Incarceration and HIV-Infected Inmates

描述(由申请人提供)：在美国，每年有近20%的艾滋病毒感染者通过惩教机构。若干研究表明，囚犯的艾滋病毒感染率比非监禁人口的感染率高出8至10倍，相当大比例的囚犯感染的风险较高。对艾滋病毒感染风险人群进行自愿咨询和检测(VCT)是一种有效的艾滋病毒一级和二级预防手段。北卡罗来纳州惩教署(NCDOC)有一项自愿进行艾滋病毒检测的政策，70%的在押囚犯拒绝接受检测。就像其他31个采用自愿检测的州立监狱系统一样，这是一个错失了识别感染者并让他们接受护理的机会。不幸的是，我们缺少一些必要的信息，既可以确定被监禁人员中艾滋病毒感染的真实流行率，也可以了解新被监禁的人如何决定接受艾滋病毒检测。在北卡罗来纳州医学院和公共卫生学院的研究人员与NCDOC和北卡罗来纳州卫生与公众服务部(NCDHHS)官员的合作下，我们将对大型州立监狱系统中艾滋病毒检测的障碍和促进者进行全面评估。首先，我们将确定新来的囚犯中急性和慢性艾滋病毒感染的实际流行率，并描述这一群体的艾滋病毒危险行为。其次，我们将在三个层面上考察最近被监禁的囚犯自愿接受艾滋病毒检测的情况与变量之间的关系：个人囚犯、NCDOC护士辅导员和监狱处理设施。最后，我们将对在监狱接受艾滋病毒诊断相关的风险进行初步检查。本申请中描述的研究的最终目标是更清楚地了解艾滋病毒感染在这一人群中的影响，并为在这种情况下促进艾滋病毒自愿咨询的干预措施的设计提供信息。具体地说，我们将：目标1。确定大型州立监狱系统中急性和慢性艾滋病毒感染的流行率。目的2.确定与同意接受HIV VCT相关的囚犯、护士-辅导员和设施特征。目的3.探索在监狱中接受艾滋病毒诊断的相关风险。

DESCRIPTION (provided by applicant): Nearly 20% of all people infected with HIV in the US pass through a correctional facility each year. Several studies suggest that the prevalence of HIV infection among prisoners is between 8 and 10-fold higher than the prevalence in non-incarcerated populations and a significant proportion of inmates are at elevated risk for infection. Voluntary counseling and testing (VCT) of individuals at risk for HIV infection is an effective means of primary and secondary HIV prevention. The North Carolina Department of Corrections (NCDOC) has a voluntary HIV testing policy and 70% of all incoming inmates decline the opportunity to receive testing. As is the case for the other 31 state prison systems that employ voluntary testing, this is a lost opportunity to identify infected people and enroll them in care. Unfortunately, we are missing several pieces of information required both to determine the true prevalence of HIV infection among incarcerated people as well as to understand how newly incarcerated people make the decision to receive an HIV test. In a collaborative effort between researchers at the UNC Schools of Medicine and Public Health and officials at the NCDOC and the North Carolina Department of Health and Human Services (NCDHHS), we will perform a comprehensive assessment of the barriers and facilitators of HIV testing in a large state prison system. First, we will determine the actual prevalence of acute and chronic HIV infection among incoming inmates and characterize the HIV risk behaviors of this group. Second, we will examine the association between the uptake of voluntary HIV testing among recently incarcerated inmates and variables at three levels: individual inmate, NCDOC nurse-counselor and prison processing facility. Finally, we will conduct a preliminary examination of the risks associated with receiving an HIV diagnosis in prison. The ultimate goals of the studies described in this application are to obtain a clearer picture of the impact of HIV infection among this population and to inform the design of interventions to promote HIV VCT in this setting. Specifically, we will: Aim 1. Determine the prevalence of acute and chronic HIV infection in a large state prison system. Aim 2. Determine the inmate, nurse-counselor and facility characteristics associated with agreeing to HIV VCT. Aim 3. Explore the risks associated with receiving an HIV diagnosis in prison.