HIV Testing is Prevention especially for African American Women with Histories of Incarceration

This paper discusses the confluence of the HIV epidemic among African American women, their alarming numbers among incarcerated populations and the urgency of public health efforts to get more women tested. The prevalence of HIV infection among incarcerated African American women is disproportionately high compared to the prevalence among incarcerated men. Multiple, complex reasons for this include poverty, exposure to violence and abuse, unemployment, substance use, and unstable living conditions. These social and structural factors raise the risk that women will engage in criminal behaviors such as illegal drug use and commercial sex work, and consequently expose them to incarceration and HIV. The CDC's Women's Testing Project funded three community-based organizations and one university to assess how well three HIV testing strategies -- social networks, alternative venue testing, and targeted outreach identify African American women with undiagnosed infection and get them into care. We found that differences in age and incarceration history influenced the success of HIV testing strategies to access women. Older women, aged 35-45 years of age were reached more successfully by social networks and alternative venue testing than were younger women who were 18-34 years of age. Also, women who had incarceration histories were more readily reached by social networks and alternative venue testing. Public health and correctional health must together develop policies that help vulnerable African American women to get tested. They can mandate that HIV-positive women receive appropriate medical care and help to prevent cycles of incarceration already endemic in men with incarceration histories.