Background:  HIV infection is more prevalent among inmates than in the non-incarcerated. About 25% of those with HIV in the United States will be incarcerated each year, and most are unaware of their serostatus.  Early diagnosis can prevent the spread of HIV and reduce the incidence of AIDS.  This study evaluated the effect of various counseling strategies and the availability of different HIV-testing methods on the rate of voluntary HIV testing; and how HIV risk factors, testing history, and attitudes about HIV testing influence HIV-testing method preferences and HIV serostatus.

Methods:  Incoming inmates at one California prison have been provided individual HIV counseling and blood testing only upon request. During the study period, inmates were either routinely offered individual HIV counseling and blood testing, routinely offered group HIV counseling and blood testing, or routinely offered group HIV counseling and either blood, urine, or oral fluid testing. Those tested were offered a questionnaire regarding HIV risk factors, testing history, and attitudes.

Results:  Of eligible inmates, 561/781 (72%) received counseling, 235/561 (42%) consented to test; 210/235 (89%) actually tested, 128/210 (61%) who tested completed the questionnaire.  When offered only blood testing, more than twice as many requested testing after individual counseling compared with group counseling (58% vs 27%).  When offered a choice of testing method, 31/52 (60%) chose blood, 21/52 (40%) chose oral fluid; no one chose urine testing.  Only 1 inmate tested positive for HIV, so serostatus was not evaluated as an outcome. Of those who had wanted to test in the past but did not (n = 43), the following reasons were given:  55% were afraid of a positive result, 30% did not know where to go to get tested, 37% said they did not have enough time, 26% did not like needles, 21% were afraid of others getting the result, 14% thought they did not have enough money to get a test; and 7% feared that their result would be reported to the government.

Conclusions:  In this population, individual counseling was twice as effective as group counseling, motivating 50% of incoming inmates to test. Among those given a choice, blood and oral fluid testing methods were preferred over urine testing.  Approximately 40% of those who elected to test chose options that did not involve a needle. Studies of further interest include examining reasons inmates chose not to test for HIV.

Keywords: hiv; testing; prisoners