U.S. Department of Justice Office of Justice Programs National Institute of Justice Jeremy Travis, Director Bureau of Justice Statistics Jan M. Chaiken, Ph.D., Director Excerpt from-- 1996-97 Update: HIV/AIDS, STDs, and TB in Correctional Facilities A Joint Publication of the National Institute of Justice, the Centers for Disease Control and Prevention, and the Bureau of Justice Statistics NCJ 174437 Note: The entire publication may be viewed at http://www.ojp.usdoj.gov/nij/pubs-sum/176344.htm Chapter 1 HIV in Prisons and Jails, 1996 Laura M. Maruschak Bureau of Justice Statistics Key Findings 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 22,747 2.4 1995 24,256 2.3 1996 24,881 2.3 * At Year-end 1996, 3.5 percent of all female State prison inmates were HIV-positive, compared to 2.3 percent of male State prisoners. HIV-positive prison inmates Percent of custody Jurisdiction Number population New York 9,500 13.6% Florida 2,152 3.4 Texas 1,876 1.4 California 1,136 .8 Note: Based on jurisdictions with more than 1,000 HIV-positive inmates. * New York held more than a third of all inmates (9,500 inmates) known to be HIV positive at Year-end 1996. * Of all HIV-positive prison inmates, 24 percent were confirmed AIDS cases. In State prisons, 23 percent of HIV-positive inmates had AIDS; in Federal prisons, 37 percent. * The overall rate of confirmed AIDS among the Nation's prison population (0.54 percent) was about six times the rate in the U.S. population (0.09 percent). * Inmates in State prisons and local jails who have been tested for HIV self-report similar HIV-infection rates: Percent HIV positive among-- Jail inmates Prison inmates All inmates 2.2% 2.2% Male 2.1% 2.2% Female 2.4 3.4 White 1.4% 1.4% Black 2.6 2.8 Hispanic 3.2 2.5 Age 24 or younger .7% .5% 25-34 2.1 2.3 35-44 3.8 3.1 45 or older 3.0 2.7 Note: From the 1996 Survey of Inmates in Local Jails and the 1997 Survey of Inmates in State Correctional Facilities. * Jail officials in the last national Census of Jails (conducted in 1993) reported that 6,711 inmates were known to be HIV positive and 1,888 had confirmed AIDS. The infection rate was highest in the largest jail jurisdictions. (End Key Findings) At Year-end 1996, 2.3 percent of all State and Federal prison inmates were known to be infected with the human immunodeficiency virus (HIV). A total of 24,881 prison inmates were HIV positive (947 Federal and 23,934 State). HIV-positive inmates made up 1.0 percent of Federal prison inmates and 2.4 percent of State prison inmates. Of those known to be HIV positive in all U.S. prisons, 5,874 were confirmed AIDS cases, while the remaining 17,656 either showed symptoms of HIV infection or were asymptomatic. In 1996, there were a total of 907 AIDS-related deaths in State prisons, down from 1,010 in 1995. For every 100,000 State prison inmates in 1996, 90 died of AIDS-related causes. Between 1991 and 1996, about 1 in 3 State prison inmate deaths were attributed to AIDS-related causes. Data based on personal interviews from the 1997 Survey of Inmates in State Correctional Facilities show that 75 percent of State inmates were ever tested for HIV. Of those who were ever tested and reported results, 2.2 percent were HIV positive--2.2 percent of males and 3.4 percent of females. As reported level of involvement in prior drug use increased, so did the percent of HIV-positive inmates--2.3 percent of those who said they had ever used drugs, 2.7 percent of those who used drugs in the month before the current offense, 4.6 percent of those who injected drugs, and 7.7 percent of those who ever shared a needle were HIV positive. Data on HIV/AIDS in jails have been collected in the 1993 Census of Jails and the 1996 Survey of Inmates in Local Jails. According to the 1993 Census of Jails, 1.8 percent of local jail inmates were known to be HIV positive. The larger the size of the jail jurisdiction, the greater the percentage of inmates with HIV/AIDS. Based on personal interviews conducted from October 1995 through March 1996 in the Survey of Inmates in Local Jails, almost 6 in 10 inmates reported ever being tested for HIV. Of those who were tested and reported results, 2.2 percent reported being HIV positive. Among female inmates, 2.4 percent said they were HIV positive; among male inmates, 2.1 percent. An estimated 2.3 percent of tested jail inmates who said they had ever used drugs were HIV positive, as were 2.9 percent who used drugs in the month before arrest, 4.0 percent who used a needle to inject drugs, and 6.3 percent who ever shared needles. Trends in HIV Infection in U.S. Prisons At Year-end 1996, 24,881 inmates in State and Federal prisons were known to be infected with the human immunodeficiency virus (HIV), up from 24,256 at Year-end 1995 (table 2). In State prisons, 23,934 inmates were known to be HIV positive, and in Federal prisons, 947 inmates were HIV positive. Although the number of HIV cases increased after 1991, the percent of the total custody population with HIV remained relatively stable. Between 1991 and 1996 the number of HIV-positive inmates grew at about the same rate as the overall prison population (both increased by about 42 percent). HIV-positive inmates comprised 2.3 percent of the State prison population in 1991 and 2.4 percent in 1996. In Federal prisons, HIV-positive inmates comprised 1.0 percent in 1996, unchanged from 1991. Percent of custody population 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 Source: BJS, National Prisoner Statistics. HIV-infected inmates were concentrated in a small number of States. New York and Florida housed the largest number of HIV-positive inmates (9,500 and 2,152, respectively). In 1996, these two States housed nearly half of all HIV-infected inmates in State prisons. More than half of the State prison inmates known to be HIV positive were found in the Northeast. Within the Northeast, 7.5 percent of the prison population were HIV positive, followed by 2.0 percent in the South, 1.1 percent in the Midwest, and 0.8 percent in the West. New York had the highest percentage of inmates known to be HIV positive (13.6 percent), followed by Connecticut (4.6 percent), and Rhode Island (3.9 percent). These three States had the highest percentage of HIV-positive inmates after 1994. Of the 48 States that reported information on the number of HIV-positive inmates in 1996, each reported having at least one. Eight States (Alaska, Maine, Montana, North Dakota, South Dakota, Vermont, West Virginia, and Wyoming) reported 10 or fewer cases of HIV-positive inmates in their prisons. Eleven States reported that fewer than 0.5 percent of their inmate population were HIV positive. Between 1995 and 1996 the largest growth of HIV-positive inmates was reported in Virginia--383 in 1996, up from 134 in 1995. Other notable increases during 1996 were reported in Michigan (up 149) and Maryland (up 108). Table 2. Inmates in custody of State or Federal prison authorities and known to be positive for the human immunodeficiency virus, 1994-96 HIV/AIDS cases as a percent of total percent of total Jurisdiction Total known to be HIV postitive custody population/a ------------------------------------------------------------------------------------- 1994 1995 1996 1994 1995 1996 ------------------------ ------------------------- U.S. total/b 22,747 24,256 24,881 2.4% 2.3% 2.3% Federal 964 822 947 1.1 0.9 1.0 State 21,783 23,434 23,934 2.5 2.4 2.4 Northeast 11,001 12,262 12,090 7.4% 7.8% 7.5% Connecticut 940 755 690 6.6 5.1 4.6 Maine 8 4 4 0.5 0.3 0.3 Massachusetts 388 409 393 3.4 3.9 3.6 New Hampshire 26 31 18 1.3 1.5 0.9 New Jersey 770 847 705 3.6 3.7 3.0 New York 8,295 9,500 9,500 12.4 13.9 13.6 Pennsylvania 461 590 652 1.6 1.8 1.9 Rhode Island 113 126 125 3.8 4.4 3.9 Vermont 0 0 3 0 0 0.3 Midwest 1,750 1,667 1,874 1.1% 0.9% 1.0% Illinois 600 583 634 1.6 1.5 1.6 Indiana -- -- -- -- -- -- Iowa 25 20 24 0.5 0.3 0.4 Kansas 20 24 16 0.3 0.3 0.2 Michigan 384 379 528 0.9 0.9 1.2 Minnesota 35 46 24 0.8 1.0 0.5 Missouri 146 173 190 0.8 0.9 0.9 Nebraska 16 19 17 0.6 0.6 0.5 North Dakota 3 2 3 0.5 0.3 0.4 Ohio 454 346 343 1.1 0.8 0.7 South Dakota 2 3 4 0.1 0.2 0.2 Wisconsin 65 72 91 0.6 0.6 0.7 South 7,440 7,870 8,162 2.0% 1.9% 1.9% Alabama 210 222 234 1.1 1.1 1.1 Arkansas 81 83 77 1.0 1.0 0.9 Delaware 34 122 -- 0.8 2.5 -- District of Columbia -- -- -- -- -- -- Florida 1,986 2,193 2,152 3.5 3.4 3.4 Georgia 884 858 814 2.6 2.5 2.3 Kentucky 44 41 55 0.5 0.4 0.5 Louisiana 285 314 347 1.8 1.8 2.0 Maryland 774 724 832 3.7 3.4 3.8 Mississippi 119 138 135 1.2 1.4 1.3 North Carolina 521 526 589 2.2 1.9 2.0 Oklahoma 102 115 108 0.8 0.8 0.7 South Carolina 434 380 422 2.5 2.0 2.1 Tennessee 89 120 131 0.7 0.9 1.0 Texas 1,584 1,890 1,876 1.6 1.5 1.4 Virginia 285 134 383 1.4 0.6 1.5 West Virginia 8 10 7 0.4 0.4 0.3 West 1,592 1,635 1,808 0.8% 0.8% 0.8% Alaska -- 5 10 -- 0.2 0.3 Arizona 143 140 205 0.7 0.7 0.9 California 1,055 1,042 1,136 0.8 0.8 0.8 Colorado 79 93 94 0.9 1 0.9 Hawaii 14 12 23 0.5 0.4 0.7 Idaho 20 11 17 0.8 0.4 0.5 Montana 7 4 6 0.4 0.2 0.4 Nevada 122 147 133 1.8 1.9 1.6 New Mexico 19 24 11 0.5 0.6 0.2 Oregon 24 29 39 0.3 0.4 0.5 Utah 48 31 31 1.5 0.8 0.7 Washington 55 92 99 0.5 0.8 0.8 Wyoming 6 5 4 0.6 0.4 0.3 --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/AIDS. Counts may differ from previous reports. Percentages for all years are based on year-end custody counts. Source: BJS National Prisoner Statistics Confirmed AIDS Cases in U.S. Prisons At the end of 1996, 5,874 inmates in U.S. prisons had confirmed AIDS: 5,521 were State inmates and 353 were Federal inmates (table 3). Of the remaining HIV-positive inmates, 1,959 showed symptoms of AIDS (symptomatic), while 15,697 were HIV positive but showed no symptoms of AIDS (asymptomatic). Table 3. Inmates in custody of State or Federal prison authorities, by type of HIV infection or confirmed AIDS, year-end 1996 Cases of HIV or confirmed AIDS Confirmed AIDS cases as a percent of -- ------------------------------- ---------------------------------------- Jurisdiction Total/a Asymptomatic/b Symptomatic/c Confirmed AIDS Total HIV cases Custody population ---------------------------------------------------------------------------------------------------------------------------------- U.S. total 24,881 15,697 1,959 5,874 23.6% 0.5% Federal 947 549 45 353 37.3 0.4 State 23,934 15,148 1,914 5,521 23.1 0.6 Northeast 12,090 9,109 846 2,135 17.7% 1.3% Connecticut 690 199 252 239 34.6 1.6 Maine 4 4 0 0 ** 0.0 Massachusetts 393 79 148 166 42.2 1.5 New Hampshire 18 0 18 0 0.0 0.0 New Jersey 705 445 -- 260 36.9 1.1 New York 9,500 8,005 287 1,208 12.7 1.7 Pennsylvania 652 318 112 222 34.0 0.6 Rhode Island 125 56 29 40 32.0 1.2 Vermont 3 3 0 0 ** 0.0 Midwest 1,874 1,017 83 584 31.2% 0.3% Illinois 634 394 42 198 31.2 0.5 Indiana -- -- -- -- -- -- Iowa 24 16 -- 8 33.3 0.1 Kansas 16 9 -- 7 43.8 0.1 Michigan 528 255 -- 273 51.7 0.6 Minnesota 24 9 7 8 33.3 0.2 Missouri 190 -- -- -- -- -- Nebraska 17 9 4 4 23.5 0.1 North Dakota 3 3 0 0 ** 0.0 Ohio 343 279 -- 64 18.7 0.1 South Dakota 4 0 0 4 ** 0.2 Wisconsin 91 43 30 18 19.8 0.1 South 8,162 3,960 820 2,221 27.2% 0.5% Alabama 234 176 0 58 24.8 0.3 Arkansas 77 20 37 20 26.0 0.2 Delaware -- -- -- -- -- -- District of Columbia -- -- -- -- -- -- Florida 2,152 1,279 -- 873 40.6 1.4 Georgia 814 -- -- -- -- -- Kentucky 55 36 13 6 10.9 0.1 Louisiana 347 -- -- -- -- -- Maryland 832 521 37 274 32.9 1.3 Mississippi 135 111 -- 24 17.8 0.2 North Carolina 589 -- 390 199 33.8 0.7 Oklahoma 108 99 -- 9 8.3 0.1 South Carolina 422 309 -- 113 26.8 0.6 Tennessee 131 -- 94 37 28.2 0.3 Texas 1,876 1,128 249 499 26.6 0.4 Virginia 383 275 0 108 28.2 0.4 West Virginia 7 6 0 1 ** *** West 1,808 1,062 165 581 32.1% 0.3% Alaska 10 4 6 -- ** -- Arizona 205 171 -- 34 16.6 0.2 California 1,136 585 122 429 37.8 0.3 Colorado 94 77 -- 17 18.1 0.2 Hawaii 23 17 4 2 8.7 0.1 Idaho 17 13 0 4 23.5 0.1 Montana 6 2 0 4 ** 0.3 Nevada 133 94 -- 39 29.3 0.5 New Mexico 11 9 0 2 18.2 *** Oregon 39 23 12 4 10.3 *** Utah 31 17 0 14 45.2 0.3 Washington 99 46 21 32 32.3 0.3 Wyoming 4 4 0 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 1996. **Not calculated for 10 or fewer cases. ***Less than .05%. --Not reported. a/Georgia, Louisiana, and Missouri reported the total of HIV-positive cases but not the type of HIV. b/Includes all inmates who had tested positive for the HIV antibody but had no HIV-related symptoms. c/Includes inmates with sumptoms of HIV infection but without a confirmed AIDS diagnosis. Source: BJS, National Prisoner Statistics. Confirmed AIDS cases made up 0.5 percent of all inmates in State and Federal prisons. Of those inmates known to be HIV positive, nearly a quarter had confirmed AIDS. During 1996 the number of confirmed AIDS cases increased by 748. Overall, after 1991 the number of confirmed AIDS cases increased by 4,165--an average annual increase of 28.3 percent. The number of inmates with lesser or no symptoms of HIV infection actually decreased in 1996, and the number was below the numbers reported in every year from 1992 to 1995. HIV-positive State and Federal inmates Year Confirmed AIDS cases Other than confirmed 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 17,656 Note: Care should be exercised when comparing the number of reported cases over time. In January 1993 the Centers for Disease Control and Prevention revised the HIV classification system and expanded the surveillance case definition for AIDS to include specific CD4+ T-lymphocyte criteria and three additional clinical conditions--pulmonary tuberculosis, recurrent pneumonia, and invasive cervical cancer. This explanation resulted in a substantial increase in the number of reported AIDS cases during 1993. See Methodology, pp. 17-19. The States with the largest number of confirmed AIDS cases were New York (1,208), Florida (873), Texas (499), and California (429). Combined, these States made up 55 percent of all confirmed AIDS cases in State prisons. Eighteen States reported having fewer than 10 confirmed AIDS cases in their prisons. The highest percentage of the State prison population having confirmed AIDS was in New York (1.7 percent), followed by Connecticut (1.6 percent), Massachusetts (1.5 percent), Florida (1.4 percent), and Maryland (1.3 percent). In 17 States confirmed AIDS cases comprised 0.1 percent or fewer of State inmates. Comparison to the U.S. Resident Population At the end of 1996, the rate of confirmed AIDS in State and Federal prisons was six times higher than in the total U.S. population. About 54 in 10,000 prison inmates had confirmed AIDS, compared to 9 in 10,000 persons in the U.S. population. In every year from 1991 to 1996, the rate of confirmed AIDS was higher among prison inmates than in the general population. In 1992 the rate of AIDS was 11 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 12 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. At year-end 1996 the rate of confirmed AIDS was six times higher in prisons than in the general population. Percent of population with confirmed AIDS Year U.S. general Inmates in State prisons population and Federal prison 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 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 percents over time, because of changes in the case definition for AIDS. See Methodology, pp 17-19. HIV Infection of Male and Female State Prison Inmates At Year-end 1996 there were 21,799 male inmates and 2,135 female inmates known to be HIV positive (table 4). Overall, 2.3 percent of male inmates and 3.5 percent of all female inmates were known to be HIV positive. The rate of HIV infection in females was higher than male infection rates in all regions except the West and in most States. Table 4. State prison inmates known to be positive for the human immunodeficiency virus, by sex, yearend 1996 Male HIV cases Female HIV cases ---------------------------------- ------------------------------------ Jurisdiction Number Percent of population Number Percent of population ---------------------------------------------------------------------------------------------------- Total 21,799 2.3% 2,135 3.5% Northeast 10,985 0.1 1,105 0.1 Connecticut 581 4.2 109 9.7 Maine 4 0.3 0 0.0 Massachusetts 327 3.2 66 9.1 New Hampshire 15 0.8 3 2.1 New Jersey 614 2.8 91 9.0 New York 8,736 13.2 764 20.5 Pennsylvania 605 1.8 47 3.2 Rhode Island 100 3.3 25 11.7 Vermont 3 0.3 0 0 Midwest 1,741 1.0% 133 1.3% Illinois 583 1.6 51 2.3 Indiana -- -- -- -- Iowa 21 0.4 3 0.6 Kansas 15 0.2 1 0.2 Michigan 498 1.2 30 1.6 Minnesota 23 0.5 1 0.4 Missouri 178 0.9 12 0.8 Nebraska 17 0.6 0 0.0 North Dakota 2 0.3 1 1.8 Ohio 317 0.7 26 0.9 South Dakota 4 0.2 0 0 Wisconsin 83 0.7 8 1.3 South 7,375 1.8% 787 3.0% Alabama 217 1.1 17 1.3 Arkansas 72 0.9 5 0.9 Delaware -- -- -- -- District of Columbia -- -- -- -- Florida 1,929 3.2 223 6.8 Georgia 734 2.2 80 3.6 Kentucky 52 0.5 3 0.6 Louisiana 329 1.9 18 2.3 Maryland 763 3.7 69 6.6 Mississippi 130 1.4 5 0.7 North Carolina 517 1.9 72 4.0 Oklahoma 98 0.7 10 0.8 South Carolina 398 2.1 24 2.1 Tennessee 129 1.0 2 0.5 Texas 1,645 1.3 231 2.3 Virginia 355 1.5 28 2.1 West Virginia 7 0.3 0 0 West 1,698 0.8% 110 0.7% Alaska 8 0.3 2 1.1 Arizona 200 1.0 5 0.3 California 1,096 0.8 40 0.4 Colorado 86 0.9 8 1.0 Hawaii 23 0.8 0 0.0 Idaho 15 0.5 2 0.9 Montana 6 0.4 0 0.0 Nevada 103 1.4 30 5.2 New Mexico 10 0.2 1 0.3 Oregon 35 0.4 4 0.7 Utah 28 0.7 3 1.1 Washington 85 0.7 14 1.5 Wyoming 3 0.2 1 1.1 --Not reported. Source: BJS, National Prisoner Statistics. Between 1995 and 1996 the number of infected female inmates decreased 2.2 percent from 2,182 to 2,135; the number of infected male inmates increased 5.4 percent from 20,690 in 1995 to 21,799 in 1996. Overall, among State prisoners, the number of males infected with HIV increased 35 percent, and the number of females infected increased 84 percent between 1991 and 1996. State prison inmates Number of Percent HIV positive in custody Year HIV-positive inmates population of reporting States Males 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 Average annual change, 1991-96* 6.2% 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 Average annual change, 1991-96* 13.0% *In 1991 North Carolina, South Dakota, and the District of Columbia did not report data by gender. In 1995 Delaware, Indiana, South Carolina, and the District of Columbia did not report data by gender. Source: BJS, National Prisoner Statistics States in the Northeast reported the largest number of HIV-positive male and female inmates (10,985 and 1,105, respectively). In eight States, more than 5 percent of all female inmates were known to be HIV positive. In two States over 10 percent of all female inmates were known to be HIV positive--New York (20.5 percent) and Rhode Island (11.7 percent). New York (13.2 percent) was the only State in which more than 10 percent of all male inmates were HIV positive. Among all States, New York reported the largest number of male and female HIV-positive inmates (8,736 and 764, respectively). The second largest number of HIV-positive male inmates were in Florida (1,929), followed by Texas (1,645). The second largest number of HIV-positive female inmates were in Texas (231), followed by Florida (223). Seven States reported no female HIV-positive inmates, and every State reported at least one male HIV-positive inmate. AIDS-Related Deaths in State Prisons The number of State inmates who died of Pneumocystis carinii pneumonia, Kaposi's sarcoma, or other AIDS-related diseases decreased from 1,010 in 1995 to 907 in 1996 (table 5). These AIDS deaths accounted for 29 percent of all deaths among State prisoners, down from 34 percent in 1995. Beginning in 1991 AIDS-related causes were the second leading cause of death in State prisons, behind natural causes other than AIDS. Table 5. Number of inmate deaths in State prisons, by cause, 1994-96 1994 1995 1996 ---------------------------- ----------------------------- ---------------------------- Cause of death Rate of death per Rate of death per Rate of death per Number 100,000 inmates Number 100,000 inmates Number 100,000 inmates ------------------------------------------------------------------------------------------------------------------------------------- Total 2,878 314 3,133 311 3,095 308 Natural causes other than AIDS 1,393 152 1,569 156 1,715 170 AIDS 955 104 1,010 100 907 90 Suicide 155 17 160 16 154 15 Accident 33 4 48 5 43 4 Execution 30 3 56 6 45 4 By another person 68 7 86 9 65 6 Other/unspecified 244 27 204 20 166 16 Note: In 1994 some States did not report complete data on cause of death. 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. Inmates in States that did not report data on inmate deaths were excluded in 1994. All States reported data on inmate deaths in 1995 and 1996. Source: BJS, National Prisoner Statistics. In 1996, for every 100,000 inmates, 90 died from AIDS-related causes. Between 1991 and 1995, the number of AIDS-related deaths in State prisons increased 94 percent; however, in 1996 the number decreased 10 percent from 1995. With the introduction of protease inhibitors and combination antiretroviral therapies, there was appreciable improvement in the effectiveness of HIV/AIDS care. The rate of death because of AIDS is about three times higher in the prison population than in the total U.S. population age 15-54. Between 1991 and 1996, about 1 in every 3 prisoner deaths were attributable to AIDS-related causes, compared to about 1 in 10 deaths in the general population. AIDS-related deaths accounted for more than half of all inmate deaths in Connecticut (65 percent), New York (55 percent), New Jersey (52 percent), and Florida (50 percent) (table 6). Seventeen States reported having no AIDS-related deaths, and five States reported one AIDS-related death. AIDS-related deaths as a percent of all deaths Year U.S. general population age 15-54* State prison inmates 1991 10.4% 28.0% 1992 11.7 35.2 1993 11.9 33.2 1994 12.7 35.1 1995 12.4 34.2 1996 -- 29.3 --Not available. *See Methodology, p. 18, for source of data. Table 6. AIDS-related deaths of sentenced prisoners under State jurisdiction, 1996 Deaths from all causes in State prisons AIDS-related deaths --------------------------------------- ------------------------------------------------------ Rate per Rate per As a percent Jurisdiction Total 100,000 inmates Total 100,000 inmates of all deaths/b ----------------------------------------------------------------------------------------------------------------------- Total 3,095 308 907 90 0.3 Northeast 691 437 329 208 0.5 Connecticut 49 327 32 213 65.3 Maine 3 206 0 0 ** Massachusetts 30 262 7 61 23.3 New Hampshire 2 97 0 0 ** New Jersey 142 554 74 289 52.1 New York 330 482 182 266 55.2 Pennsylvania 128 429 33 111 25.8 Rhode Island 7 223 1 32 ** Vermont 0 0 0 0 ** Midwest 480 252 61 41 0.1 Illinois 96 254 32 85 33.3 Indiana 39 248 2 13 5.1 Iowa 10 176 0 0 ** Kansas 20 289 2 29 10.0 Michigan 125 302 -- -- -- Minnesota 10 210 1 21 ** Missouri 37 195 0 0 0 Nebraska 8 286 0 0 ** North Dakota 0 0 0 0 ** Ohio 117 269 20 46 17.1 South Dakota 4 220 0 0 ** Wisconsin 14 132 4 38 28.6 South 1,461 327 447 109 0.3 Alabama 89 443 13 65 14.6 Arkansas 23 253 2 22 8.7 Delaware 20 430 0 0 0.0 District of Colum 29 277 -- -- -- Florida 247 398 124 200 50.2 Georgia 114 334 48 141 42.1 Kentucky 30 251 1 8 3.3 Louisiana 86 346 20 81 23.3 Maryland 48 224 16 75 33.3 Mississippi 32 257 5 40 15.6 North Carolina 74 276 26 97 35.1 Oklahoma 66 375 4 23 6.1 South Carolina 76 390 27 139 35.5 Tennessee 60 402 8 54 13.3 Texas 377 297 122 96 32.4 Virginia 84 308 31 114 36.9 West Virginia 6 246 0 0 ** West 463 220 70 33 0.2 Alaska 3 93 0 0 ** Arizona 61 292 0 0 0 California 253 192 49 37 19.4 Colorado 22 205 0 0 0 Hawaii 4 112 0 0 ** Idaho 3 93 1 31 ** Montana 5 264 0 0 ** Nevada 35 467 8 107 22.9 New Mexico 4 97 0 0 ** Oregon 25 333 2 27 8.0 Utah 7 214 1 31 ** Washington 33 289 9 79 27.3 Wyoming 8 612 0 0 ** --Not reported. **Not calculated for 10 or fewer deaths. a/Based on the number of inmates under State jurisdiction on June 30, 1996. b/National and regional totals exclude inmates in jurisdictions that did not report data on cause of death. Source: BJS, National Prisoner Statistics HIV Prevalence Rates and Testing Policies Data on HIV prevalence rates are reported in the National Prisoners Statistics series (NPS) by prison officials. The quality of the information reported varied by the testing policies that a particular State implemented. Testing policies ranged from testing all inmates to testing only upon inmate request. Although 19 States tested either all inmates in custody or a random selection, and 27 test targeted groups (high-risk individuals or upon indication or incidence), 5 tested solely upon inmate request. Official data represent the minimum number of individuals known to be HIV positive within a prison facility. Testing policy Number of jurisdictions All inmates (incoming or in custody) 16 Random 3 High-risk groups/upon incident/ indication of need 27 Inmate request only 5 Note: Categories are mutually exclusive; therefore total adds to 51. Delaware did not report data on testing policies. See chapter 5 for more detailed data on testing policies. Source: BJS, National Prisoner Statistics. Blinded or "unlinked" studies have been conducted as another means of determining the HIV prevalence in State prisons. These studies are blinded in that the identity of the inmate is not linked to the result of the HIV test. An inmate's blood that has been drawn during a routine physical examination upon entering a facility is tested for HIV. The sample is sent to a lab with no information regarding the inmate. Blinded studies may not accurately account for the prevalence rate of HIV in prisons. Often these studies are conducted in only a few facilities, and are snapshots, examined over one period solely on admission cohorts. Because of this, blinded studies are limited in that they may not be generalized to the overall prison population. Discrepancies are apparent between HIV prevalence rates reported in official records and those produced from blinded studies. Data from a blinded study conducted in Massachusetts in 1995 suggest that 6.8 percent of incoming inmates are HIV positive, while official data from 1995 indicate 3.9 percent of all inmates in custody were HIV positive. Similarly, data from blinded studies conducted in Maryland (1991), California (1994), Illinois (1991), and New Jersey (1991) suggest that official data underestimate the HIV prevalence rate. Official data from New York in 1994 and 1995, however, revealed higher HIV prevalence rates than data from a 1994-1995 blinded study. The blinded study showed that 10 percent of all incoming inmates were HIV positive, while official data showed that of all inmates in custody, 12.4 percent in 1994 and 13.9 percent in 1995 were HIV positive. Similarly, National Prisoner Statistics (NPS) data from Arkansas (1992) and Washington (1991) suggest a higher prevalence rate among inmates than data from blinded studies (0.9 percent compared to 0.6 percent, and 0.5 percent compared to 0.2 percent). Percent HIV positive States NPS Blinded studies/a Massachusetts (1995) 3.9% 6.8% Maryland (1991) 2.5 8.5 California (1994) 0.8 2.5 Illinois (1991) 1.0 4.9 New Jersey (1991) 4.0 9.5 New York (1994-95)/b 13.2 10.0 Arkansas (1992) 0.9 0.6 Washington (1991)/c 0.5 0.2 a/Data from Illinois, New Jersey, Arkansas, and Washington came from the 1994 Update: HIV/AIDS and STDs in Correctional Facilities. Data for Massachusetts, Maryland, California, and New York came from other sources. (See Methodology, p. 19, for further detail.) b/The New York blinded study covered both 1994 and 1995. The NPS rate for New York represents an average of the reporting years. c/No women were tested in the blinded study. HIV/AIDS Reported in Personal Interviews Additional information on the prevalence of HIV/AIDS may also 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 or blinded studies. 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. Similar questions were asked in the 1996 Survey of Inmates in Local Jails. (See Methodology for further detail.) In 1997, 17,674 (1.7 percent) State prison inmates and 428 (0.5 percent) Federal prison inmates were known to be HIV positive (table 7). Of those inmates who reported being tested since admission to State prison, or to Federal prison, 2.6 percent and 0.7 percent, respectively, reported being HIV positive. Table 7. Inmates ever tested or tested since admission for the human immunodeficiency virus and test results Percent of inmates ------------------------------------------------ Characteristic Local jails State prisons Federal prisons ----------------------------------------------------------------------- All inmates HIV positive 1.2% 1.7% 0.5% Ever tested 57.2% 74.6% 79.6% HIV positive 2.2 2.2 0.6 Tested since admission 17.7% 59.1% 69.7% HIV positive 3.9 2.6 0.7 Note: Data are from the 1996 Survey of Inmates in Local Jails and the 1997 Surveys of Inmates in State and Federal Correctional Facilities. Among State prisoners, female inmates (3.4 percent) were more likely than male inmates (2.2 percent) to be HIV positive (table 8). Black non-Hispanic inmates (2.8 percent) were twice as likely as white non-Hispanic inmates (1.4 percent) to report being HIV positive. Among male inmates, blacks (2.7 percent) were nearly twice as likely as whites to be HIV positive. The rates of HIV infection among female inmates were not significantly different among whites (2.3 percent), blacks (3.9 percent), and Hispanics (4.2 percent). In Federal prisons 0.6 percent of males and of females reported HIV infection. Non-Hispanic white inmates reported the lowest HIV-positive rates (0.3 percent). In both State and Federal prisons, inmates age 17 to 24 reported the lowest rate of being HIV positive (0.5 percent and 0.1 percent, respectively). In State prisons, inmates age 35 to 44 reported the highest HIV-positive rate (3.1 percent). Those State inmates in each age category over 24 were more likely to be HIV positive than those who were 24 or younger. In Federal prisons, inmates age 45 or older reported the highest rate of HIV infection (1.2 percent). HIV-Positive Prison Inmates, by Offense and Prior Drug Use Those inmates being held on a drug offense in State prisons reported the highest HIV positive rate (2.9 percent) (table 9). Of property offenders, 2.4 percent reported being HIV positive. Violent and public-order offenders reported slightly lower rates (1.9 percent each). Among Federal prison inmates, 1.0 percent of violent offenders, property offenders, and public-order offenders reported being HIV positive as did 0.4 percent of drug offenders. The percentage of State and Federal prison inmates reporting that they were HIV positive varied by level of prior drug use. By type of drug use practice, the following percentages of State prison inmates reported being HIV positive: never using drugs, 1.7 percent HIV positive; ever used drugs, 2.3 percent; used drugs in the month before their current offense, 2.7 percent; used a needle to inject drugs, 4.6 percent; and shared a needle, 7.7 percent 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 percent and 2.1 percent compared to 0.7 percent and 0.3 percent). Unlike State inmates, Federal inmates using drugs in the month prior to their current offense reported a lower rate of HIV infection (0.3 percent) than inmates who reported ever using drugs (0.7 percent). HIV Infection of Local Jail Inmates At midyear 1993, when the last national census of local jails was conducted, 1.8 percent of the inmates were known to be HIV positive. Among jails reporting data, a total of 6,711 inmates were HIV positive, and 1,888 had confirmed AIDS. The infection rate was highest in the largest jail jurisdictions. Almost 3 percent of the inmates in the Nation's largest jurisdictions were reported HIV positive. Among the remaining jurisdictions, the larger the size, the greater the percentage of inmates with HIV/AIDS. In jurisdictions with 500 or more inmates, 1.6 percent of the inmates were infected; in jurisdictions with 250 to 499 inmates, 1.2 percent; and in jurisdictions holding fewer than 250 inmates, 1 percent or less. 1993 Census of Jails HIV/AIDS as a per- Size of jurisdiction/a Number HIV positive/b cent of jail inmates Total 6,711 1.8% 50 largest 3,926 2.9 500 or more 1,374 1.6 250-499 490 1.2 100-249 470 1.0 Fewer than 100 451 0.8 a/Based on the average daily population between July 1, 1992, and June 30, 1993. b/Excludes inmates in facilities that did not report data. Source: HIV in Prisons and Jails, 1993. HIV Test Results for Local Jail Inmates, by Inmate Characteristic Detailed data, based on interviews of a national sample of inmates in local jails, are available from the 1996 Survey of Inmates in Local Jails. Conducted between October 1995 and March 1996, the survey provides national estimates of the number of jail inmates tested for HIV/AIDS and the percent HIV positive. In 1996, 6,289 local jail inmates (1.2 percent of all inmates) were known to be HIV positive (table 7). An estimated 57 percent of all respondents in the survey said they had ever been tested for HIV. Of those who had been tested for HIV, 2.2 percent said they were HIV positive. Since admission, about 18 percent of inmates had been tested for HIV, and 3.9 percent reported HIV positive results. Among jail inmates, 2.1 percent of males and 2.4 percent of females said they were HIV positive (table 8). An estimated 2.6 percent of black inmates, compared to 1.4 percent of white inmates, said they tested HIV positive. Among male inmates, blacks (2.5 percent) were nearly twice as likely as whites (1.3 percent) to report being HIV positive. Hispanic males had the highest HIV-positive rate (3.5 percent). Among female inmates, although the percentage who reported they were HIV positive was higher among blacks (3.2 percent) than whites (2.1 percent) and Hispanics (1.3 percent,) the differences were not statistically significant. Inmates age 24 or younger had the lowest HIV-positive rates (0.7 percent), while those 35 to 44 had the highest rates (3.8 percent). Inmates 25-34 and 45 or older fell in the middle (2.1 percent and 3.0 percent, respectively). Inmates who had completed high school were as likely as those who had not completed high school to say they tested HIV positive (2.3 percent). Table 8. Inmates ever tested for the human immunodeficiency virus and results, by selected characteristics Inmates ever tested ------------------------------------------------------------------------------------------------------------------ Local jails State prisons Federal prisons ----------------------- ------------------------ ----------------------- Percent Percent Percent Characteristic Number HIV positive Number HIV positive Number HIV positive ------------------------------------------------------------------------------------------------------------------ All inmates 289,991 2.2% 790,128 2.2% 70,902 0.6% Sex Male 258,019 2.1% 734,327 2.2% 65,723 0.6% Female 31,972 2.4 55,800 3.4 5,179 0.6 Race/Hispanic origin White non-Hispanic 110,023 1.4% 257,919 1.4% 21,128 0.3% Male 98,745 1.3 239,687 1.4 19,565 0.3 Female 11,278 2.1 18,232 2.3 1,563 0.3 Black non-Hispanic 125,259 2.6 384,870 2.8 28,178 0.8 Male 110,453 2.5 357,736 2.7 26,387 0.8 Female 14,806 3.2 27,135 3.9 1,791 1.3 Hispanic 45,759 3.2 123,725 2.5 18,466 0.7 Male 40,985 3.5 115,344 2.4 16,892 0.7 Female 4,774 1.3 8,382 4.2 1,573 0 Age 17-24 81,228 0.7% 154,181 0.5% 5,528 0.1% 25-34 116,532 2.1 310,161 2.3 26,262 0.5 35-44 70,776 3.8 232,835 3.1 22,228 0.4 45 or older 21,455 3.0 92,168 2.7 16,884 1.2 Marital status Married 45,890 1.4% 128,834 1.7% 21,545 0.5% Widowed/divorced 48,695 3.0 161,468 2.0 16,331 0.4 Separated 25,929 2.1 45,435 2.9 3,884 0 Never married 169,270 2.1 453,664 2.4 29,045 0.8 Education Less than high school 121,589 2.3% 302,437 2.7% 17,226 0.8% GED 45,431 1.3 231,714 1.4 16,389 0.6 High school or more 122,597 2.3 254,975 2.4 37,237 0.5 Note: Data are from the 1996 Survey of Inmates in Local Jails and the 1997 Surveys of Inmates in State and Federal Correctional Facilities. Percent HIV Positive among Jail Inmates, by Offense and Prior Drug Use Among jail inmates who said they had been tested for HIV/AIDS, those held for drug offenses were the most likely to be HIV positive (3.3 percent) (table 9). Drug offenders were twice as likely as violent offenders (1.5 percent) to report that they tested positive for HIV. Property and public-order offenders reported somewhat lower rates--2.2 percent and 1.7 percent, respectively. The percent of jail inmates reporting that they were HIV positive varied by level of prior drug use. An estimated 2.3 percent of inmates who had ever used drugs, 2.9 percent of inmates who used drugs in the month before their current offense, 4.0 percent of inmates who said they had used needles to inject drugs, and 6.3 percent of those who had shared a needle with someone else reported being HIV positive. Table 9. Inmates ever tested for the human immunodeficiency virus and results, by offense and prior drug use Inmates ever tested --------------------------------------------------------------------------------- Local jails State prisons Federal prisons ---------------------- ------------------------ ----------------------- Percent Percent Percent Characteristic Number HIV positive Number HIV positive Number HIV positive ------------------------------------------------------------------------------------------------------------------ Current offense Violent 72,846 1.5% 360,370 1.9% 10,681 1.0% Property 79,936 2.2 178,601 2.4 4,660 1.0 Drug 65,780 3.3 164,256 2.9 43,815 0.4 Public-order 64,820 1.7 77,049 1.9 10,029 1.0 Prior drug use Never 42,242 1.6% 123,049 1.7% 18,917 0.3% Ever 247,233 2.3 665,977 2.3 51,847 0.7 In the month before offense 106,907 2.9 460,685 2.7 32,113 0.3 Used needle to inject drugs 61,862 4.0 168,446 4.6 9,443 1.3 Ever shared a needle 25,476 6.3 74,393 7.7 4,022 2.1 Note: Data are from the 1996 Survey of Inmates in Local Jails and the 1997 Surveys of Inmates in State and Federal Correctional Facilities. Methodology National Prisoner Statistics The National Prisoner Statistics series (NPS) includes an annual Year-end count of prisoners by jurisdiction, sex, race, Hispanic origin, and admissions and releases during the year. The series consists of yearly reports to the Bureau of Justice Statistics from the departments of corrections of the 50 States and the District of Columbia and from the Federal Bureau of Prisons. Since 1991 respondents have been asked to indicate their policies for testing for HIV and to provide the number of HIV-infected inmates in their custody on the last day of the calendar year. Surveys of Inmates in State and Federal Correctional Facilities, 1997 The 1997 Surveys of Inmates in State and Federal Correctional Facilities were conducted for the Bureau of Justice Statistics by the U.S. Bureau of the Census. The Federal Bureau of Prisons cosponsored the Survey of Inmates in Federal Correctional Facilities. Personal interviews were conducted from June 1997 through October 1997. Information was collected about individual characteristics of prison inmates, current and prior offenses and sentences, criminal histories, characteristics of the current offense, family background, prior drug and alcohol use and treatment, and conditions of confinement. The sample for the Federal inmates survey was selected from a universe of 135 Federal prisons holding sentenced inmates. For State inmates the sample came from 1,453 State prisons counted in the 1995 Census of State Correctional Facilities performed on June 30, 1995, with prisons opening between the census and June 30, 1996, added. The overall response rate in the State survey was 92.5 percent. Similar surveys of State prison inmates were conducted in 1974, 1979, 1986, and 1991. The first survey of Federal inmates was done in 1991. Census of Jails, 1993 The 1993 Census of Jails included all locally administered confinement facilities (3,287) that held inmates beyond arraignment and were staffed by municipal or county employees. The census also included 17 jails that were privately operated under contract for local governments. Excluded from the census were temporary holding facilities, such as drunk tanks and police lockups, that do not hold persons after being formally charged in court (usually with in 72 hours of arrest). Also excluded were State-operated facilities in Alaska, Connecticut, Delaware, Hawaii, Rhode Island, and Vermont, which have combined jail-prison systems. Survey of Inmates in Local Jails, 1996 The 1996 Survey of Inmates in Local Jails was conducted for BJS by the U.S. Bureau of the Census. Through personal interviews conducted from October 1995 through March 1996, data were collected on individual characteristics of jail inmates, current offenses, sentences and time served, criminal histories, jail activities, conditions and programs, prior drug and alcohol use and treatment, and health care services provided while in jail. The sample for the 1996 survey was selected from a universe of 3,328 jails that were enumerated from the 1993 Census of Jails. The total nonresponse was 13.7 percent. Similar surveys of jail inmates were conducted in 1972, 1978, 1983, and 1989. Accuracy of the Survey Estimates The accuracy of the estimates from the 1996 Survey of Inmates in Local Jails and 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 table 10). 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 local jails who were HIV positive is approximately 2.1 percent plus or minus 1.96 times 0.33 percent (or 1.5 percent to 2.7 percent). 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, Year-end editions 1991-1996. 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 and older at Year-end from the cumulative number of total AIDS cases for people age 13 and older at Year-end as listed in the HIV/AIDS Surveillance Report. The data for the U.S. general population, excluding persons under age 13, from 1991 to 1996 were taken from the U.S. Population Estimates, by Age, Sex, Race, and Hispanic Origin: 1990 to 1995, PPL-41, and the update for 1996. 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, Year-end 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). 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. Table 10. Standard error estimates for the 1996 Survey of Inmates in Local Jails and the 1997 Surveys of State and Federal Correctional Facilities Estimated standard error of the percent who were HIV positive ------------------------------------------------------------- Characteristics Local jails State prisons Federal prisons --------------------------------------------------------------------------------------------- Sex Male 0.33% 0.20% 0.19% Female 0.44 0.44 0.35 Race/Hispanic origin White non-Hispanic 0.38% 0.29% 0.31% Male 0.41 0.31 0.33 Female 0.68 0.80 0.63 Black non-Hispanic 0.47 0.37 0.48 Male 0.53 0.38 0.51 Female 0.74 0.72 1.15 Hispanic 0.98 0.58 0.52 Male 1.09 0.61 0.56 Female 0.76 1.67 0.00 Age Under 24 0.30% 0.20% 0.27% 25-34 0.42 0.30 0.27 35-44 0.85 0.40 0.26 45 or older 1.13 0.60 0.52 Marital Status Married 0.58% 0.40% 0.30% Widowed/divorced 0.88 0.39 0.31 Separated 0.97 0.88 0 Never married 0.38 0.25 0.33 Education Less than high school 0.47% 0.33% 0.42% GED 0.46 0.27 0.38 High school graduate or more 0.49 0.34 0.23 Current Offense Violent 0.49% 0.25% 0.60% Property 0.52 0.40 0.91 Drug 0.79 0.46 0.19 Public-order 0.66 0.55 0.62 Prior drug use Never used 0.62% 0.41% 0.25% Ever used 0.33 0.21 0.23 Used month before offense 0.58 0.27 0.19 Used needle to inject drugs 0.85 0.57 0.73 Shared a needle 1.71 1.09 1.41 HIV Prevalence Rates from Blinded Studies Data from blinded studies on HIV prevalence rates in Massachusetts, Maryland, California, and New York were gathered from several sources: B. Werner et al., "Drop in HIV Seroprevalence among Men and Women Entering Massachusetts Prisons," Abstract No. 115, presented at the Third Conference on Retroviruses and Opportunistic Infections, Washington, D.C., January 28-February 1, 1996. C. Behrendt et al., "Voluntary Testing for HIV in a Prison Population with a High Prevalence of HIV." American Journal of Epidemiology, 139 (1994) pp. 918-26. J. Ruiz and J. Mikanda, Seroprevalence of HIV, Hepatitis B, Hepatitis C, and Risk Behaviors among Inmates Entering the California Correctional System (Sacramento: California Department of Health Services, Office of AIDS, HIV/AIDS Epidemiology Branch, March 1996). J. Mikl et al., "Trends in HIV Infection Rates among New York State Prison Inmates, 1987-1997," Poster abstract Number 23516, presented at the 12th World Congress on AIDS, Geneva, June 30, 1997. (End of file) 6/8/99, yb