Female Inmates Show High Rate of HIV

By Susan Levine
Washington Post Staff Writer
Thursday, August 2, 2007

About 7 percent of 607 women screened for HIV at the D.C. jail in 2006 were found to be infected with the deadly virus, a rate nearly triple that of male inmates.

The numbers were released recently by the D.C. Health Department as part of a summary of its half-year campaign encouraging District residents to get tested. Department of Corrections Director Devon Brown believes the figures offer an accurate portrait of the nearly 2,000 women processed annually at the jail.

"Look at the type of activities women engage in that come to corrections," he said. Their most common charges are related to drug use and prostitution, both of which put women at increased risk of contracting or transmitting HIV.

"That's a very high rate," Brown acknowledged. But, he added, not a surprising one. The jail was ahead of city health officials' push to make HIV testing a routine part of most medical screenings. It is one of the few detention facilities in the country to make an oral swab test for HIV automatic on entry or release, unless an individual refuses. Less than 10 percent of the men and women processed opt out, officials said, with the results generally tracking national patterns.

Of the 3,216 people tested over six months at the jail, 7.3 percent of women were HIV-positive, compared with 2.7 percent of men. Among all inmates tested, the highest positive rate by age -- 4.8 percent -- was among those 45 and older.

Given that nine in 10 inmates are released within 30 days, combating these rates of infection is integral to the city's efforts to fight the epidemic. officials said.

The Department of Corrections' approach to testing earned top marks in a report released in December by the D.C. Appleseed Center for Law and Justice, a public policy organization that has criticized the city's response to HIV/AIDS. The praise was tempered, however; adequate counseling and education about the virus should be provided no matter what the outcome of an individual's test, Appleseed noted.

Brown said that is taking place, starting with HIV-specific programming that is played on the jail's TV system. "You literally have a captive audience," he said, and the women pay closer attention than the men.

Their medical treatment is provided by the nonprofit group Unity Health Care. Infectious disease specialist Andrew Catanzaro, who spends every Tuesday at the jail and then helps to follow released patients, says the setting may be the first time many of the women are "clear enough in their heads" to understand information about the disease and how to best protect their health -- and, in numerous cases, that of their unborn child.

"If they're sobering up and you get their attention, it can change their life," Catanzaro said.

Access to care is key to the success of automatic testing, according to nationally known HIV researcher Anne De Groot, a physician who teaches at Brown University's medical school and has studied prison populations.

"You really have to give inmates an incentive to get tested," she said, stressing comprehensive access to specialists and medicines. "There has to be a carrot that comes with the stick. The stick is testing. The carrot is, okay, now you get good care."

© 2007 The Washington Post Company