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HIV and Hepatitis B and C incidence rates in US correctional populations and high risk groups: a systematic review and meta-analysis

Ethan Gough1, Mirjam C Kempf2, Laura Graham2, Marvin Manzanero3, Edward W Hook24, Al Bartolucci5 and Eric Chamot2*

Author Affiliations

1 Epidemiology Unit, Ministry of Health, Belmopan City, Belize

2 Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA

3 National AIDS Program, Ministry of Health, Belmopan City, Belize

4 Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA

5 Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA

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BMC Public Health 2010, 10:777  doi:10.1186/1471-2458-10-777

Published: 21 December 2010



High Human Immunodeficiency Virus (HIV) prevalence and high risk behaviors have been well documented within United States (US) correctional systems. However, uncertainty remains regarding the extent to which placing people in prison or jail increases their risk of HIV infection, and regarding which inmate populations experience an increased incidence of HIV. Describing these dynamics more clearly is essential to understanding how inmates and former detainees may be a source for further spread of HIV to the general US population.


The authors conducted a systematic review and meta-analysis of studies describing HIV incidence in US correctional facility residents and, for comparison, in high risk groups for HIV infection, such as non-incarcerated intravenous drug users (IVDU) and men who have sex with men (MSM) in the US. HIV incidence rates were further compared with Hepatitis B and Hepatitis C Virus rates in these same populations.


Thirty-six predominantly prospective cohort studies were included. Across all infection outcomes, continuously incarcerated inmates and treatment recruited IVDU showed the lowest incidence, while MSM and street recruited IVDU showed the highest. HIV incidence was highest among inmates released and re-incarcerated. Possible sources of heterogeneity identified among HIV studies were risk population and race.


Although important literature gaps were found, current evidence suggests that policies and interventions for HIV prevention in correctional populations should prioritize curtailing risk of infection during the post-release period. Future research should evaluate HIV incidence rates in inmate populations, accounting for proportion of high risk sub-groups.