Preventing Spread of HIV in Jails: Best Window of Opportunity Early in Incarceration

With World AIDS Day less than a week away, two new studies from Yale School of Medicine show that jail inmates, one of the highest risk groups for AIDS, are far more likely to be tested for HIV if given the opportunity in the first 24 hours of incarceration. The studies, which could lead to better prevention and earlier and more effective treatment of inmates, are published in the November 25 issue of PLoS ONE, a journal of the Public Library of Science.

The research was spearheaded by a Yale medical student, Ravi Kavasery, under the mentorship of Frederick Altice, M.D., professor of medicine and director of clinical and community research for the Yale AIDS Program and principal investigator of grants from the National Institutes of Drug Abuse and the Health Services Resources Agency, which funded this research.

The two Yale studies, both prospective controlled trials involving more than 600 Connecticut jail detainees, looked at the willingness of men and women to be screened for HIV as part of the routine while entering the correctional system. Of the 298 newly imprisoned men, the greatest proportion accepted testing on the day after incarceration—53 percent. Those offered testing on the same day as incarceration had a somewhat lower rate of acceptance, 45 percent. After a week, the testing rate dropped significantly, to 33 percent.

The second study involved 323 newly incarcerated women and showed a similar trend: the best time to offer HIV screening was the day after incarceration, when 73 percent received testing. Rates were lower on the actual day of entry – 55 percent – and even more so after seven days, at 50 percent.

“More than a quarter of people with HIV in the U.S. have no idea that they are infected and continue unknowingly to engage in high-risk behaviors,” noted Altice, the principal investigator on the studies. “Just letting them know they have HIV results in impressive reductions in sexual risk-taking.”

Lead author Kavasery said, “The findings from our studies have two major public health implications. First, we show that offering routine opt-out HIV testing in jails is feasible. Second, and perhaps more importantly, our studies demonstrate that offering testing within the first 24 hours of admission results in the highest number of individuals receiving HIV testing.”

The participation of medical students in research projects is an integral part of medical education at Yale. Each medical student must complete a research thesis prior to graduation, a requirement for graduation since 1839. “Ravi’s contribution to this research project is the caliber of research we expect from our students,” noted John Forrest, M.D., professor of medicine and director of student research at Yale. “Getting two first-authored publications in a top-tier journal speaks to the quality.” Kavasery also oversaw the scientific rigor of the men’s study, where 5 additional students from the School of Public Health participated as part of their community project.

“I’ve been fortunate to have had the luxury of working with a number of remarkably talented and accomplished students over the years. It humbles me to see their abilities harnessed to create new knowledge while simultaneously contributing to science and socially responsible research,” Altice said. Forrest indicated that more than 75% of Yale medical students publish their research in peer-reviewed journals or present their work at national research meetings. “Yale leads the country in the quantity of important medical research done by medical students,” Forrest said.

Other authors on the study of male inmates are: Duncan Smith-Rohrberg Maru, M.D., Ph.D., Laurie N. Sylla, M.A. and David Smith, Ed.D. The same authors contributed to the study of female inmates, as did Joshua Cornman-Homonoff, B.A.

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