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

HIV in Prisons, 2005

September 2007, NCJ 218915

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This file is text only without graphics and many of the
tables. A Zip archive of the tables in this report in 
spreadsheet format (.csv) and the full report including 
tables and graphics in .pdf format are available from:
http://www.ojp.usdoj.gov/bjs/abstract/hivp05.htm

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#hivpj
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By Laura M. Maruschak
BJS Statistician

On December 31, 2005, correctional authorities reported that
20,888 State inmates (1.8%) and 1,592 Federal inmates (1.0%)
were infected with the human immunodeficiency virus (HIV) or
had confirmed AIDS. This was a total of 22,480 inmates, a
slight decrease from 22,936 inmates in 2004.

Half of the HIV/AIDS cases were in the South, nearly a third
in the Northeast, and about a tenth in both the Midwest and
the West. The Northeast reported the highest percentage of
HIV/AIDS cases based on its custody population (3.9%). At
yearend 2005, three states   New York (4,440), Florida
(3,396), and Texas (2,400) housed nearly half (49%) of all
HIV/AIDS cases in State prisons. 

At yearend 2005, an estimated 18,953 males (1.8%) and 1,935
females (2.4%) in State prisons were HIV-infected or had
confirmed AIDS. The number of cases for both males and
females were down from 2004. At yearend 2005, five States
reported no female HIV/AIDS cases: New Hampshire, North
Dakota, West Virginia, Hawaii, and Montana. Among Federal
inmates, 1,491 men (1.0%) and 101 women (0.9%) were
HIV-infected or had confirmed AIDS.

An estimated 5,620 inmates had confirmed AIDS, down from
5,969 in 2004. Of the confirmed cases, 5,026 were in State
prisons and 594 were in Federal prisons. Four States
accounted for nearly half (47%) of all confirmed AIDS cases:
Texas (894), New York (700), Florida (645), and
Maryland (408). Maryland (1.8%) had the highest percentage of
confirmed AIDS cases among its custody population, followed
by Connecticut, New York, and Delaware (1.1% each). Five
States (New Hampshire, Indiana, North Dakota, Idaho, and
Wyoming) reported having no confirmed AIDS cases.

During 2005 an estimated 176 State inmates died from
AIDS-related causes, down from 185 in 2004. For every 100,000
State inmates, 13 died from AIDS-related causes. AIDS-related
deaths accounted for nearly 1 in 20 deaths reported in State
prisons. New York reported the largest number of AIDS-related
deaths (19), followed by Florida (17) and California (14).
Relative to the number of inmates in custody, the Northeast
reported the highest rate of AIDS-related deaths (28
per 100,000 inmates), followed by the South (13 per 100,000
inmates).
 
Among Federal inmates, 27 died from AIDS-related causes in
2005, up from 18 in 2004. For every 100,000 Federal inmates,
15 died from AIDS-related causes. AIDS-related deaths
accounted for 7% of all deaths in Federal prisons.
 
State-level data and other detailed information are available
in appendix tables on the BJS website at <http://www.
ojp.usdoj.gov/bjs/pub/hivp05.pdf>. 

HIV/AIDS cases in State and Federal prisons steadily
declining since 1999 

The Bureau of Justice Statistics (BJS) began collecting
official data on HIV infection in State and Federal prisons
in 1991 (see Methodology). At that time, 17,551 State and
Federal inmates were HIV-infected or had confirmed AIDS
(figure 1). This number steadily increased through yearend
1995, but fluctuated thereafter until reaching a high of
25,807 at yearend 1999. Since then, the number of HIV/AIDS
cases has steadily declined, reaching 22,480 at yearend 2005.
 
New York accounted for more than three-quarters of the
decline in HIV/AIDS cases between 1999 and 2005

Between 1999 and 2005, the number of inmates who were
HIV-infected or had confirmed AIDS increased in 18 States and
the Federal system, while the number decreased in 27 States
(table 1). The remaining five States and the District of
Columbia either reported no change or did not report data for
1999 or 2005. 

The largest increases were reported in Florida (up 763), the
Federal system (up 436), Georgia (up 196), and North Carolina
(up 164). New York reported the largest decrease, with 2,560
fewer --HIV-infected or confirmed AIDS inmates, followed by
New Jersey (down 329), and California (down 321). New York
alone accounted for more than three-quarters (83%) of the
total reported decrease in comparable HIV/AIDS cases.
***Footnote 1: New York estimates the number of HIV/AIDS
cases based on data obtained through blind sero-prevalence
studies conducted biennially by the New York State Department
of Health. See Methodology for details on the estimation
procedures.***
 
Number of confirmed AIDS cases fluctuated between 1999 and
2005 

Between 1999 and 2005, the estimated number of confirmed AIDS
cases in State and Federal prisons fluctuated, reaching a
high of 7,039 in 1999 and a low of 5,607 in 2002 (table 2).
Overall, the estimated number of confirmed cases decreased by
1,419 cases between 1999 and 2005. Since 2000, the estimated
confirmed AIDS cases as a percent of all HIV/AIDS cases have
remained stable at about 25%.

The number of confirmed AIDS cases was estimated because not
all States reported counts in every year during the 7-year
period between 1999 and 2005. For States that reported
counts, the number of confirmed AIDS cases ranged between
6,642 in 1999 and 4,862 in 2002.

A total of 31 States and the Federal system provided data in
all 7 years (see comparable column in table 2). The pattern
of change in confirmed AIDS cases was similar across the
three measures  --estimated, reported, and comparable
confirmed AIDS cases. The number fluctuated but
decreased overall during the period.

Difference between the rate of confirmed AIDS cases 
in prisons and the general population shrinking

In each year since 1991, the rate of confirmed AIDS has been
higher among prison inmates than in the U.S. general
population, but the gap has been narrowing. At yearend 2005,
the estimated rate of confirmed AIDS in State and Federal
prisons was more than 2 times higher than in the
general population (table 3). In 1999 it was nearly 5 times
higher.

The shrinking difference between the rate of confirmed AIDS
cases in prisons and the general population between 1999 and
2005 resulted from a decrease in the number of confirmed AIDS
cases in prisons (down 20%) and an increase in cases (up 44%)
among the general population.

HIV/AIDS cases among both male and female State inmates
declining, but at a faster rate for females

Since 1999 the estimated number of both male and female
inmates who had HIV infection or confirmed AIDS has
decreased. Among men, HIV/AIDS dropped from 22,175 cases to
18,953 between 1999 and 2005 (table 4). For women, the number
of cases dropped from 2,402 to 1,935. The percentage of male
inmates who were HIV positive or had confirmed AIDS decreased
from 2.2% to 1.8%; the percentage for female inmates fell
from 3.4% to 2.4%.

While both groups experienced a decrease in the number of
HIV/AIDS cases, females had a larger decrease in the
percentage of HIV/AIDS cases. This can be explained by the
faster growing female population in prisons and a larger
decrease in the number of HIV/AIDS cases among
women.

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Inmate survey data support decline in HIV infection in 1997
and 2004

Data reported by inmates in personal interviews, collected in
the BJS Survey of Inmates in State Correctional Facilities,
were consistent with the decline in HIV infection observed in
National Prisoner Statistics (NPS-1) official records.
Personal interview data are obtained every 5 to 6 years. The
most recent data collections were in 1997 and 2004. In each
year, inmates were asked if they had been tested for HIV at
admission or had ever been tested and the results of the
test. In 2004, 1.6% of tested State inmates reported being
HIV positive, down from 2.2% in 1997.

Decreases found in the percent of HIV positive among male and
female inmates and inmates ages 25 to 34

The inmate survey data provide a broad range of individual
characteristics, including gender, race, age, current
offense, and prior drug use, that can be used to describe
trends. Despite apparent declines within each category, not
all declines were statistically significant (see table
footnote "a" for statistically significant items).

Overall, the percentage of State inmates reporting HIV
infection in 2004 was down from 1997. Both male and female
inmates were less likely to report being HIV positive in 2004
than in 1997. In 2004, 1.6% of male inmates, compared to 2.2%
in 1997, were HIV positive. For female inmates, 1.9% in 1997,
down from 3.4% in 2004, reported being HIV positive.

Among State inmates ages 25 to 34, there was a sharp decline
in the number who reported being HIV positive between 1997
and 2004 (2.3% compared to 0.8%). Over the same time period,
inmates in each of the other age categories were equally
likely to report being HIV positive.

Decrease in HIV infection found among drug offenders and
inmates who reported prior drug involvement

Drug offenders were less likely in 2004 to report being HIV
positive than in 1997. In 2004, 1.8% of drug offenders
reported being HIV positive, down from 2.9% in 1997. Between
1997 and 2004, significant decreases in the percentage of
inmates who reported being HIV positive were found among
inmates who ever used drugs, used drugs in the month before
arrest, and used needles to inject drugs. Among inmates who
reported ever using drugs, 1.7% reported being HIV positive
in 2004, down from 2.3% in 1997. Inmates who used drugs in
the month before arrest were less likely to report being HIV
positive in 2004 (1.9%) than in 1997 (2.7%). Among inmates
who said they had used a needle to inject drugs, 2.8%
reported being HIV positive in 2004, down from 4.6% in 1997. 
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Number of AIDS-related deaths declined dramatically between
1995 and 2000

The number of State inmates who died of AIDS-related
diseases, such as Pneumocystis carinii pneumonia and Kaposi's
sarcoma, ***Footnote 2: Center for Disease Control, 1993,
Revised Classification System for HIV Infection and Expanded
Surveillance Case Definition for AIDS Among Adolescents and
Adults. MMWR 1992; 41(RR-17).*** peaked in 1995 at 1,010
deaths and declined through 2000 to 185 deaths. In 2001 the
number of AIDS-related deaths reported in the NPS-1 increased
to 256 and has steadily declined since (figure 2). 

In 2001 BJS began collecting individual-level information
about deaths in State prisons, under the Death in Custody
Reporting Program (DCRP). ***Footnote 3: In 2001 BJS began to
estimate the number of AIDS-related deaths using data from
the NPS-1 and the DCRP. The most complete data for each
State's number of deaths were used to calculate the estimated
number of AIDS-related deaths. See Methodology.*** The
estimated number of AIDS-related deaths calculated using data
from both the NPS-1 and the DCRP followed the same downward
trend between 2001 and 2005 that was found using data from
NPS-1 only. The estimated number of AIDS-related deaths was
176 in 2005, down from 311 in 2001.

Between 1995 and 2000, New York reported the largest decline
in AIDS-related deaths (down 250), followed by Florida (down
102) and California (down 68). These three States combined
accounted for more than half of the total decline (825) in
the number of AIDS-related deaths. New Jersey (down 46) and
Georgia (down 42) also had large declines.
          
Almost all of the decrease in AIDS-related deaths attributed
to male inmates

Using the individual records collected under the DCRP,
estimates of AIDS-related deaths by gender, age, and race
were calculated by applying the percentages in DCRP in each
year to the estimated total number of deaths. The number of
AIDS-related deaths decreased across gender, age, race and
Hispanic origin. Between 2001 and 2005, male inmates, inmates
ages 35 to 44, and black non-Hispanic inmates accounted for
most of the decrease (table 5). 

In 2005, 166 male inmates died from AIDS-related causes, down
from 295 in 2001. This decrease of 129 AIDS-related deaths
among male inmates was almost all (96%) of the total
decrease of 135 deaths among all inmates. 

Between 2001 and 2005, inmates ages 35 to 44 accounted for
half of the decrease (down 68) in the total number of
AIDS-related deaths. AIDS-related deaths of black
non-Hispanic inmates accounted for 65% of the total decline
of 88 AIDS-related deaths reported between 2001 and 2005
(down from 208 to 120).

AIDS-related deaths as a percent of all deaths decreasing
more rapidly in State prison than in the general population

AIDS-related deaths as a percent of total deaths in State
prisons also decreased significantly between 1995 and 2000,
from 34.2% to 5.3% (table 6). Over a slightly different time
period (1995 to 2004, the most recent year for which data are
available), AIDS-related deaths among the general population
ages 15 to 54 decreased 68%, from 44,233 to 14,315. 
AIDS-related deaths as a percent of all deaths in the general
population declined from 12.9% to 4.3% during the period. 

Between 2001 and 2004, the rate of AIDS-related deaths among
prison inmates as a percent of all deaths in the prison
population was nearly cut in half (from 10.3% to 5.6%).
However, the rate in the general population remained stable
at about 4.3%. 

Rate of AIDS-relate deaths declining in prisons, stabilizing
in the general population

Between 1995 and 2001, the rate of AIDS-related deaths
declined from 100 deaths per 100,000 inmates to 25 per
100,000 (table 7). In the general population the rate dropped
from 29 per 100,000 to 9 per 100,000. After 2001, while the
rate of AIDS-related deaths in the State prison population
continued to decline, from 25 to 13 per 100,000 inmates, the
rate in the general population ages 15 to 54 remained stable
between 8 and 9 deaths per 100,000 persons. 

Older persons in State prisons had a higher rate of
AIDS-related deaths than those in the general population

Older inmates were more likely to die from AIDS-related
causes than persons in the same age group in the general
population. In 2005, inmates ages 35 to 44 were almost twice
as likely to die from AIDS-related causes (21 per 100,000
State inmates) than their counterparts in the general
population (12 per 100,000 persons) (table 8). Among persons
ages 45 to 54, State inmates were more than twice as likely
as those in the general population to die from AIDS-related
causes (31 per 100,000 compared to 14 per 100,000). 

Methodology

National Prisoner Statistics

The National Prisoner Statistics collection (NPS-1), which
primarily measures prison population movement, began in 1926.
The 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 departments of corrections in the 50 States
and the Federal Bureau of Prisons. In 1991 BJS began
collecting data on HIV/AIDS in prisons in NPS-1. BJS
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 Correctional Facilities

The Survey of Inmates in State Correctional Facilities
provides nationally representative data on State prison
inmates. The 1997 and  2004 surveys used the same
questionnaire and a stratified two-stage sample design.
Facilities were selected in the first stage and inmates were
selected for interviews in the second stage. Detailed
descriptions of each survey's methodology and links to
other reports or findings are available on the BJS Website
<http://www.icpsr.umich.edu/NACJD/bjs.html#sisfcf>.

Accuracy of the survey estimates

The accuracy of the estimates in this report depends on two
types of error: sampling and nonsampling. Sampling error is
the variation that may occur by chance because a sample
rather than a complete enumeration of the population was
conducted. Nonsampling error can be attributed to many
sources, such as nonresponses, differences in the
interpretation of questions among inmates, recall
difficulties, and processing errors. In any survey the full
extent of the nonsampling error is never known. The sampling
error, as measured by an estimated standard error, varies by
the size of the estimate and the size of the base population.

Testing for differences in the proportions of inmates
reporting that they were HIV positive within subgroups in the
1997 and 2004 surveys compared a calculated z-value against
the critical value of 1.645 (the 95% level for a one-tail
test). Given the overall declines in HIV cases reported in
the administrative data, a one-tail test showed that the
difference in proportions was less than zero. The z-value was
calculated by taking the ratio of the estimated difference in
proportions to the square root of the pooled variances of the
two samples. (See standard errors in appendix table
7 at <http://www.ojp.usdoj.gov/pub/hiv05.pdf>.)

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 from 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).

Estimation of HIV/AIDS cases in New York State

New York estimates the number of HIV/AIDS cases based on data
from blind sero-prevalence studies conducted biennially by
the New York State Department of Health. Blood samples are
taken from all inmates entering New York State prisons. Every
other year an extra sample from 1,000 sequential admissions
at reception in four reception centers is tested for various
diseases, including HIV. The percentage with HIV infection is
applied to the total inmate population, then adjusted for
length of stay and data from other studies. Projections for
interim years are made without blind studies.

AIDS in the U.S. resident population

The number of persons with confirmed AIDS in the U.S. general
population (age 13 and older) was derived from the Centers
for Disease Control and Prevention (CDC), HIV/AIDS
Surveillance Report, yearend editions 1995-2005. For each
year the number of active AIDS cases in the United States was
calculated by taking the-- 

* cumulative number of total AIDS cases for persons age 13 or
older at yearend (from the HIV/AIDS Surveillance Report),
minus estimated confirmed AIDS cases in State and Federal
prisons, and subtracting the

* cumulative number of AIDS deaths for people age 15 or older
at yearend, minus estimated number of AIDS-related deaths in
State and Federal prisons.

The rate of confirmed AIDS cases in the U.S. general
population was calculated by  

* dividing the annual total number of individuals with AIDS
by the estimated U.S. general population (age 13 or older
before 2000; age 15 or older since 2000) minus the State and
Federal custody population. 

AIDS-related deaths in the United States

The number of AIDS-related deaths for persons ages 15 to 54
was based on the CDC, HIV/AIDS Surveillance Report, yearend
editions. Deaths in the U.S. population for persons ages 15
to 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). Also
deaths were taken from the 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; Vol. 53, No. 15; and
Vol. 54, No. 19.

For 2001 to 2005, AIDS-related deaths were calculated as a
percent of all deaths among persons ages 15 to 54 in the U.S.
general population. The difference of the national estimate
of AIDS deaths of persons ages 15 to 54 minus AIDS-related
deaths of persons ages 15 to 54 in State prison was divided
by the national mortality estimates of persons ages 15 to 54
minus total deaths in State prisons. 

For 2001 through 2005, the rates of AIDS-related deaths in
the general population were calculated by taking the
difference of the national estimate of AIDS-related deaths
for persons ages 15 to 54 minus AIDS-related deaths for those
ages 15 to 54 in State prisons and dividing it by the U.S.
general population estimate minus the State prison population
ages 15 to 54. 

Because data on AIDS-related deaths by age in State prisons
were not collected prior to 2001, the total number of
AIDS-related deaths in State prison were subtracted from the
national estimate of AIDS-related deaths for the 1995 rate
calculations.

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The Bureau of Justice Statistics is the statistical agency of
the U.S. Department of Justice. Jeffrey L. Sedgwick is the
director.

BJS Bulletins present the first release of findings from
permanent data collection programs. This Bulletin was written
by Laura M. Maruschak. Margaret Noonan and Heather Couture
verified the report. Theresa M. Reitz carried out the data
collection and processing under the supervision of Charlene
M. Sebold, Governments Division, Census Bureau, U.S.
Department of Commerce. Duane H. Cavanaugh and Diron J.
Gaskins provided technical assistance. Tina Dorsey and
Carolyn C. Williams edited the report and Jayne Robinson
prepared it for final printing, under the supervision of
Doris J. James. 

September 2007, NCJ 218915 
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This report in portable document format and in ASCII and its
related statistical data and tables  are available at the BJS
World Wide Web Internet site: <http://www.ojp.usdoj.gov/bjs/
abstract/hivp05.htm>.

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09/27/07 td