Getting HIV out of jail
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Your local jail may be the last frontier in the fight against HIV infection. HIV infection among inmates in the United States is more than three times higher than among the general public, says Anne Spaulding, an epidemiologist at Emory’s Rollins School of Public Health.
Spaulding, a physician who has researched public health issues among inmates for 15 years, recently conducted a study in collaboration with the Fulton County Jail in Atlanta that found a high number of people with HIV who previously had been undiagnosed. Spaulding’s team used a mouth swab to test inmates who volunteered for the HIV screening. Of the volunteers, the rate of HIV detection was about two in 100 inmates. By contrast, among the general public, the rate is approximately one in 500 people.
“Most people—including inmates—who find out they are HIV-positive take precautions to decrease the risk of transmission,” says Spaulding.
Jails that test for HIV do not incur higher health care costs since most inmates, with average jail stays of two days, are already back in their communities before they start medication. In Fulton County, for example, inmates who test positive but are returning to the community are referred to various Atlanta programs for treatment.
Testing inmates often catches the infection at an early stage and leads to earlier treatment. In a study released in April by the CDC, the average CD4 count of a person in the general population first testing positive for HIV was less than 200. CD4 is a type of white blood cells targeted by HIV, and too few CD4 cells indicate a weak immune system. In another Emory study among jails nationally, the median CD4 count of inmates first diagnosed in jail was more than 400.
“People are less likely to transmit HIV if they start medications early,” Spaulding says. “They have fewer hospitalizations and problems with their immune systems. This translates to less financial burden on our health care system.”—Kay Torrance
