RALEIGH — The number of North Carolina prison inmates who are tested for the HIV virus has increased in the past four years after the state changed the way it offers the test when inmates arrive at prisons.

More than 90 percent of inmates in North Carolina prisons are now tested for HIV, up from 15 percent for men and 80 percent for women just four years ago, according to Dr. Paula Smith, head of health services for the N.C. Department of Public Safety. The higher numbers make it easier to monitor the spread of HIV and identify people who may need treatment.

The increase resulted from a new way of presenting options to prisoners to find out if they carry HIV, recommended by the Centers for Disease Control in 2006 and adopted by prisons in North Carolina in 2008.

Each year, an estimated one in seven people infected with HIV nationwide passes through a correctional facility, suggesting a disproportionate number of people in the criminal justice system are infected with the virus, according to the National Institute of Health. The South, which has more prisoners than any other region of the country, has more than double the number of inmates with HIV than any other region.

Before 2008, inmates in North Carolina could choose to be tested for HIV when asked if they had engaged in high-risk behavior, including drug use, or had unprotected sex. Many declined.

Now, the HIV testing is provided as part of the routine health check when inmates arrive at state prisons, and inmates must choose not to be tested if they do not want it.

Nearly all prisoners end up getting the test, according to Dr. David Wohl, co-director of HIV Services for the N.C. Department of Correction.

The low number of men who were being tested for HIV became a concern for researchers at UNC and prison administrators when they concluded in 2008 that more than 60 percent of men with high-risk behavior, such as heroin, crack or cocaine use, were not tested. Men are also more at-risk for developing HIV than women, according to the Centers for Disease Control.

Mandatory testing

Though the number of inmates tested is still not 100 percent, Wohl said he’s not concerned. He said 97 percent of inmates who tested positive for HIV already knew they carried the virus.

Mandatory HIV testing has been adopted by 24 states, according to the U.S. Department of Justice. But Wohl thinks mandatory testing is not a good idea because it could lead to resistance or resentment among inmates.

“The idea of coercing inmates into being tested makes me uncomfortable,” Wohl said.

Prisons in North Carolina do not segregate inmates who have HIV, as prisons in states such as South Carolina and Alabama do. Even so, there is a cultural stigma against the virus that leads some people to not want to be tested, said Wohl.

The head of the Department of Correction for the state, Jennie Lancaster, said she would “not have a problem with” mandatory testing for HIV across the state for inmates if the legislature approved it.

Since inmates are not segregated, it is possible they could spread the virus to someone else, either through sexual acts or tattooing, both of which are prohibited but still occur. Transmission while in prison happens rarely, though, said Wohl.

The World Health Organization has recommended distributing condoms in prisons to prevent the spread of HIV and AIDS, a move Wohl said he would support.

But Lancaster said allowing the use of condoms could send the message that prisons are condoning sexual behavior. Inmates receive an infraction if they are caught partaking in any form of sex. When asked about allowing the distribution of condoms in the state, Lancaster said, “Not on my watch.”

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