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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 the research was completed, David L. Rosen, David A. Wohl, and Carol E. Golin were with the Schools of Public Health and Medicine, University of North Carolina, Chapel Hill. Victor J. Schoenbach and Paul W. Stewart are with the School of Public Health, University of North Carolina, Chapel Hill. Becky L. White is with the School of Medicine, University of North Carolina, Chapel Hill.

Correspondence: Correspondence should be sent to Victor J. Schoenbach, UNC School of Public Health, Campus Box 7435, Chapel Hill, NC, 27599-7435 (e-mail: vjs{at}unc.edu). Reprints can be ordered at http://www.ajph.org by clicking on the "Reprints/Eprints" link.

Objectives. We examined the use of voluntary HIV testing among state prisoners in the North Carolina prison system.

Methods. We calculated system-wide and facility-specific proportions and rates of adult inmates tested for HIV and estimated associations between testing status and inmate characteristics for prisoners in North Carolina.

Results. Of the 54 016 inmates who entered prison between January 2004 and May 2006, 20 820 (38%) were tested for HIV; of those tested, 18 574 (89%) were tested at admission. Across the 8 intake prisons, more than 80% of inmates in both female facilities but less than 15% of inmates in 4 of 6 male facilities were tested. Prisoners with a documented history of heroin use, crack or cocaine use, conventional HIV risk behavior, or tuberculosis were at least 10% more likely to be tested than were inmates without these characteristics. However, more than 60% of men reporting conventional risk behaviors were not tested. Before covariate adjustment, Black men were 30% less likely than White men to be tested; in the multivariable regression model, this difference was attenuated to 13%.

Conclusions. Rates of HIV testing varied widely across intake prisons, and many male inmates with documented risk of infection were never tested.