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91 HIV/AIDS in Jails and Prisons Jim McAuley Cook County Jail, Chicago, IL, USA |
Background: The adult justice system in the United States consists of police holding-cells, pre-trial detention centers (jails), and prisons (state, federal, military). The length of stay for jails varies by jurisdiction but is typically several days to a few weeks while prisons house persons for at least one year. The 2002 date from the Bureau of Justice indicates that over 2 million Americans were held in jails (665,475) and prisons (1,355,748) throughout the United States each day and that more than 10 million pass through the system each year. Nearly 6 in 10 persons in local jails were racial or ethnic minorities, and 88% were men. Epidemiologic data indicate that indigent populations are disproportionately incarcerated. Rates of HIV infection in jail detainees vary by gender and race ethnicity but are several orders of magnitude higher for each group studied when compared to the general population: African American males 2.5%, African American females 3.2%, Latino males 3.5%, Latino females 1.3%, white males 1.3%, white females 2.1%. The infection rates for state prisons are slightly higher for each group except Latino males: African American males 2.7%, African American females 3.9%, Latino males 2.4%, Latino females 4.2%, white males 1.4%, white females 2.3%. There are limited data on transmission of HIV within correctional facilities. Conclusions: The major focus of programs and research has been on accessing this highly vulnerable population with treatment and education with the goal of slowing disease progression and decreasing transmission upon return to the community. Cook County Jail (CCJ) in Chicago houses ~11,000 individuals each day, with ~100,000 passing through each year. Cermak Health Services (CHS) of the Cook County Bureau of Health Services provides health care at CCJ. With Centers for Disease Control and Prevention (CDC) support CHS has developed an extensive system of health education, case management, counseling and testing, and treatment for persons with HIV/AIDS. Programs include rapid testing, standard of care HAART, discharge medications, and continuity of care programs. Experience with these programs as well as review of other programs nationally will be presented.
Keywords: CD8+ T cells; clade B consensus sequence; immunogenicity
