HIV Testing in Jails

Early diagnosis of HIV infection is essential in ensuring that all infected individuals are identified, started on treatment, monitored as well as linked into counseling as well other social support groups that may be needed. To reduce the number of new HIV infections in the US, the implementation of HIV testing programs in correctional facilities is vital. Every year about 10 million people enter US jails and the return to their community. In 2006, one out of every seven persons in the US living with HIV/AIDs passed through a correctional facility, of which the first point of contact is the jail and most are released before going to prison. Compared to persons in the community, incarcerated individuals are four times more likely to have HIV, making correctional facilities strategic points for HIV testing

CDC specific recommendations for HIV testing

  • HIV screening is recommended for all persons who seek evaluation and treatment of STDs

  • HIV testing must be voluntary and free from coercion. Patients must not be tested without their knowledge

  • HIV screening after notifying the patient that an HIV test will be performed (unless the patient declines) is recommended in all health-care settings

  • Specific signed consent for HIV testing should not be required. In most settings, general informed consent for medical care is considered sufficient to encompass informed consent for HIV testing.

  • Use of rapid HIV tests should be considered, especially in clinics where a high proportion of patients do not return for HIV test results

  • Positive screening tests for HIV antibody must be confirmed by supplemental test before the diagnosis of HIV infection can be established

  • Providers should be alert to the possibility of acute HIV infection and perform a nucleic acid test in addition to an antibody test for HIV, if indicated. Persons suspected of recently acquired HIV infection should be referred for immediate consultation with an infectious disease specialist.

HIV testing procedures

An HIV test does not detect the presence of HIV virus immediately after exposure. Positive test results may be identified between 2 to two weeks and in some cases it may take up to 6 months. There are several tests that can be used for HIV testing;

  1. The conventional HIV testing algorithm is most commonly used in the US and it consists of two tests; the HIV enzyme immunoassay (EIA) that is capable of identifying HIV-1 and HIV-2 antibodies and an HIV-1 Western blot or immunoflourescence assay (IFA) that is used for confirmation. A ‘window period’ exists during early infection when the EIA may be non-reactive but true HIV infection is present, which may result in a false-negative result. The window period often occurs between the first 8-12 weeks following infection with HIV. The conventional HIV tests can be performed on serum or plasma however its disadvantage in a correctional setting is the turnaround time for obtaining results which ranges from seven days to weeks thus limiting the opportunity of delivering HIV test results to inmates before release

  2. The Oral fluid HIV test identifies antibodies from an oral fluid specimen. Results are obtained between 3-5 days .it’s an accurate HIV testing algorithm for established HIV infection with a built-in confirmatory test. However its more expensive than the conventional blood sample HIV testing and is slightly less sensitive during early conversion.

  3. Rapid HIV tests can be administered at the point of care and results are available between 10 – 30 minutes. There are six FDA approved rapids HIV tests currently in the US. They are simple to perform are require minimal equipments. They detect antibodies analogous to the conventional tests. Repeat rapid testing is often required if an invalid result is obtained and preliminary positives must be confirmed using western blot or IFA tests. Rapid tests are convenient in correctional facilities because inmates are able to receive their results before they are released from the jail even if that happens in less than 24 hours.