HIV in Prisons and Jails, 1993 U.S. Department of Justice Office of Justice Programs Bureau of Justice Statistics Bulletin August 1995, NCJ-152765 (Note: This file does not contain data tables or figures. The full text with tables is available from the Bureau of Justice Statistics Clearinghouse, 800-732-3277, using the NCJ order number.) This report is one in a series. More recent editions may be available. To view a list of all in the series go to http://www.ojp.usdoj.gov/bjs/pubalp2.htm#hhivpj By Peter M. Brien Caroline Wolf Harlow, Ph.D. BJS Statisticians At yearend 1993, 21,538 of the 880,101 inmates held in U.S. prisons--2.4% of Federal and State prison inmates--were known to be infected with the human immunodeficiency virus (HIV) that causes AIDS. Of the total prison population, 3,765 inmates, or 0.4%, had AIDS, and 2,312 inmates, or 0.3%, showed lesser symptoms of infection. On June 30, 1993, 6,711 local jail inmates were infected with HIV, and of these, 1,888 had AIDS and 1,200 had some symptoms. Of local jail inmates in reporting jurisdictions, 1.8% carried HIV, almost 0.5% had confirmed AIDS, and 0.3% had HIV symptoms. Highlights * State prisons reported that 2.6% of inmates were HIV positive; Federal prisons reported 1.2%. * Nine States had 500 or more inmates known to be HIV positive at yearend 1993: Percent of custody State Number population ---------------------------------------- New York 8,000 12.4% Florida 1,780 3.4 Texas 1,212 1.7 California 1,048 .9 Connecticut 886 6.6 New Jersey 881 3.7 Maryland 769 3.8 Georgia 745 2.7 Illinois 591 1.7 * The highest percentage of prisoners infected with HIV was in the Northeast (7.4% of all State prisoners in that region), followed by the South (2.1%), Midwest (1.1%), and the West (0.8%). * After 1991, when the Bureau of Justice Statistics first reported these numbers, HIV cases increased from 17,551 to 21,538 prison inmates--from 2.2% to 2.4% of the prison population. * In 1993, 4.2% of female prison inmates in reporting States were HIV positive, up from 3.0% in 1991. Among male State prison inmates the percentages were 2.5% in 1993 and 2.2% in 1991. * At midyear 1993 an estimated 1.8% of all local jail inmates were known to be HIV positive. In the Nation's largest jails, 2.9% of inmates were HIV positive. * There were 89 AIDS-related deaths per 100,000 State prison inmates during 1993 and 15 such deaths per 100,000 local jail inmates from midyear 1992 to midyear 1993. * Fifteen States and the Bureau of Prisons tested all inmates for the presence of HIV, either on admission or at release. Two more States and the District of Columbia tested random samples. All other States tested selected inmates, such as high-risk groups or those presenting clinical symptoms. Data sources Local jail administrators, the departments of corrections of the 50 States and the District of Columbia, and the U.S. Bureau of Prisons provided the data in this report to the Bureau of Justice Statistics. (See Methodology on page 10.) Jurisdictional testing policies varied. Some policies mandated testing all inmates; some provided for testing of a sample of inmates or established testing under specified conditions. The reported number of cases of known HIV infection in part reflected the jurisdictions' policies for testing for the virus. Trends in HIV infection in U.S. prisons In State and Federal prisons at yearend 1993, 21,538 inmates were reported to have the human immunodeficiency virus (HIV) that causes AIDS. In State prisons 20,579 inmates were HIV positive, and in Federal prisons, 959. In total, 2.4% of prison inmates had HIV--2.6% of State inmates and 1.2% of Federal inmates. In 1991, 17,551 Federal and State prisoners were known to be HIV infected, and in 1993, 21,538--an increase of 3,987 inmates. In 1991 2.2% were HIV positive; in 1993, 2.4%. At the end of 1991, States had 16,921 inmates infected with HIV. The number grew to 20,579 by yearend 1993, a 22% increase. The Federal Bureau of Prisons had 630 HIV-positive inmates in 1991 and 959 in 1993, a 52% increase. HIV-infected inmates were concentrated in relatively few States. Four States--New York, Florida, Texas, and California--had over half of known HIV cases. Connecticut, New Jersey, Maryland, Georgia, Illinois, and North Carolina together had another fifth of the cases. Six States reported having fewer than 10 cases. States reporting the highest percentage of prisoners infected with HIV were New York (12.4%), Connecticut (6.6%), Massachusetts (3.9%), Maryland (3.8%), and New Jersey (3.7%). Twenty-five States reported that less than 1.0% of their inmates were HIV positive. Confirmed AIDS cases in U.S. prisons At yearend 1993, 3,765 State and Federal prisoners were confirmed AIDS cases and another 2,312 had some symptoms of HIV infection . The remaining 14,151 inmates who were positive for HIV showed no symptoms of the infection. Confirmed AIDS cases in State and Federal prisons grew from 1,682 to 3,765 from yearend 1991 to yearend 1993--a 124% increase over the period. HIV cases Confirmed other than AIDS cases confirmed AIDS ----------------------------------- 1991 1,682 15,797 1992 2,644 18,087 1993 3,765 17,773 Over 50% of all inmates with AIDS were held in New York, Florida, Texas, and Connecticut prisons--32% in New York alone. Overall, almost half of the States reported having fewer than 20 inmates with confirmed AIDS within their prison systems. HIV infection of male and female State inmates There were 18,218 male and 1,796 female State inmates infected with HIV at yearend 1993. Approximately 2 in every 100 males and 4 in every 100 females were HIV positive. In each region, male inmates had lower rates of infection than female inmates. The difference in infection rates between the sexes was greatest in the Northeast, where 7.1% of male prisoners and 12.7% of female prisoners were HIV positive. The difference was smallest in the Midwest, where 1.0% of male inmates and 1.5% of female inmates had the virus. Only in New York were more than 10% of male inmates infected with HIV. In three States--New York, Connecticut, and Massachusetts--more than 10% of women in prison were HIV positive. The number of male inmates infected with HIV grew from 16,150 in 1991 to 18,218 at yearend 1993, a 13% increase, while the number of female inmates grew from 1,159 to 1,796, a 55% increase. Percent of Number custody population HIV positive in reporting States ------------------------------------------- Males 1991 16,150 2.2% 1992 18,266 2.6 1993 18,218 2.5 Females 1991 1,159 3.0% 1992 1,598 4.0 1993 1,796 4.2 Note: In 1993 the Federal Bureau of Prisons, Delaware, Indiana, South Dakota, Alaska, South Carolina, and the District of Columbia did not provide separate data for men and women. Prison HIV-testing policies All 50 States, the District of Columbia, and the Federal Bureau of Prisons tested inmates for HIV on some basis. Fifteen States and the U.S. Bureau of Prisons tested all inmates upon admission or release. Rhode Island and Wyoming tested all inmates currently in custody. New York, New Jersey, the District of Columbia, and the Federal Bureau of Prisons tested random samples. In most of the jurisdictions (43 of 52), inmates were tested if they exhibited HIV-related symptoms or if the inmate requested to be tested. Twenty States tested inmates who belonged to designated "high risk groups," and 23 States tested inmates upon involvement in an incident. Number of Testing policy jurisdictions ----------------------------------------------- Upon inmates' requests 39 Upon clinical indication of need 39 Upon involvement in incident 23 High-risk groups 20 All incoming inmates 15 All inmates at time of release 4 Random sample 4 All inmates currently in custody 2 Note: Detail adds to more than 52 because a jurisdiction may have more than one policy. Of the 9 States with more than 500 known cases of HIV infection, only 1 (Georgia) tested all incoming inmates. Of the remaining eight States, two (New Jersey and New York) tested random samples. Five States (Connecticut, Florida, Illinois, New York, and Texas) tested high risk inmates, and five (California, Florida, Illinois, Maryland, and New York) tested inmates who requested it. Each of the nine States tested both upon clinical indication of need and if an inmate was involved in an incident. Deaths from AIDS in prison During 1993, 761 prisoners in 29 States died from Pneumocystis carinii pneumonia, Kaposi's sarcoma, or other AIDS-related diseases. Eighty-nine inmates in every 100,000 died from AIDS-related causes. In 1991, 520 State inmates died of AIDS. Between 1991 and 1993 the number of AIDS-related deaths in prison increased 46%. AIDS-related deaths accounted for a third of all deaths of State prison inmates during 1993. In six States AIDS-related deaths comprised about half or more of all deaths: New York (58.4%), New Jersey (57.9%), Connecticut (49.5%), Georgia (49.4%), Massachusetts (48.3%), and Florida (47.3%). In 18 States no prisoners died of AIDS. AIDS-related deaths as a percentage of all deaths was highest in the Northeast (50.9%) and lowest in the Midwest (10.8%). In the South 31.2% of deaths were AIDS-related and in the West 22.8%. In total 736 men and 25 women died from AIDS in State prisons during 1993. Males were almost twice as likely to die of AIDS as females; 98 per 100,000 male inmates died of AIDS during 1993 and 54 per 100,000 female inmates. The rates of death from AIDS in the Northeast were higher than the rates in other parts of the country--256 per 100,000 male inmates and 239 per 100,000 female inmates died compared to rates of less than 100 per 100,000 in other regions of the country. AIDS-related deaths in State prisons ------------------------- Number Rate per 100,000 --------------------------------------- Males Total 736 98 Northeast 343 256 Midwest 32 22 South 276 93 West 85 50 Females Total 25 54 Northeast 18 239 Midwest 1 12 South 5 27 West 1 9 HIV infection of local jail inmates At midyear 1993, 3,304 local jails in 2,974 jail jurisdictions held 459,804 inmates. For jails reporting on HIV infection or confirmed AIDS in the inmate population, 1.8% of the inmates were HIV positive (6,711 inmates) or had AIDS (1,888). The reporting jails housed approximately 83% of all jail inmates on June 30, 1993. The infection rate was highest in the largest jail jurisdictions. Almost 3% of the inmates in the Nation's largest jurisdictions were reported to be HIV positive or to have AIDS. Among the remaining 2,924 jurisdictions, the larger the size, the higher the percentage of inmates with HIV/AIDS. In jurisdictions with 500 or more inmates, 1.6% of inmates were infected; in jurisdictions with 250 to 499 inmates, 1.2% of inmates; and in jurisdictions holding fewer than 250 inmates, 1% or less of the inmates. HIV in the 50 largest jail jurisdictions Of the 50 largest jail jurisdictions, 38 provided data on HIV infection of their inmates. These 38 jurisdictions represented 79% of inmates in the 50 largest jail jurisdictions. The 38 jurisdictions reported 3,926 inmates infected with HIV, including 929 with AIDS. If these numbers are projected to the 50 jurisdictions, an estimated 5,000 inmates were HIV positive and 1,200 had AIDS. Eight of the 38 jurisdictions reported more than 100 inmates with HIV: New York City (1,070), Essex County, New Jersey (625), Dade County, Florida (350), Cook County, Illinois (264), Harris County, Texas (181), the District of Columbia (169), Dallas County, Texas (165), and Philadelphia (124). Eight of the largest jurisdictions reported holding fewer than 10 inmates with HIV. Four of the 38 largest jail jurisdictions reported that at least 10% of their populations were HIV positive: Essex County, New Jersey (37.4%), Philadelphia (11.8%), New York City (11.4%), and the District of Columbia (10.0%). HIV testing policies in the largest jail jurisdictions Four of the 47 largest jail jurisdictions which provided information on their testing policies reported testing all jail inmates (Santa Clara County, California; New York, New York; Fulton County, Georgia; and Davidson County, Tennessee). Two jurisdictions tested a random sample of inmates (the District of Columbia and New York, New York). Five tested high risk groups: Los Angeles and San Diego, California; Duval County, Florida; King County, Washington; and Richmond County, Virginia. All of the remaining 37 jurisdictions tested at least some inmates. Other policies followed by jail jurisdictions included testing under specific circumstances: 42 tested if an inmate asked; 36, if indicated clinically; 36, if ordered by a court; and 21, if an inmate was involved in an incident. Deaths of jail inmates from AIDS In the 2,933 jails which reported deaths of inmates for the period from July 1, 1992, to June 30, 1993, (90% of all jails covering 93% of inmates), 63 inmates died from AIDS-related causes . About 1 in 10 jail deaths during this period resulted from AIDS-related illnesses. In the 50 largest jurisdictions, almost 17% of deaths were AIDS-related, compared to 14% of deaths in jails with 500 or more inmates, excluding the 50 largest. In the jurisdictions housing fewer than 500 inmates, less than 3% of jail inmate deaths were because of AIDS. Most of the AIDS-related deaths occurred in jail jurisdictions with 500 or more inmates on average--55 out of the 63 deaths or 87%. Methodology National Prisoner Statistics The National Prisoner Statistics series (NPS-1) includes an annual yearend count of prisoners by jurisdiction, sex, race, Hispanic origin, and admissions and releases during the year. This series has provided counts of inmates in the Nation's prisons since 1926. The series consists of yearly reports to BJS from the departments of corrections of the 50 States, the District of Columbia, and the U.S. Bureau of Prisons. All 52 jurisdictions routinely complete the NPS-1 reports. 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. Respondents have been asked to categorize those inmates as asymptomatic, symptomatic, or with confirmed AIDS. Respondents have also been requested to give the number of deaths from HIV-related infections as well as deaths from a number of other causes. Census of Jails The 1993 Census of Jails was the sixth in a series of data collection efforts aimed at studying the Nation's locally administered jails. Previous jail censuses were conducted in 1970, 1972, 1978, 1983, and 1988. The U.S. Bureau of the Census collects the data for the Bureau of Justice Statistics. The 1993 census 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 within 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. Five locally operated jails in Alaska were included. The census forms were mailed to 3,506 facilities on June 22, 1993. Twenty-eight jails were added to the initial mailout, and 230 were deleted, resulting in a total of 3,304 facilities. Completed forms with data for all or most items were received from 2,961 jails, a 90% response rate. These reporting jails housed 93% of all local jail inmates on June 30, 1993. Each facility was asked to indicate its policies for testing for HIV by checking from a list. They were also requested to provide the numbers of HIV-positive inmates who were asymptomatic, symptomatic, or with confirmed AIDS and who were being held on June 30, 1993. AIDS-related deaths were included among the causes of deaths of inmates within the jail's jurisdiction during the period from July 1, 1992, through June 30, 1993. They were asked to give the number of inmates who had died, both in total and for each cause from a list of causes of death. The data reported from the BJS collection series complement those collected in surveys sponsored by the National Institute of Justice and the Centers for Disease Control and Prevention. A forthcoming report, "1994 Update: HIV/AIDS and Sexually Transmitted Diseases in Correctional Facilities," will present findings from the eighth national survey. The 1994 update contains detailed reporting about prevalence, testing, treatment and education for HIV and AIDS in Federal, State, and 29 large city/county correctional systems. The inmate population was itself concentrated in the largest jail jurisdictions--40% in the largest 50 and another 23% in jurisdictions not among the largest 50 but housing 500 or more inmates. Jails with 250 to 499 inmates held 11%; those with 100 to 249, 12%; and those with less than 100, 14%. The Bureau of Justice Statistics is the statistical agency of the U.S. Department of Justice. Jan M. Chaiken, Ph.D., is the director. BJS Bulletins present the first release of findings from permanent data collection programs. Peter M. Brien and Caroline Wolf Harlow wrote this report under the supervision of Allen J. Beck. Tom Hester edited the report. Marilyn Marbrook administered final production, assisted by Yvonne Boston and Jayne Robinson. Data collection and processing were carried out by Kenneth Dawson, Marita Perez, Arlene Rasmussen, Carol Spivey, and Stephen Wenck under the supervision of Gertrude Odom and N. Gail Hoff of the Demographic Surveys Division, U. S. Bureau of the Census. August 1995, NCJ-152765 (end of file)