HIV Risk Factors and PrEP Knowledge of Incarcerated Women in a County Jail

Background: Disproportionate numbers of individuals within criminal justice settings are HIV positive or high-risk for HIV infection; prevalence of HIV is 1.3% in incarcerated populations relative to 0.3% in general US populations. Additionally, there is a confluence of HIV risk within correctional settings because substance users and/or individuals whom engage in transactional sex are likely to be incarcerated. Reentry can be a crucial opportunity to provide HIV prevention interventions. Pre-exposure prophylaxis (PrEP) is shown to be effective in preventing HIV among high-risk populations. However, little is known about clinical indication for, knowledge about and acceptability of PrEP among incarcerated females. Methods: We partnered with the largest county jail in Arkansas to screen jail detainees at intake. Screening questions were based on Centers for Disease Control and Prevention (CDC) guidelines on clinical indication for PrEP. Results: During January, 2018, 155 women were offered the PrEP screener upon jail intake evaluations. Of these, 78% completed the screening. Fourteen percent (18) reported injection drug usage; Of those, 28% reported sharing needles with others prior to incarceration. Approximately one-fifth (21%) reported never using a condom during their sexual encounters in the 6 months prior to their incarceration. Importantly, 93% (112) of the women screened never heard of PrEP previously. Conclusions: County jails represent an important setting to screen individuals for HIV risk and provide prevention interventions. Future interventions should focus educating female detainees about PrEP, screening for clinical indication for PrEP, and linking high-risk HIV negative women to PrEP services upon release from jail.