HIV Testing in NYC Correctional Facilities

HIV testing, identification of new HIV positive patients and connection to care in the community upon discharge are major public health challenges in correctional facilities with high risk populations. The New York City correctional system consists of eleven separate jails in three boroughs with an average daily census of 13,000. About 25% - 30 % of new admissions are discharged within seventy two hours, which limits the time to identify HIV positive patients. Voluntary HIV testing is offered to all persons entering the NYC Correctional system. The average acceptance rate for HIV testing ranges from 20 % to 28 %. The reasons for the low acceptance rate are not definitively known, but the long intake process, withdrawal from alcohol/other substance abuse, confidentiality and approach to offering testing may contribute to the high declination rate. Our previous work has identified the existence of a significant number of HIV+ patients who are unaware of their HIV status and who refused testing at intake. Consequently, we have initiated a point of service HIV testing program to augment our current testing efforts. Both health education and HIV testing are conducted on a one-to-one basis in confidential spaces on the evening tour to reduce other competing demands such as meal time, court appearances and count times. Preliminary data after 2 months of testing (over 600 persons tested) indicate an acceptance rate of approximately 60%, well above that for our intake testing. Common reasons for having refused intake testing were misconception about having already been tested, not being asked, and feeling exhausted and overwhelmed about being in jail. The project will be expanded to all NYC jail facilities over the course of the year to increase testing and evaluate the reasons for declinations among detainees.