Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
BMC Public Health. 2010 Dec 21;10:777. doi: 10.1186/1471-2458-10-777.
High Human Immunodeficiency Virus (HIV) prevalence and high risk behaviors have been well documented within United States (US) correctional systems. However, uncertainty remains regarding the extent to which placing people in prison or jail increases their risk of HIV infection, and regarding which inmate populations experience an increased incidence of HIV. Describing these dynamics more clearly is essential to understanding how inmates and former detainees may be a source for further spread of HIV to the general US population.
The authors conducted a systematic review and meta-analysis of studies describing HIV incidence in US correctional facility residents and, for comparison, in high risk groups for HIV infection, such as non-incarcerated intravenous drug users (IVDU) and men who have sex with men (MSM) in the US. HIV incidence rates were further compared with Hepatitis B and Hepatitis C Virus rates in these same populations.
Thirty-six predominantly prospective cohort studies were included. Across all infection outcomes, continuously incarcerated inmates and treatment recruited IVDU showed the lowest incidence, while MSM and street recruited IVDU showed the highest. HIV incidence was highest among inmates released and re-incarcerated. Possible sources of heterogeneity identified among HIV studies were risk population and race.
Although important literature gaps were found, current evidence suggests that policies and interventions for HIV prevention in correctional populations should prioritize curtailing risk of infection during the post-release period. Future research should evaluate HIV incidence rates in inmate populations, accounting for proportion of high risk sub-groups.
在美国（US）的惩教系统中，高人类免疫缺陷病毒（HIV）流行率和高风险行为已经得到充分记录。然而，仍不确定将人监禁或监禁在多大程度上会增加他们感染 HIV 的风险，以及哪些囚犯群体的 HIV 发病率增加。更清楚地描述这些动态对于了解囚犯和前被拘留者如何可能成为 HIV 向美国普通人群进一步传播的源头至关重要。
作者对描述美国惩教设施居民 HIV 发病率的研究进行了系统回顾和荟萃分析，并与美国未被监禁的静脉吸毒者（IVDU）和男男性行为者（MSM）等 HIV 感染高危人群进行了比较。进一步比较了这些人群中乙型肝炎和丙型肝炎病毒（HCV）的发病率。
共纳入 36 项主要前瞻性队列研究。在所有感染结果中，连续监禁的囚犯和接受治疗的招募的 IVDU 显示发病率最低，而 MSM 和街头招募的 IVDU 显示发病率最高。释放后重新入狱的囚犯 HIV 发病率最高。在 HIV 研究中确定的可能存在异质性的来源是风险人群和种族。
尽管发现了重要的文献空白，但现有证据表明，针对惩教人群的 HIV 预防政策和干预措施应优先考虑在出狱后期间遏制感染风险。未来的研究应评估囚犯人群中的 HIV 发病率，同时考虑高风险亚群的比例。
