HIV Testing in State Correctional Systems

Article excerpt

   I. INTRODUCTION
  II. TESTING METHODS
      A. Mandatory Testing
      B. Voluntary Testing
      C. Testing Under Other Circumstances
 III. HIV TESTING POLICY ADOPTION
  IV. RELATED ISSUES
      A. Testing of Sexual Offenders
      B. Housing, Segregation, and Medical Isolation
      C. Pre-Test and Post-Test Counseling
      D. Medical Treatment and Care
      E. Post-Release Treatmen
      F. HIV Education
   V. QUICK REFERENCE CHART
  VI. STATE SUMMARIES
 VII. PUBLIC HEALTH ORGANIZATION TESTING
      RECOMMENDATIONS
      A. The Centers for Disease Control and
         Prevention (CDC)
      B. WHO, UNODC and UNAIDS
      C. The Council for AIDS Action
      D. National Commission on Correctional Health
         Care OVCCHC)
VIII. MODEL STATE TESTING POLICIES
      APPENDIX A

I. INTRODUCTION

In recent years, reports have surfaced that the prevalence of acquired immunodeficiency syndrome (AIDS) and human immunodeficiency virus (HIV) within U.S. prison systems is three to five times higher than that of the general population. (1) These reports, combined with the release of new HIV testing guidelines by the Centers for Disease Control (CDC) in 2006, have caused many states to change their laws and policies regarding HIV testing in state correctional facilities.

This report briefly discusses some of the issues related to HIV testing within state correctional facilities. This report also discusses the methods of HIV testing currently used in state correctional systems as well as provides an overview of the laws governing HIV testing within each U.S. correctional system. Lastly, this report concludes with a survey of recommendations from various health organizations.

This report focuses on HIV testing methods as inmates enter prison and as they are released from prison. The summaries contained in this report are based on current state statutes, codes, rules, and regulations, as well as applicable reports and department of corrections policies, where available. (2) It does not cover other state detention facilities, such as city or county jails.

II. TESTING METHODS

A majority of U.S. prisons perform either voluntary or mandatory HIV tests upon entry and/or prior to release from state correctional facilities. In addition, many correctional facilities also perform HIV tests upon inmate request, upon physician request, or under other circumstances, such as when an inmate has a high risk of HIV infection or has been involved in an incident where there may have been possible exposure to HIV.

A. Mandatory Testing

Mandatory testing refers to an HIV test that is performed regardless of inmate consent. Although most public health organizations strongly discourage mandatory testing, it appears that twenty-four state correctional systems currently require mandatory HIV tests at intake and/or prior to release. In addition, most prisons also require mandatory testing upon the happening of some event, such as when an inmate becomes exposed to another person's blood or bodily fluids.

States are increasingly adopting policies of mandatory testing at intake and/or prior to release. (3) It is difficult to speculate why a state would favor mandatory testing, but it may be easier to implement because it does not require individual HIV risk assessments or written consent forms. Additionally, if every inmate is tested, the correctional system would have more data on the inmate population and may be in a better position to prevent HIV transmission within the prison system. However, most public health organizations not only believe that mandatory testing is unethical, but also suggest that is not an effective way to reduce the transmission of HIV.

B. Voluntary Testing

Voluntary testing refers to performing an HIV test only after receiving informed consent. Most correctional facilities that require informed consent prior to performing an HIV test will only test upon inmate request. …