Reena Mahajan, MHS¹, Philippa Hubscher, MPH², Farah M. Parvez, MD, MPH³, Michele D. McNeill⁴, Wanda D. Roberts⁵, Jay A. Heitzner, BS¹, and James L. Capoziello, JD⁶. (1) New York City Department of Health and Mental Hygiene, Office of Correctional Public Health, 225 Broadway Street, 23rd Floor, Room 1, New York, NY 10007, 646-498-3312, rmahajan1120@yahoo.com, (2) New York City Department of Health and Mental Hygiene, Management Planning and Analysis, 161 William Street, 6th Floor, New York, NY 10038, (3) Office of Correctional Public Health, New York City Department of Health and Mental Hygiene, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, 225 Broadway Street, 23rd Floor, Room 27, New York, NY 10007, (4) Office of Correctional Public Health, New York City Department of Health and Mental Hygiene, 225 Broadway, 23rd Floor, Room 1, New York, NY 10007, (5) Correctional Health Services, New York City Department of Health and Mental Hygiene, 225 Broadway, 23rd Floor, New York, NY 10007, (6) Health Care Access and Improvement, New York City Department of Health and Mental Hygiene, 161 William Street, 5th Floor, New York, NY 10038

Background: Recent efforts to decrease perinatal Human Immunodeficiency Virus (HIV) transmission have focused on increasing HIV testing of pregnant women. Prompt identification and treatment of HIV-positive pregnant women dramatically reduces the risk of perinatal HIV transmission. Rikers Island, one of the largest jails in the country, offers comprehensive prenatal care, including voluntary HIV counseling, testing, and treatment. We evaluated the prenatal care program at Rikers Island to assess acceptance rates of HIV counseling and testing by pregnant women newly incarcerated in New York City jails. Methods: We conducted a retrospective analysis of all pregnant women admitted to Rikers Island in 2002. We reviewed patient medical records for HIV risk factors, prenatal screening, and HIV counseling and testing. Results: In 2002, 437 pregnant women were incarcerated at Rikers Island; median age was 27 (range: 14-47) years. Of 437 women, 355 (81%) received a prenatal screening during their incarceration; 216/355 (61%) reported not having any prenatal care prior to admission at Rikers Island. Of 355 women, race included: black (n=200; 56%); Hispanic (n=102; 29%); white (n=32; 9%); and other (n=21; 6%). HIV risk behaviors included: current drug use (n=199; 56%); multiple sexual partners (n=67; 19%); and sex with substance users (n=62; 17%). Median gestational age, available for 308/355 women, was 16.7 (range: 3-40) weeks. Twenty-two (6%) of 355 women disclosed a prior HIV-positive status. Of 333 women eligible for HIV counseling and testing, 288 (86%) received counseling; of these, 140 (49%) consented to testing. Of those tested, 61 (44%) did not receive their results prior to release. Of 147 (51%) women who refused HIV testing, 14 (9.5%) cited “leaving soon” as their primary reason. Conclusions: Our data reveal that: 1) a high prevalence of pregnant women did not receive prenatal care prior to incarceration; 2) a substantial number of women reported HIV risk behaviors; 3) over 40% of women tested for HIV were discharged prior to receiving their results; and 4) the majority of women refused HIV testing. Jail prenatal screening programs may be the primary source of healthcare for high-risk pregnant women. Multiple strategies should be developed to increase prenatal HIV diagnosis and treatment, including enhanced education and implementation of rapid HIV testing.

Learning Objectives: At the conclusion of the session, the participant in this session will be able to

• Identify high risk behaviors of pregnant women incarcerated in NYC jails
• Describe HIV counseling and testing acceptance rates by newly incarcerated pregnant women in NYC jails
• List strategies that can be used to increase prenatal HIV diagnosis and treatment

Keywords: Jails and Prisons, Prenatal Care

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.