N.C. urged to test inmates for HIV

Prisons spur epidemic, advocates warn

Inmates leave prison each year with a weapon potentially more dangerous than the crime that put them there: the virus that causes AIDS.

Some have no idea they're sick. Neither will the women they sleep with or the drug addicts with whom they share needles.

Black religious leaders, some public health officials and several legislators say prisoners are impeding the state's effort to end the spread of HIV, a sexually transmitted virus that can debilitate the body's immune system. As they see it, prisons host those most at risk of carrying HIV; rates of infection are seven times as high in prison as in the general population.

The ministers and some public health officials are pressing prison officials to routinely screen every inmate and treat those infected with medicine that greatly reduces the ability to transmit the virus. Stopping short of that, they say, will allow an epidemic to spread unchecked.

"Prison is a chance to do intervention, and they haven't seen that as their job," said Dr. Peter Leone, medical director of the HIV/STD Prevention and Care Branch of the N.C. Division of Public Health.

North Carolina prisons don't require inmates to be tested for HIV. Only those who ask for the test get it; new arrivals who admit risky behaviors such as intravenous drug use or having sex with prostitutes are encouraged to take the test. The state does require prisoners to be tested for syphilis, another sexually transmitted disease that began plaguing North Carolina in the 1990s.

Twenty-two states, including the vast majority of states in the South, where the number of new cases are highest, require HIV testing for prisoners.

Andrew Moore, an HIV-positive Raleigh man released from prison in February, thinks North Carolina ought to join other states in mandating tests in prison.

"You're going to catch the people most exposed to getting it," Moore said. "We're drug users. We've led promiscuous lives. Prison's where you ought to be heading this off."

North Carolina's voluntary screening practices haven't produced much demand for the test, particularly among men. Dr. David L. Rosen, a medical and doctoral student at the University of North Carolina at Chapel Hill, found that about a quarter of men not previously diagnosed as HIV-positive in North Carolina asked to take the test when they came into prison.

Rates of testing varied at the six prisons that process men arriving at the state Department of Correction. The two prisons housing the youngest men, however, tested fewer than 5 percent of inmates between the ages of 18 and 25. In addition, Rosen found that African-Americans, a segment plagued with the highest rates of infection, were less likely to request an HIV test.

Some public health officials worry this shows that the prisons might be entirely missing their most at-risk population.

Screening is costly

Rosen shared his findings with prison and public health officials earlier this year. Prison officials say they have not been asked to change the way they screen. Although they are not opposed to a screening requirement, they say it would require money they don't have.

Prison officials estimate the annual cost of screening everyone and treating an additional load of cases at $21 million, though that estimate is based on a 10 percent infection rate, much higher than any state has seen in its prison population. In South Carolina, which requires testing, about 2.3 percent of inmates are HIV-positive.

Last year, the prison system spent $7 million on medicines needed to treat HIV-positive inmates.