle and shared a needle had a higher rate of HIV infection than those inmates who reported ever using drugs or using drugs in the month before their current offense (1.3% and 2.1% compared to 0.7% and 0.3%). Methodology Data are based on yearly reports from prison officials in the departments of corrections of the 50 States and the District of Columbia and in the Federal Bureau of Prisons. The National Prisoner Statistics series (NPS-1) includes an annual yearend count of prisoners by jurisdiction, gender, race, Hispanic origin, and admissions and releases during the year. 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. To obtain more detailed information on inmates, this report also used data from the 1997 Surveys of Inmates in State and Federal Correctional Facilities. Detailed descriptions of the methodology and sample design of each survey can be found in the following: Substance Abuse and Treatment of State and Federal Prisoners, 1997 (NCJ 172871). Accuracy of the survey estimates The accuracy of the estimates from the 1997 Surveys of Inmates in State and Federal Correctional Facilities depends on two types of error: sampling and nonsampling. Sampling error is 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 nonresponse, 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. Estimates for the percentage of inmates ever tested for HIV and the percentage who tested HIV positive have been calculated (see appendix table). Standard error estimates for Surveys of State and Federal Correctional Facilities, 1997 Estimated standard error of the percent of reporting inmates who were HIV positive State Federal Characteristic prison prisons Gender Male 0.20 0.19 Female 0.44 0.35 Race/Hispanic origin White non-Hispanic 0.29 0.31 Male 0.31 0.33 Female 0.80 0.63 Black non-Hispanic 0.37 0.48 Male 0.38 0.51 Female 0.72 1.15 Hispanic 0.58 0.52 Male 0.61 0.56 Female 1.67 0.00 Age Under 24 0.20 0.27 -9 0.30 0.27 -9 0.40 0.26 45 or older 0.60 0.52 Marital status Married 0.40 0.30 Widowed/divorced 0.39 0.31 Separated 0.88 0.00 Never married 0.25 0.33 Education Less than high school 0.33 0.42 GED 0.27 0.38 High school graduate or more 0.34 0.23 Current offense Violent 0.25 0.60 Property 0.40 0.91 Drug 0.46 0.19 Public-order 0.55 0.62 Prior drug use Never used 0.41 0.25 Ever used 0.21 0.23 Used month before offense 0.27 0.19 Used needle to inject drugs 0.57 0.73 Shared a needle 1.09 1.41 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 2.2% plus or minus 1.96 times 0.20 (or 1.8% to 2.6%). These standard errors may also be used to test the statistical significance of the difference between two sample estimates by pooling the standard errors of the estimates (that is, by taking the square root of the sum of the squared standard errors for each sample estimate). All comparisons discussed in this report were statistically significant at the 95-percent confidence level. 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 1991-97. 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 data for the U.S. general population, excluding persons under age 13 from 1991 to 1997 were taken from the U.S. Population Estimates, by Age, Sex, Race, and Hispanic Origin: 1990 to 1995, PPL-41, and update for 1996 and 1997). The rate of confirmed AIDS cases in the U.S. resident population was calculated by dividing the annual totals for individuals with AIDS by the population estimates for the U.S. resident population of individuals 13 and older. The classification system for HIV infection and the case definition for AIDS were expanded in 1993. This expansion improved estimates of the number and the 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, November 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. 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 the CDC, National Vital Statistics Report, Vol. 47, No. 9, and Vol. 47, No. 25. 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. The Bureau of Justice Statistics is the statistical agency 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 collection programs such as the National Prisoner Statistics. Laura Maruschak wrote this report, under the supervision of Allen J. Beck. Lauren E. Glaze and Chris- topher J. Mumola provided statisti- cal review. Tom Hester and Tina Dorsey edited the report. Jayne Robinson, assisted by Yvonne Boston, prepared the report for publication. October 1999, NCJ 178284 This report and others from the Bureau of Justice Statistics are available through the Internet- http://www.ojp.usdoj.gov/bjs/ The data from the 1997 Surveys of Inmates in State and Federal . Correctional Facilities is available from the National Archive of Crimi- nal Justice Data, maintained by the Institute for Social Research at the University of Michigan, 1-800-999- 0960. The archive may also be accessed through the BJS Internet site 11/3/99 ih revised 12/9/99 th