AIDS behind bars. Epidemiology of New York State prison inmate cases, 1980-1988.

During the last five years, AIDS has become the preeminent health care problem in New York State correctional facilities. Through December 31, 1988, 915 cases of AIDS had been diagnosed among inmates. This represented approximately 1% of the cumulative AIDS cases in the United States, 4% of those in New York State, and 40% of those reported in state correctional systems nationwide. An analysis of epidemiologic data on these cases showed an annual increase in cases from 3 in 1981 to 227 in 1988, with an incidence greater than 400 per 100,000 inmates per year over the past four years. While most cases occurred in males (96%), females had the same high incidence rates (compared to the general population, in which female rates are one-eight of males). Forty-seven percent of infected inmates were Hispanic, 38% black, and 13% white. Pneumocystis carinii pneumonia was the most common diagnosis (65%), while Kaposi's sarcoma was rare (3%). Previous intravenous drug use has been the major risk factor, seen in 95% of cases. A comparison of 54 inmate AIDS cases with 107 matched and 196 unmatched controls showed that inmates in whom AIDS developed had significantly lower white blood cell counts on entry into prison, lower hematocrits and serum albumin levels, and higher serum glutamic oxaloacetic transaminase and globulin counts. Through July 1989, 643 (70%) of these 915 inmates had died of AIDS, and HIV infection and AIDS account for 68% of recent inmate deaths.

Prolonged incubation period of AIDS in intravenous drug abusers: epidemiological evidence in prison inmates.

Fourteen heterosexual inmates who developed acquired immunodeficiency syndrome (AIDS) while incarcerated in New York state prisons were studied. All 14 had regularly used illicit drugs intravenously in New York City prior to imprisonment. Leukocyte counts on admission to the state prison system--when all of these inmates were well--were depressed by one-third when compared with those in matched intravenous drug-using inmates used as controls (mean leukocyte counts, 4,430 vs. 6,320 cells/mm3, respectively; P less than .005); twelve (86%) of the 14 inmates who developed AIDS had counts of less than 5,000 cells/mm3, compared with only six (14%) of the 42 controls (P less than .00001). The 14 inmates developed AIDS symptoms a mean of 22.6 +/- 9.6 months after imprisonment. We conclude that leukopenia is frequently to be found in presymptomatic AIDS infection and that the minimum mean incubation period of AIDS in intravenous-drug abusers is quite prolonged.