HIV-positive inmates say they frequently have unprotected sex before, after release

February 11, 2003

CHAPEL HILL -- Inmates infected with HIV, the virus that causes AIDS, engaged in unprotected sex both before imprisonment and after their release at "exceedingly high rates," according to a new University of North Carolina at Chapel Hill School of Medicine study.

Seventy-eight percent of N.C. men and women prisoners carrying the virus who had a main sex partner reported unprotected sex with that person in the year before they were locked up, the study showed. Twenty-six percent of them interviewed again soon after release admitted to already having sex without condoms with their main sex partners.

For about half the subjects, the time between regaining their freedom and having sex averaged fewer than nine days and ranged from one hour to 31 days. Two-thirds of inmates had least one other sex partner prior to imprisonment, and of those with multiple partners, the average number was eight, researchers found.

Given their current sexual behavior, 29 percent of former inmates felt it was "very" or "somewhat" likely that they would infect their HIV-negative main sex partner. It was not clear why that did not change their behavior or why others did not think they could pass on the disease.

"This clearly should be a wake up call for public health experts, physicians, prison officials and others concerned about reducing the spread of HIV," said Dr. David A. Wohl, assistant professor of medicine at UNC and an infectious disease expert. "Despite progress made in the past decade or so, AIDS remains a deadly illness and is a major social and economic burden across the United States and around the world.

"We need to develop better educational and other types of interventions that can reduce HIV transmission behaviors among those infected. This study highlights the need to also concentrate prevention efforts in communities where HIV and incarceration are both endemic."

Wohl presented the findings Tuesday (Feb. 11) in Boston at the 10th Conference on Retroviruses and Opportunistic Infections. The annual scientific meeting is the largest of its kind in the United States.

In their study, which ran from May 2001 to the present, UNC researchers enrolled and interviewed inmates from larger facilities across North Carolina, including Central Prison, about their behaviors before being locked up. Investigators have so far reached 75 of them again via telephone after their release and asked comparable questions. Two interviewed earlier already had died of HIV-related illnesses, and five were locked up again before the second interview.

Subjects ranged in age from 18 to 55 and averaged 36 years old. Fifty-seven percent were women, 74 percent were black, 4 percent were Native American and 83 percent described themselves as heterosexual. Half had at least a high school education.

"Prior to incarceration, 72 percent had a main sex partner, and 57 percent of those were reported to be HIV negative," Wohl said. "Post release, 93 percent had a main sex partner, and 82 percent of releasees returned to their prior main partner."

About two-thirds of former inmates with multiple partners reported having at least one partner before going to prison who did not have the virus yet.

Just over 3 percent of the U.S. population -- 6.5 million people -- were in some form of correctional custody nationwide in 2002, according to Bureau of Justice statistics. Of those in prisons and jails, between 35,000 and 47,000 were HIV-infected, which was more than 10 times the prevalence of HIV among those not incarcerated. The vast majority were infected outside prison, not inside, Wohl said.

A recent study led by Dr. Adaora Adimora, assistant professor of medicine at UNC, of 244 black men and women with and without HIV showed that HIV-positive men were six times more likely than HIV-negative men to have had a sex partner who had been incarcerated in the previous year, Wohl said. HIV-positive women were four times more likely than others to have had a partner who had been locked up in the past year.

Others involved in Wohl's continuing study were Dr. Becky Stephenson, assistant professor of medicine; Dr. Andrew Kaplan, associate professor of medicine; Dr. Ronald P. Strauss, profess and chair of dental ecology at the UNC School of Dentistry; research assistants Laura Shain and Monica Adamian; and Dr. Carol Golin, assistant professor of medicine.
Support for the research came from the UNC Center for AIDS Research.

UNC News Services

Note: Wohl can be reached via cell phone at 919-216-0629.

University of North Carolina at Chapel Hill

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