Confidentiality: The duty of those who receive private information not to disclose it without prior consent.
Clinical Laboratory Improvement Amendments (CLIA): Establish quality standards for all laboratory
testing to ensure the accuracy, reliability, and timeliness of patient test results regardless of where the test was performed.
Diagnostic testing: Performing an HIV test for persons with clinical signs or symptoms consistent with HIV infection.
Enzyme Immunoassay (EIA): A test used to detect and quantify specific antigen-eliciting molecules involved in biological processes, specifically processes related to cancer and autoimmune disorders.
HIV-prevention counseling: An interactive process of assessing risk, recognizing specific behaviors that
could result in acquiring or transmitting HIV, and developing a plan to make specific behavioral changes to reduce risks.
HIV provider: A provider with experience working with HIV-infected inmates who is able to provide routine HIV care and follow-up.
HIV specialist: A provider with specialized training in HIV care who is knowledgeable about the complicated clinical issues and medication management required to care for HIV-infected inmates.
Informed consent: A process of communication between an inmate and a provider through which the inmate decides to accept or decline a procedure. The communication typically includes providing oral or written information regarding HIV, the risks and benefits of testing, the meaning of HIV test results, how test results will be communicated, and the opportunity to ask questions.
Immunofluorescent Assay (IFA): A laboratory test that uses antibodies chemically linked to a fluorescent dye to detect antibodies in serum or other bodily fluid. The specific antibodies are labeled with a compound that makes them glow an apple-green color when observed microscopically under ultraviolet light.
Mandatory testing: Performing HIV testing as mandated by state or federal statute.
Opt-in HIV testing: Performing voluntary HIV testing at the request of the inmate.
Opt-out HIV screening: Performing routine voluntary HIV testing after notifying the inmate that the test will be performed and that the inmate may elect to decline or defer testing. Permission is inferred unless the inmate actively declines an HIV test.
Partner Services: A confidential service created for persons who are infected with HIV to have their past and present sexual and/or needle-sharing partners notified of a possible exposure.
Preliminary Positive Result: Interpretation of a rapid test result provided to a person whose rapid HIV test is reactive. The result is preliminary because rapid testing does not provide a definitive diagnosis and requires confirmatory testing.
Privacy: The right and power to control the information about oneself that others possess.
Screening: Performing a test for all persons in a defined population without regard to the individual’s characteristics.
Targeted testing: Performing a test for subpopulations of persons at higher risk, typically defined on the basis of behavior, clinical, or demographic characteristics.
Window period: Period of time during early HIV infection when an HIV enzyme immunoassay test may be non-reactive, but when true HIV infection is present.
B. Clinical indications of HIV/AIDS
Signs and symptoms of HIV disease may include unexplained weight loss, persistent or high fever,
night sweats, diarrhea > 1 month, generalized lymphadenopathy, oral thrush, oral hairy leukoplakia,
idiopathic thrombocytopenic purpura (ITP), peripheral neuropathy, and/or herpes zoster as well as
Signs and symptoms of opportunistic infections may include shortness of breath, cough, diarrhea, swollen lymph nodes, focal neurological signs, altered mental status, visual complaints, pain or difficulty upon swallowing, and abdominal pain. (See Web site for Clinical Guidelines).
Candidiasis of the bronchi, trachea, or lungs
Cervical cancer, invasive
Coccidomycosis, disseminated or extrapulmonary
Cryptosporidiosis, chronic intestinal for > one month
Cytomegalovirus disease (other than liver, spleen, or lymph nodes)
Herpes simplex: chronic ulcer(s) for more than 1 month or bronchitis, pneumonitis, or esophagitis
Lymphoma, Burkitt’s, immunoblastic or primary brain
Mycobacterium Avium Complex
Mycobacterium, other species, disseminated or extrapulmonary
Pneumocystis jirovecii pneumonia (formerly Pneumocystis carinii)
Progressive multifocal leukoencephalopathy
Salmonella septicemia (recurrent)
Toxoplasmosis of the brain
Wasting syndrome due to HIV
C. Useful resources
AIDS Education and Training Centers
Alan Guttmacher Institute (AGI). New York: AGI, April 1, 2007.
Minors’ Access to STD Services. Summary table of age of consent for STD services, HIV testing and treatment, and parental notification.
American Academy of HIV Medicine
American Correctional Association
American Jail Association
Bureau of Justice Statistics
Centers for Disease Control and Prevention, HIV/AIDS Prevention
Clinical Laboratory Improvement Amendments (CLIA)
Federal Bureau of Prisons
Guide to Recognizing Acute Infection
National Criminal Justice Reference Service
National Commission on Correctional Health-care
National Institute of Health, AIDS info
New York State Department of Health
Society of Correctional Physicians
Treating Adolescents with HIV: Tools for Building Skills in Cultural Competence, Clinical Care, and Support
U.S. Department of Health and Human Services. HIV/AIDS Treatment, Prevention, and Research: Clinical Guidelines Portal
U.S. Department of Labor Occupational Safety & Health Administration, Occupational Safety and Health Standards, Toxic and Hazardous Substances, Bloodborne pathogens, 1910.1030
University of California, San Francisco, National HIV/AIDS Clinicians’ Consultation
D. Federal Bureau of Prison criteria for testing, 200648
All inmates with the following (regardless of sentencing or duration of stay):
Unexplained signs/symptoms compatible with acute HIV infection
|Including, but not limited to: fever, adenopathy, pharyngitis, rash, myalgias, and headache.
Signs/symptoms of HIV-related condition
|Including, but not limited to: thrush, herpes zoster, oral hairy leukoplakia, severe seborrhea, unexplained lymphadenopathy, and opportunistic infections.
Testing is recommended for all pregnant women as early as possible during pregnancy. Current antiretroviral therapy and obstetrical interventions markedly reduce the risk of transmitting HIV from infected mothers to their infants.
Recent exposures to HIV
Follow-up HIV-antibody testing should be performed at the following intervals after the exposure date: 6 weeks, 12 weeks, and 6 months (and 12 months for those who become infected with HCV after exposure to a source co-infected with HIV and HCV).
HIV infection is a potent risk factor for developing active tuberculosis.
Positive tuberculin skin test
Persons who are co-infected with HIV and TV are high priority candidates for treatment of latent TB infection.
Otherwise clinically indicated
On a case-by-case basis.
Sentenced (6 months or more) inmates with the following risk factors:
- Injected illegal drugs and shared equipment
- (For males) sex with another man
- Had unprotected intercourse with a person with known or suspected HIV infection
- History of gonorrhea or syphilis
- Had unprotected intercourse with more than one sex partner
- From a high-risk country (Sub-Saharan Africa or West Africa)
- Received blood products between 1977 and May 1985
- Percutaneous exposure to blood
- Or when the inmate requests to be tested
Repeat testing is permitted every six months either by inmate request or clinician order.
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention, the Bureau of Justice Statistics, Departments of Corrections, Health Departments, or other agencies by which the authors are employed.
Curt Beckwith, Joseph Bick, Walter Chow, Cari Courtenay-Quirk, Renata Ellington, Timothy Flanigan, Juarlyn Gaiter, Gail Goldsmith, Theodore Hammett, Nina Harawa, Kirk Henny, Krishna Jafa, P. Todd Korthuis, Marlene LaLota, Madeleine LaMarre, Robin MacGowan, Andrew Margolis, Laura Maruschak, Farah Parvez, Laurie Reid, Dean Rieger, April Richardson-Moore, Mara San Antonio-Gaddy, James Sosman, Anne Spaulding, Lara Strick, Jennifer Taussig, Zelalem Temesgen, William Young.
We thank Bernard Branson, Timothy Dondero, Donna Hubbard-McCree, David Purcell, and Amy Stone for their assistance with critical reviews in developing this document.