Mass incarceration and the impact of prison release on HIV diagnoses in the US South

BACKGROUND: The purpose of this study was to determine the impact of prison release on HIV incidence in the southern region of the United States, the region with the highest rates of both incarceration and new HIV diagnoses nationwide. METHODS: 5-year HIV diagnoses rates were calculated at the ZIP code level for nine cities and metropolitan statistical areas in the US South (ZIP codes, N = 600). Multilevel regression models were constructed and adjusted rate ratios (ARRs) were estimated for overall, male and female HIV diagnoses rates. RESULTS: Across the nine cities, in multilevel, multivariate analysis, controlling for income inequality (GINI coefficient), percent living in poverty and percent Non-Hispanic Black population, the ZIP code level overall HIV diagnosis rate was significantly associated with prison release [ARR 1.004 (95%CI 1.0007, 1.006), p<0.01]. A 10-person increase in prison release rate would result in a 4% increase in overall 5-year HIV diagnosis rate—approximately 9.4 additional cases per 100,000 population. In gender-stratified models, prison release rate was significantly associated with the ZIP code level HIV diagnosis rate for males [ARR 1.004 (95%CI 1.0004, 1.007), p<0.01], but not for females. CONCLUSIONS: In the southern region of the US, prison release is significantly associated with HIV incidence. HIV prevention interventions should promote timely linkage to ongoing treatment for released inmates living with HIV.