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)