Women in the criminal justice (CJ) system experience higher rates of HIV infection compared to both men in the CJ system and non-CJ involved women, due to high-risk factors and are eligible for pre-exposure prophylaxis (PrEP), though limited data exist on the implementation of PrEP in this population.
The results of all Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (GC) urine and HIV/Syphilis testing in women in the Dallas County Jail (DCJ) were compiled from January to October 2020. Electronic medical records (EMR) from the DCJ for a month-long period (March 2020) were manually reviewed and data collected regarding age, substance use, homelessness, patient request for STI testing, and time between GC/CT and HIV/syphilis results.
From January to October 2020, 4398 females were tested for CT and 4389 for GC, and among this group, 479 (11%) were also tested for HIV and 562 (13%) for syphilis. Of women tested, median age was 42, and 462/4398 (11%) were positive for CT, 323/4389 (7%) positive for GC, 10/479 (2%) women had positive HIV tests, of whom 6 (1.3%) were new diagnoses and 75 (13%) had a reactive rapid plasma regain test. In March, 541 women were tested for CT and GC, 90 of whom tested positive for either CT or GC. Of these 90, the vast majority, 70 (78%) did not receive testing for HIV or syphilis, including women with the following risk factors: 4 (6%) were pregnant, 10 (14%) were homeless, 19 (27%) had requested STI/HIV testing at jail intake, 11 (16%) reported heroin use and 10 (14%) reported methamphetamine use. Individuals tested for all four infections (CT/GC/HIV/syphilis) were incarcerated for a longer period of time compared to those not tested for HIV/syphilis (83 v 30 days), with median time to HIV/syphilis testing after GC/CT result at 11 days.
Women incarcerated at a county jail had high rates of STIs and multiple other HIV risk factors, though only 1 in 5 with acute STIs (11% overall) were tested for HIV or syphilis. Efforts to improve HIV prevention in this high-risk, vulnerable population should include expansion of HIV testing, through paired STI and HIV testing offered early during incarceration, and utilization of automated EMR tools to highlight women who are PrEP candidates, like those testing positive for bacterial STIs or those with active substance use. Identification of those with elevated HIV risk, followed by counseling and linkage to PrEP care, could have a major impact on HIV prevention for incarcerated women.
