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This Article Full Text Full Text (PDF) Data Supplement All Versions of this Article: AJPH.2007.133389v1 99/6/1123    most recent Submit a response View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Rosen, D. L. Articles by Golin, C. E. Search for Related Content PubMed PubMed Citation Articles by Rosen, D. L. Articles by Golin, C. E. Related Collections HIV/AIDS Hepatitis Tuberculosis Lesbian/Gay/Bisexual/Transgender Persons

David L. Rosen, PhD, Victor J. Schoenbach, PhD, David A. Wohl, MD, Becky L. White, MD, Paul W. Stewart, PhD and Carol E. Golin, MD

At the time of the study, David L. Rosen was a student at the Schools of Public Health and Medicine, University of North Carolina, Chapel Hill. Victor J. Schoenbach and Paul W. Stewart were with the School of Public Health, University of North Carolina, Chapel Hill. David A. Wohl and Carol E. Golin were with the Schools of Public Health and Medicine, University of North Carolina, Chapel Hill. Becky L. White was with the School of Medicine, University of North Carolina, Chapel Hill.

Correspondence: Requests for reprints should be sent to Victor J. Schoenbach, University of North Carolina–Chapel Hill Gillings School of Public Health, Campus Box 7435, Chapel Hill, NC 27599-7435 (e-mail: vjs{at}unc.edu).

Objectives. We identified factors associated with testing HIV positive in a prison system performing voluntary HIV testing on inmates and estimated the number of undetected HIV cases to evaluate the efficacy of risk-factor–based HIV testing.

Methods. We used logistic regression to estimate associations between HIV serostatus and HIV risk behaviors, mental health, coinfection status, and sociodemographic characteristics for prisoners entering the North Carolina Department of Correction from January 2004 through May 2006. We estimated the number of undetected HIV cases on the basis of age-, gender-, and race-specific HIV prevalences among prisoners and in the state.

Results. Nearly 3.4% (718/21 419) of tested prisoners were HIV positive. The strongest risk factors for infection among men were having sex with men (odds ratio [OR] = 8.0), Black race (OR = 6.2), other non-White race (OR = 7.4), and being aged 35 to 44 years (OR = 4.1). The strongest risk factor among women was Black race (OR = 3.8). Among HIV-positive prisoners, 65% were coinfected with HCV. We estimated that between 24% (223) and 61% (1101) of HIV cases remained undetected.

Conclusions. The associations between HIV serostatus and a variety of factors highlight the potential limitations of risk-factor–based HIV testing in prisons, as do the high number of potential undetected HIV cases.