Addressing HIV with Incarcerated Individuals Requires Understanding of PrEP

The prevalence of HIV in jails and prisons is approximately 4 times higher than that of the general United States population.

Disease transmission is also high when incarcerated individuals are released back into the community. During this time, these individuals are more likely to engage in behaviors that increase risk of acquiring or transmitting HIV. Some of these behaviors include injection drug use, transactional sex, condomless sex, and concurrent sexual relationships.

Traditional HIV prevention approaches for incarcerated individuals reentering the community have demonstrated limited efficacy, however, daily oral pre-exposure prophylaxis (PrEP) has successfully prevented HIV transmission in certain high-risk groups. It has been particularly effective in groups such as men who have sex with men, high-risk heterosexual populations, and people who use injection drugs. Currently or recently incarcerated individuals may have little knowledge about PrEP, and are unaware of its potential benefits.

A study at the Rhode Island Department of Corrections (RIDOC) in 2015 involved approximately 15,000 incarcerated men, of which 3% were HIV positive. The researchers asked questions about PrEP knowledge and interest, if participants ever engaged in sex with other men without the use of condoms, and injection drug use. Of the 417 men that were screened, most had an HIV test (61%) previously.

The knowledge of PrEP as a tool for HIV prevention was also very low among the population studies. However, among all men, approximately 25% were interested in learning about PrEP or would be willing to take daily medications to prevent HIV. Only a few incarcerated individuals from this study considered themselves at risk for HIV, despite their elevated lifetime risk for acquisition of the virus.

Implementing a PrEP education program in this population would require preliminary education on HIV transmission and individual risk factors. PrEP provision should be part of the discharge planning or post release. Screening at intake into correctional facilities will improve identification, and deliver PrEP services to individuals with higher risk.

The incarcerated population generally has a much higher HIV rate than the general public, according to the study. PrEP may substantially help incarcerated individuals prevent HIV that are reentering the community.

However, the Rhode Island study has some limitations. Individuals who are screened within the first 48 hours in a correctional facility may still be under the influence of drug substances, and incarcerated individuals may not be willing to truthfully disclose their high-risk HIV behavior.

Although there are some limitations, using PrEP can ultimately decrease the prevalence of HIV in certain settings.

Aaron Wang is a 2020 PharmD candidate at the University of Connecticut in Storrs.

REFERENCE

Brinkley-Rubinstein L, Crowley C, Montgomery MC, et al. Interest and knowledge of HIV pre-exposure prophylaxis in a unified jail and prison setting. J Correct Health Care. 2020;26(1):36-41.