Nearly 1.4 million men are incarcerated in federal and state prisons in the United States. These men are disproportionately affected by HIV in comparison with the at-large male population. The elevated prevalence of HIV infection in U.S. prisons has raised concerns over the potential for intraprison HIV transmission due to rape and other forms of sexual victimization. However, the number of men who acquire HIV after being raped in U.S. prisons is not known. We developed a mathematical model of HIV transmission to estimate the likelihood that an incarcerated man would become infected as a result of prison rape and to provide preliminary estimates of the number of prison rape victims who acquire HIV. Our results suggest that between 43 and 93 currently incarcerated men already have or will acquire HIV as a result of being raped in prison.
Keywords prison rape; HIV; mathematical modelMore than 2 million U.S. adults were incarcerated in federal and state prisons and local jails at the end of 2003 (Harrison & Beck, 2004). Federal and state prisons alone house nearly 1.5 million inmates, the majority (93%) of whom are men (Harrison & Beck, 2004).A disproportionate number of U.S. prison inmates are infected with HIV-the virus that causes AIDS-in comparison with the at-large population. Approximately 1.9% of men and 2.8% of women incarcerated in state and federal prisons are known to have HIV (Maruschak, 2004); the true prevalence of infection is likely to be higher. The elevated prevalence of HIV infection in U.S. prisons has raised concerns over the potential for intraprison HIV transmission due to rape and other forms of sexual victimization (Dumond, 1992;Krebs, 2002;Mair, Frattaroli, & Teret, 2003;Mariner, 2001;Robertson, 2003; Stop Prisoner Rape, 2005).Although estimates of the frequency of prison rape vary widely, prisoner-on-prisoner sexual assaults occur with alarming regularity. A recent meta-analysis of published studies of prison sexual assault indicated that approximately 1.9% of all inmates are raped or otherwise seriously assaulted while in prison (Gaes & Goldberg, 2004). Notably, prison rape incidents often involve multiple perpetrators (Banbury, 2004;Mariner, 2001; Struckman-Johnson, StruckmanJohnson, Rucker, Bumby, & Donaldson, 1996) and sometimes cause serious injury to the victim, including trauma to rectal and vaginal tissue (Dumond & Dumond, 2002), both of which increase HIV risk (Schoub, 1999). Moreover, unlike sexual assault in the general community, a person who is raped in prison may be unable to remove him-or herself from the vicinity of the perpetrator or perpetrators and thus may be raped repeatedly while incarcerated (Banbury, 2004;Dumond, 2003;Mariner, 2001;Struckman-Johnson et al., 1996).
Context of Prison RapeMost of the available evidence regarding the experiences of men who are raped in prison is anecdotal, informal, or otherwise drawn from first-person accounts (e.g., Anderson, 2001;Brook, 2004;Chonco, 1989;Mariner, 2001). These accounts suggest that many initial rape attempt...