Estimated incidence of HIV acquisition due to prison rape in the U.S

Background: Nearly 1.4 million men are incarcerated in federal and state prisons in the U.S. The disproportionately high prevalence of HIV infection in U.S. prisons has raised concerns over the potential for HIV transmission due to prison rape. However, the number of men who acquire HIV after being raped in prison is not known.

Methods: We developed a mathematical model of HIV transmission to estimate the likelihood that an incarcerated man would become infected as a result of prison rape, and to provide preliminary estimates of the number of prison rape victims who acquire HIV. Estimates of key parameter values were derived from the literature on sexual victimization in U.S. prisons, epidemiological studies of HIV infection among incarcerated men, and studies of the risk of HIV transmission during anal intercourse.

Results: For men who are raped in prison, the probability of acquiring HIV ranged from 1 in 794 for a single incident of forced anal intercourse to 1 in 195 for repeated victimizations. Overall, we estimate that between 23 and 81 currently-incarcerated men already have or will acquire HIV as a result of being raped in prison. These results should be interpreted cautiously in light of the considerable uncertainty in several key parameter values.

Conclusion: Men who are raped while incarcerated may suffer physical, emotional and/or psychological injuries. They also may acquire HIV. The findings of this study provide additional support for the “zero tolerance” objective of the federal Prison Rape Elimination Act.