Hispanics, Incarceration, and TB/HIV Screening: A Missed Opportunity for Prevention
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ORIGINAL PAPER
Hispanics, Incarceration, and TB/HIV Screening: A Missed Opportunity for Prevention Dora M. Dumont • Annie Gjelsvik Nadine Chen • Josiah D. Rich
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Published online: 5 January 2013 Ó Springer Science+Business Media New York 2013
Abstract Disparities in incarceration rates and in prisonbased TB/HIV testing may contribute to health disparities in the communities most affected by incarceration. We analyzed Bureau of Justice Statistics surveys of federal and state prison inmates to assess TB and HIV screening rates for US-born Hispanics, foreign-born Hispanics, nonHispanic blacks, and non-Hispanic whites. Screening rates were high overall but foreign-born Hispanic inmates had significantly lower odds of being tested for TB in both state (AOR 0.55) and federal prisons (AOR 0.31) compared to white inmates. Foreign-born Hispanics also had lower odds of being tested for HIV in state prisons and Hispanics had lower odds of being tested for HIV in federal prisons compared to white inmates. Screening for infectious diseases in state and federal prisons is high but Hispanics have
D. M. Dumont (&) The Center for Prisoner Health, The Miriam Hospital, 1125 North Main Street, Providence, RI 02909, USA e-mail: [email protected] A. Gjelsvik Department of Epidemiology, Brown University, Providence, RI, USA e-mail: [email protected] N. Chen Division of Global Public Health, University of California, San Diego, San Diego, CA, USA e-mail: [email protected] J. D. Rich Division of Infectious Diseases, The Miriam Hospital, Providence, RI, USA e-mail: [email protected] J. D. Rich Brown University Medical School, Providence, RI, USA
higher odds of going untested; this has important consequences for prevention of further transmission in the communities to which they return. Keywords Incarceration Prisons Hispanics Disparities HIV TB
Introduction The US has the highest incarceration rate in the world, and prisons are mandated to provide certain screenings and healthcare. Correctional facilities thus have the potential to serve as public health sentinels by diagnosing and treating a medically underserved, high-needs population [1, 2]. State and federal prisons screen the vast majority of inmates for selected infectious diseases and other medical conditions, but some remain untested. Although non-Hispanic black, non-Hispanic white, and Hispanic inmates appear to undergo health screening at similar rates for most types of tests, there are disparities in Hispanic screening that may reflect unequal diagnosis and subsequent provision of care. 95 % of state prison inmates eventually return to their communities [3] and those communities are predominantly low-income and non-white. Thus, disparities in screening for infectious disease in prison may contribute to disparities in communities most affected by incarceration.
Background The 30-year-old HIV epidemic largely overlaps with a 40-year-old epidemic of incarceration in the US. Starting in the 1970s, incarceration rates in the US accelerated rapidly (see Fi
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