U.S. Department of Justice
Office of Justice Programs
Bureau of Justice Statistics
Bulletin

HIV in Prisons, 2004

November 2006, NCJ 213897

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By Laura M. Maruschak
BJS Statistician

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Highlights

Number of HIV-infected inmates steadily decreasing since 1999

* Between 2003 and 2004 the number of HIV-positive prisoners 
decreased 2.6%, while the overall prison population grew 1.7% 
during the same period.

* At yearend 2004, 2.6% of all female State prison inmates 
were HIV positive, compared to 1.8% of males.

* During 2004, 20 States reported a decrease in the number of 
HIV-positive prisoners, and 24 States and the Federal system 
reported an increase.

* New York held about a fifth of all inmates(4,500 inmates)
known to be HIV positive at yearend 2004.

* Florida, with an increase of 138 HIV-positive inmates, 
reported the largest increase, followed by Mississippi(up
54). 

* The overall rate of confirmed AIDS among the prison 
population (0.50%) was more than 3 times the rate in the U.S. 
general population (0.15%).

Rate of AIDS-related deaths in State prisons decreased in
2004

* In 2004, 203 prisoners died from AIDS-related causes --185 
State inmates and 18 Federal inmates.

* The number of AIDS-related deaths in State prisons
decreased 
82% from 1995 to 2004.

* Pennsylvania reported the largest number of AIDS-related 
deaths (21), followed by New York and Florida (both 20). 
Twenty States reported having no AIDS-related deaths.
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On December 31, 2004, 1.9% of State prison inmates and 1.1%
of Federal prison inmates were known to be infected with 
the human immunodeficiency virus (HIV). Correctional 
authorities reported that 21,366 State inmates and 1,680 
Federal inmates were HIV positive. The number known to be 
HIV positive totaled 23,046, down from 23,663 at yearend 
2003.

Of those known to be HIV positive in all U.S. prisons at
yearend 2004, an estimated 6,027 were confirmed AIDS cases, 
up from 5,944 in 2003. Among State inmates, 0.5% had AIDS; 
among Federal inmates, 0.4%.

During 2004, 185 State prisoners died from AIDS-related
causes, down from 268 in 2003. In 2004, 6% of State inmate 
deaths were attributed to AIDS, down from 32% in 1995. Among
Federal prisoners 18 died from AIDS-related causes, up 4
deaths from the total in 2003.

This report is based on the 2004 National Prisoners
Statistics 
(NPS-1) and the Deaths in Custody Reporting Program (DCRP). 
Data from NPS-1 are reported on one form by the departments
of
corrections in 50 States and by the Federal Bureau of
Prisons. 
DCRP data are from individual records for each death. A
record 
includes information on the deceased's characteristics such
as 
gender, age, and race/Hispanic origin.

Nearly half of HIV-infected State 
prison inmates at yearend 2004 
were housed in three States 

At yearend 2004, HIV-infected inmates were concentrated in a 
small number of States. New York(4,500), Florida(3,250), and 
Texas(2,405) held the largest number of HIV-positive inmates. 
These three States housed nearly half(48%)of all HIV-infected 
inmates in State prisons. 

Excluding New York, the number of HIV-infected inmates has 
been stable among the States. Since reaching a peak of 19,333 
in 2000, the number has fluctuated reaching a low of 18,546 
in 2004. New York estimates are based on data obtained
through
blind sero-prevalence studies conducted biennially by the New 
York Department of Health.***New York draws blood from all 
entering inmates. Every other year an extra sample from 
1,000 sequential receptions in each of 4 reception centers is 
tested for various diseases including HIV. The percentage
with 
HIV-infection is applied to the total inmate population and 
then adjusted for length of stay and findings from other 
studies. Projections are made for the interim years without 
the blind studies.***  Due to this estimation method, New
York 
has reported very large decreases in the number of
HIV-positive 
inmates from year to year.   

HIV-positive inmates comprised 1.9% of the State prison 
population in 2004, down from 2.0% in 2003. In Federal
prisons 
HIV-positive inmates comprised 1.1% in 2004, unchanged since 
2002. After remaining constant at 1.9% in 2002 and 2003, the 
overall percentage of the total prison population with HIV 
decreased to 1.8% in 2004.

Inmates in the Northeast had the highest rate 
of HIV infection

In the Northeast, 4.1% of the prison population were known to 
be HIV positive in 2004, followed by 2.1% in the South, 0.9% 
in the Midwest, and 0.7% in the West. New York had the
highest 
percentage of inmates known to be HIV positive (7.0%),
followed 
by Rhode Island (5.1%) and Florida (3.9%).

North Dakota, South Dakota, Montana, and Wyoming reported
fewer 
than 10 HIV-positive inmates in their prisons. In 2004 every 
reporting jurisdiction held at least one HIV-positive inmate. 
Six States reported that fewer than 0.5% of their inmate 
population were HIV positive. 

Between 2003 and 2004, 20 States reported a decrease in the 
number of HIV-positive inmates. The largest decrease was 
reported in New York (down 500), followed by Maryland (196), 
Connecticut (95), and Pennsylvania (82). Twenty-four States 
and the Federal system reported an increase. The largest 
increases were reported in Florida (up 138), Mississippi(54), 
the Federal system(49), Delaware(44), and Rhode Island (41). 

A greater percentage of females than males with HIV 
infection

On December 31, 2004, 20,668 male inmates and 2,084 female 
inmates in State and Federal prisons were known to be HIV 
positive (table 2). Overall, 1.7% of male inmates and 2.4% 
of all female inmates were known to be HIV positive. New York 
reported the largest numbers of male and female HIV-positive 
inmates (4,100 and 400, respectively). The second largest 
numbers of HIV-positive male and female inmates were in
Florida 
(2,911 and 339, respectively), followed by Texas (2,199 and
206,
respectively). Two States, Vermont and Montana, reported
having 
no HIV-positive female inmates. Every reporting State had
some 
HIV-positive male inmates.

Over 10% of all female inmates were known to be HIV positive
in 
two States  Rhode Island (15.6%) and New York (14.2%). New
York 
(with 6.7%) was the only State with more than 5% of male
inmates 
known to be HIV positive.

Number of HIV-positive male and female inmates in 
State prisons declined during 2004

Based on these yearend estimates, the number of HIV-infected 
females in State prisons decreased from 2,131 to 1,983 and
the 
number of infected males in State prisons decreased from
20,060 
to 19,383 during 2004. The estimated number of male
HIV-positive 
inmates in State prisons increased between 1998 and 1999 and
has 
decreased every year since 1999. The estimated number of
female 
HIV-positive inmates in State prisons decreased between 1998
and 
1999, increased in 2000, and has decreased every year since
2000. 
Between 1998 and 2004 the percentage of male HIV-positive
inmates 
decreased from 2.2% to 1.8%, and the percentage of female
inmates 
fell from 3.8% to 2.4%.  

Confirmed AIDS cases in U.S. prisons increased 
during 2004

At the end of 2004, a reported 5,483 inmates in U.S. prisons 
had confirmed AIDS, up from 5,227 in 2003. Among those with 
confirmed AIDS, 4,842 were in State prisons, and 641 were in 
Federal prisons. 

For States that did not provide a breakdown of the number of 
HIV cases by type of HIV infection, estimates of the number
of 
confirmed AIDS cases were made to provide comparable year-to-
year data. Based on yearly estimates, the number of confirmed 
AIDS cases increased from 5,944 in 2003 to 6,027 in 2004.

Between 1998 and 2004, 32 States and the Federal system 
consistently reported the number of inmates with confirmed
AIDS. 
As with the reported and estimated numbers, the comparable
number 
of inmates with confirmed AIDS declined between 1998 and
2004, 
from 5,859 to 5,070.

Confirmed AIDS cases made up 0.5% of inmates in State prisons 
and 0.4% of those in Federal prisons. Of those known to be
HIV-
positive inmates, nearly a quarter had confirmed AIDS.

The States with the largest number of confirmed AIDS cases
were 
Texas (801), New York (800), and Florida (721). Combined,
these 
States held nearly half of all confirmed AIDS cases in State 
prisons. The Federal system held 641 inmates with confirmed 
AIDS. Thirteen States reported having fewer than 10 confirmed 
AIDS cases in their prisons; 3 reported having none.

Rhode Island (1.8%) had the highest percentage of confirmed 
AIDS, followed by Connecticut and New York(both 1.2%). In 13 
States, confirmed AIDS cases comprised 0.1% or less of State 
inmates. 

During 2004, 11 States reported a decrease in the number of 
confirmed AIDS cases. Maryland, with a decrease of 49, had
the 
largest drop in the number of confirmed AIDS cases, followed
by 
Pennsylvania (48) and New Mexico (25). Eighteen States and
the 
Federal system reported an increase in the number of
confirmed 
AIDS cases, led by Illinois (up 91) and New Jersey (34).

Rate of confirmed AIDS 3 times higher among prison 
inmates than in the U.S. general population

In every year since 1991, the rate of confirmed AIDS has been 
higher among prison inmates than in the general population.
At 
yearend 2004 the rate of confirmed AIDS in State and Federal 
prisons was more than 3 times higher than in the total U.S. 
population. About 50 in every 10,000 prison inmates had 
confirmed AIDS, compared to 15 in 10,000 persons in the U.S. 
general population.

Twenty States test all inmates for HIV at admission or 
while in prison 

Forty-eight States and the Federal Bureau of Prisons reported 
that they test inmates if they have HIV-related symptoms or
if 
the inmates request a test. Forty-one States and the Federal 
system test inmates after they are involved in an incident in 
which an inmate is exposed to possible HIV transmission, and
17 
States and the Federal system test inmates who belong to 
specific "high-risk" groups.

Missouri, Alabama, and Florida test all inmates upon their 
release. Arkansas and Nevada test all inmates while in
custody. 
Three States (New York, Alabama, and Oregon) test inmates 
selected at random.

AIDS-related deaths in State prisons dropped between 
1995 to 2004

The number of State inmates who died of Pneumocystis carinii 
pneumonia, Kaposi's sarcoma, or other AIDS-related diseases 
peaked in 1995 and steadily decreased until 2001. According
to 
data reported in the NPS-1, the number of AIDS-related deaths 
decreased by 85 from 213 in 2003 to 128 in 2004. This was the 
largest decrease reported since 1999. Overall, since 1995 the 
number of AIDS-related deaths has decreased by 882.

Among Federal inmates, 18 died from AIDS-related causes, up 
from 14 in 2003. In 2004 for every 100,000 inmates, 10 died 
from AIDS-related causes. These AIDS-related deaths accounted 
for 5% of all deaths in Federal prison.

The introduction of protease inhibitors and combination 
antiretroviral therapies produced a substantial improvement
in 
the effectiveness of HIV/AIDS care in correctional
facilities. 
See Hammett and Harmon, "Medical Treatment and a Continuum of 
Care" in 1996-1997 Update: HIV/AIDS, STDs and TB in
Correctional 
Facilities (July 1999, NCJ 176344). 

Deaths in Custody Reporting Program identifies more 
States with AIDS-related deaths in State prisons

Pursuant to the Death in Custody Reporting Act of 2000, BJS
began 
in 2001 to collect individual-level information about deaths
in 
State prisons (DCRP). Overall, 14 States under-reported AIDS-
related deaths in the NPS-1 collection, while 3 States under-
reported AIDS-related deaths in DCRP.

For a total of AIDS-related deaths in prisons, DCRP and NPS-1 
data were combined. The most complete data for each State's 
number of deaths were used to calculate the totals for 2001 
through 2004. An additional 57 AIDS-related deaths were
identified 
in 2004, 55 in 2003, 68 in 2002, and 55 in 2001. Adjusted for 
under-reporting, the number of AIDS-related deaths was 14 per 
100,000 State prison inmates in 2004, down from 21 in 2003.

For the general population the percentage of deaths due to
AIDS 
remained constant at 4.4% in 2003. In 2003 the percentage of 
deaths due to AIDS was more than 1  times higher in the
prison 
population than in the U.S. general population ages 15-54. 
Nearly 1 in every 13 prisoner deaths were attributable to
AIDS-
related causes compared to 1 in 23 deaths in the general 
population.

In 2004 about 1 in 18 deaths in State 
prisons due to AIDS-related 
illnesses

In 2004 for every 100,000 State inmates, 14 died from AIDS-
related causes. The most AIDS-related deaths were reported in 
the South (84), followed by the Northeast (60). Together,
these 
two regions accounted for more than three-quarters of AIDS-
related deaths in State prisons.

Pennsylvania reported the largest number of AIDS-related
deaths 
(21), followed by New York and Florida (both 20). Twenty
States 
reported having no AIDS-related deaths.

Relative to the number of inmates, Maryland had the highest 
rate of AIDS-related deaths (63 per 100,000 inmates),
followed 
by Connecticut (55 per 100,000), Pennsylvania (52 per
100,000), 
and New York (31 per 100,000).

For AIDS-related deaths among 
inmates rates higher for males, 
blacks, and those age 45 or older 

Of the 179 AIDS-related deaths reported in DCRP in 2004, 
information on gender, age, and race/Hispanic origin is known 
for 145. Of those, 138 were male, and 7 were female. Inmates 
between ages 35 and 44 accounted for almost half of all AIDS-
related deaths (69). Black non-Hispanic inmates accounted for 
about two-thirds of AIDS-related deaths (96).
 
Relative to the total number of inmates under State
jurisdiction, 
males (12 deaths per 100,000) were 1  times as likely as 
females (8 per 100,000) to die from AIDS-related causes
during 
2004. Black non-Hispanic inmates (19 per 100,000) were nearly 
2 times more likely than whites (8 per 100,000) and almost 5 
times more likely than Hispanics (4 per 100,000) to die from 
AIDS. Inmates age 45 or older had the highest rate of AIDS-
related deaths (23 per 100,000), 4  times the rate among 
inmates age 25 to 34 (5 per 100,000). 

HIV/AIDS reported by prison 
inmates in personal interviews

The 2004 Survey of Inmates in State and Federal Correctional 
Facilities asked inmates if they had ever been tested for
HIV, 
if they had been tested since admission, and whether they
were 
HIV positive. (See Methodology for further detail.)

Though some inmates may refuse to report that they are HIV 
positive and others may not know, the survey provided a means 
to track HIV infection among demographic and "high-risk" 
groups.

Of inmates who reported being tested since admission and
reported 
a result, 1.9% in State prison and 1.1% in Federal prison 
reported being HIV positive.  

Among State prisoners who were tested for HIV, female inmates 
(1.9%) were more likely than male inmates (1.6%) to be HIV 
positive.  Black non-Hispanic inmates (2.0%) and Hispanic
inmates 
(1.8%) were about twice as likely as white non-Hispanic
inmates 
(1.0%) to report being HIV positive. Among male inmates, 1.9%
of 
black non-Hispanics, 1.8% of Hispanic, and 1.1% of white non-
Hispanics said they were HIV positive. Among female inmates,
black
non-Hispanics (3.4%) and Hispanics (2.7%) were about 6 times
as 
likely as white non-hispanic inmates (.5%) to be HIV
positive.

In Federal prisons 1.0% of male inmates and 1.4% of female 
inmates reported HIV infection. HIV-positive rates were
highest 
among black non-Hispanic female inmates (2.6%).  
 
In both State and Federal prisons, inmates age 34 or younger 
had the lowest rates of HIV infection. The highest
HIV-positive 
rates in State prisons were among those age 45 or older and
in 
Federal prisons among those age 35-44 (1.9%). 

In both State and Federal prisons, inmates with less than a 
high school education were more likely than those with a high 
school education to be HIV positive. 

Among prisoners property 
offenders reported the highest 
prevalence of HIV

Inmates held on a property offense in State and Federal
prisons 
had the highest HIV-positive rate (both 2.6%). Among State 
inmates, public-order offenders (0.9%) were least likely to 
report being HIV positive; among Federal prisoners, drug 
offenders (0.7%) were least likely to report being HIV
positive.

The percentage of State and Federal prison inmates reporting 
that they were HIV positive varied by degree of involvement 
in prior drug use. The percentage of State prison inmates who 
were HIV positive was 

* 1.3% of those who never used drugs 

* 1.7% of those who had ever used drugs 

* 1.9% of those who used drugs in the month before 
their current offense

* 2.8% of those who had used a needle to inject drugs

* 5.1% of those who had shared a needle.

Like State inmates, Federal inmates who used a needle and 
shared a needle had higher rates of HIV infection than those 
inmates who reported ever using drugs or using drugs in the 
month before their current offense. 

Methodology

National Prisoner Statistics

The National Prisoner Statistics series(NPS-1)includes
yearend 
counts of prisoners by jurisdiction, gender, race, Hispanic 
origin, and admissions and releases during the year. The
series 
consists of reports from the depart-ments of corrections in
the 
50 States and the Federal Bureau of Prisons. Since 1991 
respondents have indicated the circumstances under which
inmates 
are tested for HIV and have provided the number of
HIV-infected 
inmates in their custody.

Surveys of Inmates in State and 
Federal Correctional Facilities

The Survey of Inmates in State and Federal Correctional 
Facilities, 2004, is comprised of two separate surveys: one 
in State adult correctional facilities and one in Federal 
correctional facilities. The surveys provide nationally 
representative data on State prison inmates and sentenced 
Federal inmates. Both surveys used the same questionnaire and 
a stratified two-stage sample design where facilities were 
selected in the first stage and inmates to be interviewed in 
the second stage.

The State prison sample was selected from a universe of 1,585 
facilities that were enumerated in the 2000 Census of State 
and Federal Correctional Facilities, or had opened between
the 
completion of the Census and May 31, 2003. A total of 287
State 
prisons participated in the survey; 2 refused, 11 were closed 
or had no inmates to survey, and 1 was erroneously included
in 
the universe.

The Federal prison sample was selected from 148 Federal
prisons 
and satellite facilities holding inmates on January 4, 2003. 
Thirty-nine of the 40 Federal prisons selected participated
in 
the survey.

A total of 14,499 inmates in the State facilities were 
interviewed; 1,653 inmates refused to participate, resulting 
in a second-stage nonresponse rate of 10.2%. In the Federal 
survey, after the initial sample of inmates, a secondary
sample 
of 1 in 3 drug offenders was selected for participation in
the 
survey. A total of 3,686 inmates in Federal facilities were 
interviewed and 567 refused to participate, for a
second-stage 
nonresponse rate of 13.3%.

The accuracy of the 2004 Survey of Inmates in State and
Federal 
Correctional Facilities depends on sampling and measurement 
errors. Sampling errors occur by chance because a sample
rather 
than a complete enumeration of the population was conducted. 
Measurement error can be attributed to many sources, such as 
nonresponse, recall difficulties, differences in the 
interpretation of questions among inmates, and processing 
errors.

The sampling error, as measured by an estimated standard
error, 
varies by the size of the estimate and the size of the base 
population. Estimates for the percentage of inmates ever
tested 
for HIV and the percentage who tested HIV positive have been 
calculated. These standard errors may be used to construct 
confidence intervals around percentages. For example, the 95-
percent confidence interval around the percentage of males in 
State prisons who were HIV positive is approximately 1.6%
plus 
or minus 1.96 times .20% (or 1.2% to 2.0%).

Detailed descriptions of the methodology for each of these 
surveys, including standard error tables and links to other 
reports or findings from these surveys, are available on the 
BJS Website <www.icpsr.umich.edu/NACJD/bjs.html#sisfcf>.

AIDS in the U.S. resident population

The number of persons with confirmed AIDS in the U.S. general 
population (age 13 and over) was derived from the Centers for 
Disease Control and Prevention (CDC), HIV/AIDS Surveillance 
Report, yearend editions 1995-2004. For each year the number 
of active AIDS cases in the United States was calculated by 
subtracting the number of cumulative AIDS deaths for people
age 
15 or older at yearend from the cumulative number of total
AIDS 
cases for people age 13 or older at yearend as listed in the 
HIV/AIDS Surveillance Report.

The rate of confirmed AIDS cases in the U.S. general
population 
was calculated by dividing the annual totals for individuals 
with AIDS by the population estimates for the U.S. general 
population of individuals 13 or older prior to 2000 and 15 or 
older for 2000 and beyond. 

AIDS-related deaths in the United 
States

The number of AIDS-related deaths for persons age 15-54 was 
derived from the CDC, HIV/AIDS Surveillance Report, yearend 
editions. Deaths in the U.S. population for persons age 15-54 
were taken from the CDC, Monthly Vital Statistics Report,
Vol. 
42, No. 2(S); Vol. 43, No. 12; Vol. 43, No. 6(S); Vol. 45,
No. 
3(S); and Vol. 45, No. 11(S); and from CDC, National Vital 
Statistics Report, Vol. 47, No. 9; Vol. 47, No. 25; Vol. 48, 
No. 11; Vol. 49, No. 8; Vol. 50, No. 15; and Vol. 53, No. 15.

AIDS-related deaths as a percentage of all deaths in the U.S. 
population were calculated by dividing the national estimate 
of AIDS deaths of persons age 15-54 by the national mortality 
estimates of persons age 15-54 in a given year. 

BJS Deaths in Custody Reporting 
Program

To implement the Death in Custody Reporting Act of 2000 
(PL 106-297), BJS developed four quarterly data collections 
of death records: local jails(begun in 2000), State prisons 
(2001), State juvenile correctional agencies(2002), and 
State and local law enforcement agencies (2003). Records 
include data on the deceased's characteristics(such as age, 
gender, and race/Hispanic origin), criminal background (such 
as legal status, offenses, and time in custody), and the
death 
itself (such as cause, time, location, and medical conditions 
and treatment).

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The Bureau of Justice Statistics is the statistical 
agency of the U.S. Department of Justice. Jeffrey L. 
Sedgwick is director. Laura M. Maruschak wrote this 
report, under the supervision of Allen J. Beck. Todd 
D. Minton provided statistical review. Tina Dorsey 
and Marianne Zawitz edited the report. Jayne Robinson 
prepared the report for final printing.

November 2006, NCJ 213897
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This report in portable document format and in ASCII 
and its related statistical data and tables including 
five appendix tables are available at the BJS World 
Wide Web Internet site: <http://www.ojp.usdoj.gov/bjs/>
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10/19/06 ih