Background
The syndemic model of HIV prevention frames HIV transmission as a product of complex biological and social factors that intersect with viral hepatitis, sexually transmitted infections (STIs), substance use, and behavioral health issues. Incarceration may play a role in perpetuating these cycles, while also serving as a key opportunity for healthcare access. The purpose of this analysis is to estimate the baseline incidence of HIV, syphilis, and fatal overdose among individuals experiencing incarceration in jails, describe the acute impact of jail on the incidence of these conditions, and identify key demographic determinants that may be relevant to prevent disease in this population.
Methods
We linked 2023 Washington state HIV, STI, and fatal overdose surveillance data to a 2023 corrections registry built from public jail rosters. We calculated the baseline incidence of each condition (pre-incarceration for syphilis and HIV, and >90 days post-incarceration for fatal overdose) and compared this to published statewide statistics. We then calculated incidence post-incarceration (180 days following release for HIV and syphilis, and 90 days for fatal overdose). We estimated rate differences using a Poisson model and calculated the number of cases attributable to incarceration. Finally, we described the inferred route of transmission, gender, race, and census-tract level socioeconomic characteristics among those experiencing one or more conditions.
Results
Among the 129,661 individuals incarcerated in 2023, there were19 HIV diagnoses, 608 syphilis diagnoses, and 349 fatal overdoses. Baseline incidence rates for these conditions were 2.6 to 10.0 times higher than Washington state as a whole (14.1 vs 5.4 for HIV, 453.1 vs 50.7 for syphilis, and 463.7 vs 44.3 per 100,000 person-years). Rates were significantly higher post-incarceration for syphilis and fatal overdose (Table 1). Across all conditions, 55% of individuals had documentation of substance use, 46% were people of color, and 40% resided in census tracts in the lowest income quartile.
Conclusions
Incarcerated individuals in 2023 experienced disproportionately high rates of HIV, syphilis, and fatal overdose across WA The immediate effect of incarceration was an increased risk for these conditions, which is likely compounded other social and biological determinants. These findings underscore the crucial need for targeted interventions during and after incarceration toward reducing the burden of these syndemic conditions.
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