Cervical Dysplasia Among Incarcerated Women: A Comparison of HIV-Seropositive and HIV-Seronegative Inmates

Abstract

The number of women in state and federal prisons more than tripled between 1980 and 1990. Among incarcerated populations, women have higher rates of human immunodeficiency virus (HIV) infection than men. HIV seroprevalence ranges from 2.1% to 16.1% for men and 2.5% to 25.8% for women in U.S. prisons. The objective of this study was to determine the prevalence of cervical dysplasia among HIV-seropositive and HIV-seronegative women in a prison population and to correlate Papanicolau (Pap) smear results with demographic and clinical variables in this population at high risk for HIV infection. A review of Pap smear slides from 51 HIV-seropositive and 140 HIV-seronegative inmates was done by pathologists blinded to the women's serostatus. Cytologie findings were correlated with several variables, and differences between HIV-seropositive and HIV-seronegative women were analyzed. Thirteen of 51 (25%) HIV-seropositive women had squamous intraepithelial lesions as compared with 22 of 140 (16%) HIV-seronegative women (OR = 1.8; 95% CI 0.8-^.0). Cervical dysplasia was more prevalent in HIV-positive women with CD4 cell count <200/mm3 (OR = 2.0; 95% CI 0.4-10). Overall, changes suggestive of human papillomavirus (HPV) on Pap smear were twice as likely in the slides of HIV-seropositive women (OR = 2.5; 95% CI 1.0-6.3). Trichomoniasis was very prevalent among both seropositive (45%) and seronegative (43%) inmates. Squamous intraepithelial lesions and changes suggestive of HPV infection on Pap smears were more prevalent in HIV-seropositive than HIV-seronegative women in a prison population in which 12% of women are HIV infected and over 70% have a history of injection drug use. Trichomoniasis was very prevalent among both groups. Incarcerated women require intensive gynecologic monitoring and care.

Human Immunodeficiency Virus in Correctional Facilities: A Review

“…A study of women inmates in Rhode Island showed that 25% of HIV-seropositive inmates had squamous intraepithelial lesions. Cervical dysplasia was correlated with HIV seropositivity and, among HIV-infected women, with lower CD4 cell counts [12].…”

“…The latter 2 infections can lead to pelvic inflammatory disease. Trichomonas infection has been found to be highly prevalent among both HIVseropositive and HIV-seronegative women inmates in Rhode Island (45% and 43%, respectively) [12].…”

“…Although surveys of the nonprison population in the United States have shown that a higher percentage of men than women are infected with HIV, the inverse is true in correctional institutions [8,12]. Nationwide, the prevalence of HIV infection among inmates is 3.5% among women and 2.2% among men [8].…”

Comprehensive Medical Care among HIV-Positive Incarcerated Women: The Rhode Island Experience

“…Because of concern about the reliability of cytology readings, an independent pathologist reviewed these Pap smears. 11 The data on 41 women involved in the Prison Release Program during its first year were collected by chart review and from the computer database at the prison facility. 12…”

Transitioning HIV-Infected Women After Release From Incarceration: Two Models for Bridging the Gap

“…To aid the transition of HIV-positive women offenders into comprehensive care upon release, the Rhode Island Department of Corrections -in conjunction with the Rhode Island Department of Health, the Miriam Hospital and Brown University -has developed two programs that connect incarcerated HIV-infected women to community resources and continuity of HIV care (Cu-Uvin et al, 1996;Dixon et al, 1993;Flanigan et al, 1996;Kim et al, 1997;Skolnick, 1998). The limited geographic area and population of Rhode Island have facilitated the initiation of care within the prison, and then the follow-up upon release with the same health care workers.…”