Evidence of intraprison spread of HIV infection

Background: Individuals entering prison are known to have high rates of human immunodeficiency virus (HIV) infection, and inmates are known to engage in high-risk behavior. This suggests the potential for intraprison spread of HIV infection, but this has not been documented. Methods: All prisoners (N=556) in the Florida Department of Corrections who had been continuously incarcerated since 1977 were identified. The medical records of these prisoners were reviewed to determine whether they had been tested for HIV infection and, if tested, whether the results were positive. Results were considered positive if there were reactions to two enzyme-linked immunosorbent assays confirmed by Western blot assay. If an individual tested positive, the medical record was reviewed to determine whether the patient had been treated for conditions consistent with HIV infection. Results: Eighty-seven of the 556 prisoners had undergone testing for HIV infection. Of the tested inmates, 18 (21%) were found to be positive for HIV infection. Eight of these individuals had no HIV-related conditions, and 10 had HIV- related symptoms. Conclusions: The results present strong evidence for intraprison transmission of HIV infection. Given that most inmates serve relatively short sentences, there is a strong possibility that prison- acquired HIV infection will be carried into the 'free world.' Preventive programs in prisons may be very important in controlling HIV infection in our society.