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  Reported by Jules Levin
IDWeek Oct 26-30
New Orleans 2016
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Prison Release, Poverty, Inequality Tied to Higher HIV Prevalence
  IDWeek 2016, October 26-30, 2016, New Orleans
Mark Mascolini
Higher rates of prison release, poverty, and other sociodemographic variables were linked to HIV prevalence in an analysis of 12 major US cities [1]. Every 1-unit jump in prison release rate boosted HIV prevalence 4%.
More than 2.2 million people are incarcerated in the United States, according to researchers from Boston's Beth Israel Deaconess Medical Center and collaborators who conducted this study. HIV prevalence among prisoners stands 5 times higher than in nonincarcerated people. Releasing prisoners into the community can raise HIV rates, especially if released HIV-positive people are not linked to care. The Boston team aimed to quantify the impact of prison release and sociodemographic factors on HIV prevalence in 12 US cities.
The researchers started with 2012 ZIP Code-level HIV surveillance data in Tampa, Columbia (South Carolina), Orlando, Detroit, Jacksonville (Florida), Houston, Baton Rouge, Atlanta, Miami, Philadelphia, New Orleans, and New York City. Compared with an overall US HIV prevalence of 0.39%, HIV prevalence in those cities ranged in ascending order from 0.42% in Tampa to 1.50% in both New Orleans and New York City.
The investigators used regression models to estimate the impact of several socioeconomic variables on HIV prevalence, including prison release rate, distance of residence from city center, poverty, percent black population, and GINI index, which measures social inequality on a scale from 0 (perfect equality) to 1 (greatest inequality).
HIV prevalence stood substantially higher in men than women in all 12 cities: 0.64% versus 0.26% in Tampa, 0.71% versus 0.27% in Columbia, 0.73% versus 0.27% in Orlando, 0.92% versus 0.38% in Detroit, 0.83% versus 0.53% in Jacksonville, 1.05% versus 0.41% in Houston, 1.10% versus 0.74% in Baton Rouge, 1.51% versus 0.39% in Atlanta, 1.85% versus 0.77% in Miami, 2.11% versus 0.71% in Philadelphia, 2.15% versus 0.82% in New Orleans, and 2.30% versus 0.80% in New York City.
Overall prison release rate in the study population averaged 4.4 per 1000 adults in 2008, while the GINI index averaged 0.4. An average 17.7% of these populations lived below the poverty level, 61.6% were white, 24.7% black, and 9.8% Hispanic.
Spearman correlations between all variables and HIV prevalence were statistically significant except for Hispanic ethnicity (with negative numbers indicating lower HIV prevalence): prison release (0.26), GINI index (0.49), poverty (0.49), black race (0.41), white race (-0.47), Hispanic ethnicity (-0.07, not significant), kilometers from city center (-0.49) (all P < 0.01).
Regression analysis indicated that every 1-unit increase in prison release rate was associated with a 4% increase in overall (male and female) HIV prevalence in the 12 study jurisdictions. Every 1-unit increase in GINI index (indicating greater inequality) meant a 15% increase in HIV prevalence. Every 1-unit increase in residence distance from city center meant a 3% decrease in HIV prevalence. Every 1-unit increase in percent of people living in poverty meant a 2.2% increase in HIV prevalence. And every 1-unit increase in percent of black population meant a 1.1% increase in HIV prevalence.
The researchers concluded that "prison release is an important population-level factor with a significant association with neighborhood HIV prevalence" overall and in men. Results of this study confirm prior research indicating that "on a population level, HIV prevalence is most highly correlated with inequality."
1. Ojikutu BO, Srinivasan S, Bogart LM, Mayer KH. Mass incarceration and economic inequality: the impact of the criminal justice system on HIV prevalence in the US. IDWeek 2016, October 26-30, 2016, New Orleans. Abstract 2384.