HIV Testing, HIV Positivity, and Linkage and Referral Services in Correctional Facilities in the United States, 2009-2013.

BACKGROUND: Because of health disparities, incarcerated persons are at higher risk for multiple health issues, including HIV. Correctional facilities have an opportunity to provide HIV services to an underserved population. This article describes Centers for Disease Control and Prevention (CDC)-funded HIV testing and service delivery in correctional facilities. METHODS: Data on HIV testing and service delivery were submitted to CDC by 61 health department jurisdictions in 2013. HIV testing, HIV positivity, receipt of test results, linkage, and referral services were described, and differences across demographic characteristics for linkage and referral services were assessed. Finally, trends were examined for HIV testing, HIV positivity, and linkage from 2009 to 2013. RESULTS: Of CDC-funded tests in 2013 among persons 18 years and older, 254,719 (7.9%) were conducted in correctional facilities. HIV positivity was 0.9%, and HIV positivity for newly diagnosed persons was 0.3%. Blacks accounted for the highest percentage of HIV-infected persons (1.3%) and newly diagnosed persons (0.5%). Only 37.9% of newly diagnosed persons were linked within 90 days; 67.5% were linked within any time frame; 49.7% were referred to partner services; and 45.2% were referred to HIV prevention services. There was a significant percent increase in HIV testing, overall HIV positivity, and linkage from 2009 to 2013. However, trends were stable for newly diagnosed persons. CONCLUSIONS: Identification of newly diagnosed persons in correctional facilities has remained stable from 2009 to 2013. Correctional facilities seem to be reaching blacks, likely due to higher incarceration rates. The current findings indicate that improvements are needed in HIV testing strategies, service delivery during incarceration, and linkage to care postrelease.

Pandemic influenza and jail facilities and populations.

Persons processed into and through jail facilities in the United States may be particularly vulnerable during an influenza pandemic. Among other concerns, public health and corrections officials need to consider flow issues, the high turnover and transitions between jails and the community, and the decentralized organization of jails. In this article, we examine some of the unique challenges jail facilities may face during an influenza pandemic and discuss issues that should be addressed to reduce the spread of illness and lessen the impact of an influenza pandemic on the jail population and their surrounding communities.

An HIV/AIDS crisis among African American women: a summary for prevention and care in the 21st century.

The meeting, HIV/AIDS and African American Women: A Consultation Supporting CDC's Heightened National Response to the HIV/AIDS Crisis among African Americans, provided a forum to address gaps in prevention and HIV/AIDS infection for African American women. Health researchers, community-based organization leaders, and representatives from both healthcare and non-healthcare sectors took this opportunity to discuss and develop a variety of priorities and suggestions for HIV/AIDS prevention. Four focus areas were provided for meeting attendees to promote discussion and strategy development. The resulting list of priorities and suggestions for HIV/AIDS prevention may provide future steps for researchers, communities, and physicians to increase prevention and decrease infection rates. Novel, innovative, and participatory approaches are needed within and outside the public arena to decrease the gaps in HIV/AIDS prevention for African American women.

Influence of Trap Distance From a Source Population and Multiple Traps on Captures and Attack Densities of the Redbay Ambrosia Beetle (Coleoptera: Curculionidae: Scolytinae).

The redbay ambrosia beetle, Xyleborus glabratus Eichhoff, is the principal vector of laurel wilt disease in North America. Lures incorporating essential oils of manuka plants ( Leptospermum scoparium J. R. Forster & G. Forster) or cubeb seeds ( Piper cubeba L.f.) are the most effective in-flight attractants to date. Using grids of traps baited with these essential oil lures, we evaluated 1) the effect of trap distance from a source beetle population on beetle captures, 2) the feasibility of trapping out low-density beetle populations, and 3) the effect of trap spacing on beetle captures. In the first experiment, increasing trap distance up to 300 m from a source X. glabratus population had little effect on beetle captures. In a second experiment conducted in a study area with very low beetle densities, trapping for 5 mo prior to deploying freshly cut, uninfested redbay bolts had no effect on subsequent attack densities. In a third experiment, numbers of X. glabratus captured in traps in the center of a grid of nine traps spaced 1 or 5 m apart were compared with lone baited or unbaited traps 30 m away. Relative to the more distant traps, the grid of baited traps neither increased captures in the unbaited center trap nor decreased captures in the baited center trap, regardless of spacing. The results suggest that the effective trapping distance of essential oil lures for X. glabratus is <1 m, and that newer, more attractive lures will be needed to be useful in managing X. glabratus populations.

Costs of Rapid HIV Screening in an Urban Emergency Department and a Nearby County Jail in the Southeastern United States.

Emergency departments and jails provide medical services to persons at risk for HIV infection and are recommended venues for HIV screening. Our main objective in this study was to analyze the cost per new HIV diagnosis associated with the HIV screening program in these two venues. The emergency department's parallel testing program was conducted at Grady Memorial Hospital in Atlanta, Georgia starting in 2008; the jail's integrated testing program began at the Fulton County (GA) Jail in 2011. The two sites, four miles apart from one another, employed the same rapid HIV test. Ascertainment that cases were new differed by site; only the jail systematically checked identities against health department HIV registries. The program in the emergency department used dedicated HIV test counselors and made 242 diagnoses over a 40-month period at a cost of $2,981 per diagnosis. The jail program used staff nurses, and found 41 new HIV cases over 10.5 months at a cost of $6,688 per new diagnosis. Differences in methods for ascertainment of new diagnoses, previously undiagnosed HIV sero-positivity, and methodologies used for assessing program costs prevent concluding that one program was more economical than the other. Nonetheless, our findings show that testing in both venues yielded many new diagnoses, with the costs within the range reported in the literature.

The status of HIV prevention efforts for women in correctional facilities.

In the United States, women are a significant proportion of the correctional population. Women also account for an increasing proportion of newly diagnosed human immunodeficiency virus (HIV) cases. When compared with white women, black women have higher incarceration rates and represent more of the newly diagnosed HIV cases. Correctional facilities offer an opportunity to provide women with HIV testing and prevention services so that they will know their status and receive HIV/sexually transmitted disease (STD) risk-reduction counseling and other preventive services. In this report, we describe incarcerated population statistics and HIV surveillance epidemiology for women. We also describe HIV prevention activities undertaken by the Centers for Disease Control and Prevention's National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention. Additional research, program development, and implementation are needed to improve HIV prevention efforts for high-risk women.