Profile of HIV seropositive inmates diagnosed in Maryland's State correctional system

Correctional systems increasingly serve as the health care nexus for the initial diagnosis and treatment of human immunodeficiency virus (HIV) infection, particularly among traditionally under-served populations. A survey was conducted to describe the clinical profile of inmates in a State correctional system diagnosed with HIV infection by various testing strategies. Approximately 50 percent of the inmates diagnosed were potential candidates for anti-retroviral therapy, and 17 percent were severely immunocompromised. Implementation of voluntary HIV testing at prison entry increased the number of persons identified with HIV infection; however, since volunteers at entry had higher CD4 cell counts compared with infected inmates diagnosed by other methods, there was not a parallel increase in the percentage requiring immediate medical treatment. These data are important for planning medical resources in the correctional setting and underscore the opportunity to provide prevention and therapy for a vulnerable population with HIV infection. Public health interventions within the correctional setting have a broader societal impact, since most infected inmates serve short sentences (median, 3 years). Clinical case management is critical for inmates with HIV infection released to the community so that linkages with primary care providers and support services can be established.