Responding to the burden of STD, HIV, and viral hepatitis in correctional populations through program collaboration and integration.

OVER 2 MILLION INDIVIDUALS ARE estimated to be incarcerated in the United States and this number is projected to increase.1 This special supplement of Sexually Transmitted Diseases (STD) focuses on significant developments in national and local efforts to confront the disproportionately and consistently high burden of STD, human immunodeficiency virus (HIV), and viral hepatitis found in the large and growing US correctional population. Addressing health disparities in racial and ethnic groups is a high priority for the Centers for Disease Control and Prevention and the National Center for HIV/AIDS, viral hepatitis, STD, and tuberculosis prevention; responding to the burden of disease in correctional populations, which are disproportionately comprised of minorities, is a critical strategy for reducing these disparities.2,3 Local, state, and federal jurisdictions face considerable challenges due to shrinking budgets ineffectively serving the multifaceted health problems and high risk health behaviors prevalent in correctional populations. However, entry into the correctional system also offers an important opportunity for primary, secondary, and tertiary prevention strategies to be implemented, particularly in the area of communicable diseases. The development of effective multifaceted control strategies to identify infection early upon entry into detention is necessary to prevent ongoing transmission in the community upon release (which usually occurs within a week) and within detention. The articles and an editorial from the San Francisco County Sheriff in this Journal Supplement underscore the importance of collaborative approaches involving public health departments, and correctional health care and corrections professionals to develop effective integrated programs and services for these populations.4 Articles have been chosen related to the sexual health of correctional populations including behavioral risk factors for infection, prevalence estimates to identify target subpopulations in need of screening, assessment of local correctional program capacity to provide quality STD care, implementation of screening and treatment programs, cost-effectiveness analyses of screening interventions, and evaluation of impact of STD/HIV screening in correction populations on communities. Joesoef et al. reported on chlamydia data collected from a large sample of participating juvenile correctional facilities and jails across the United States showing consistently higher Chlamydia trachomatis prevalence among young females compared with males and among black detainees compared with those of other racial/ethnic groups.5 McDonnell et al. reported on demographic and sexual risk behavioral data among female juvenile detainees collected over a 4-year period; they demonstrate that this population has a consistently high prevalence of sexual risk behaviors including low rates of condom use and high chlamydia rates.6 Barry et al. presented a different perspective on the role of incarceration through a case-control study of gonorrhea among heterosexuals.7 Their finding that female gonorrhea cases were more likely than population controls to report recent incarceration for themselves and for their recent sex partners emphasizes how recently incarcerated populations may facilitate ongoing transmission and might serve as a point of intervention in high STD prevalence networks. Articles that address the challenges of implementing STD/HIV screening in state and local correctional settings recognize numerous issues related to the availability of resources, such as clinical staff and laboratory facilities, needed to conduct screening, diagnose, treat, and ensure partner management. McIntyre et al. reported the results of a survey of Illinois correctional providers that indicated significant gaps in STD, HIV/AIDS, and hepatitis services across facilities associated with limited funding and staffing.8 Burke and Rhodes reported on a collaboration between the local health department and North Carolina jails to facilitate syphilis screening through assignment of a disease intervention specialist.9 Miller et al. reported on the feasible and successful implementation The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy. Correspondence: Joan M. Chow, MPH, DrPH, Chief, Epidemiology Unit, Epidemiology and Surveillance Section, California Department of Public Health, 850 Marina Bay Parkway, Bldg. P, 2nd Floor, Richmond, CA 94804. E-mail: joan.chow@cdph.ca.gov. Received for publication November 7, 2008, and accepted November 10, 2008. From the *California Department of Public Health, Sexually Transmitted Disease Control Branch, Richmond, California; †Division of STD Prevention, Centers for Disease Control, Atlanta, Georgia and ‡San Franciso Department of Public Health, San Francisco, California Sexually Transmitted Diseases, February Supplement 2009, Vol. 36, No. 2, p.S1–S2 DOI: 10.1097/OLQ.0b013e3181949359 Copyright © 2009, American Sexually Transmitted Diseases Association All rights reserved.