Jonathon Poe, MSSWProgram Specialist VTB/HIV/STD Epidemiology and SurveillanceTexas Department of State Health Services
HIV in the Texas Department of Criminal Justice (TDCJ) Inmate PopulationHIV in the Texas Department of Criminal Justice (TDCJ) Inmate Population
Texas Department of State Health Services 2
Outline
About Texas Department of Criminal Justice (TDCJ)
2008 General TDCJ Demographics
HIV Testing, Reporting and Prevention in TDCJ
HIV Diagnoses in TDCJ
Summary
Texas Department of State Health Services 3
About TDCJ
Composed of eleven divisions Correctional Institutions Division
113 Units 59 Prisons 20 State Jails 5 Substance Abuse Felony Punishment
Facilities (SAFPF) 13 Transfer facilities 15 Other facility types
156,126 people were “on hand” on August 31, 2008 “On Hand” includes people incarcerated in a prison,
state prison or SAFPF facility
Texas Department of State Health Services 4
About TDCJUnit Map
Texas Department of State Health Services 5
2008 General TDCJ Demographics
Texas Department of State Health Services 6
2008 General TDCJ Demographics
2008 Age Groups
11%2%
19%29%
18%29%
18%
26%
34%15%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
TDCJ (n=156,128) Texas (n=19,021,721)
Per
cen
t o
f P
op
ula
tio
n 50+
40-49
30-39
20-29
14-19
Texas Department of State Health Services 7
General TDCJ Population in 2008
Race/Ethnicity
11%
37%36%
31%5%
<1%47%
31%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
TDCJ (n=156,126) Texas (n=19,021,721)
Per
cen
t o
f P
op
ula
tio
n
White
Other
Hispanic
Black
Texas Department of State Health Services 8
General TDCJ Population in 2008
Sex for TDCJ Population
Female8.0%
Male92.0%
Texas Department of State Health Services 9
HIV Testing, Reporting and Prevention in TDCJ
Texas Department of State Health Services 10
HIV Testing, Reporting and Prevention in TDCJ
Mandatory testing for all offenders At intake Before release
Voluntary testing twice per year
Possible exposures
Texas Department of State Health Services 11
HIV Testing, Reporting and Prevention in TDCJ
TDCJ HIV/AIDS Coordinator
Positive Western Blot Lab Report
DSHS Central Office Loc./Reg. HD
Unit Galveston HD
Texas Department of State Health Services 12
Post-test counseling
Education
Drug Rehab
Condom distribution prohibited
HIV Testing, Reporting and Prevention in TDCJ
Texas Department of State Health Services 13
HIV Diagnoses in TDCJ
Texas Department of State Health Services 14
HIV Diagnoses in TDCJ
Compare diagnosis rates for two populations Initial HIV Diagnosis (DX) in TDCJ
Includes concurrent diagnoses Initial HIV Diagnosis Not in TDCJ Excludes people under 14 years of age Denominator for TDCJ Diagnosis Rates from TDCJ
Statistical Reports Number of people on hand on August 31 Transient population
Texas Department of State Health Services 15
Number of HIV Diagnoses in TDCJ 2000-2008*
0
50
100
150
200
250
300
350
400
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year of Diagnosis
Num
ber
Dia
gnos
ed
HIV Diagnoses in TDCJ
Texas Department of State Health Services 16
HIV Diagnoses in TDCJ
TDCJ HIV Diagnosis Rates 2005-2008
181 181 184169
18 17 18 18
0
20
40
60
80
100
120
140
160
180
200
2005 2006 2007 2008
Year
HIV
Dia
gnos
is R
ate
per
100,0
00
TDCJ
Texas
Texas Department of State Health Services 17
HIV Diagnoses in TDCJ
Ten Texas Counties with Most HIV Diagnoses in 2008
1266
811
285 264 258 21384 73 67 66
0
200
400
600
800
1000
1200
1400
Harris
Dalla
s
Bexa
rTD
CJ
Tarran
t
Trav
is
El Pas
o
Collin
Jeffer
son
Hida
lgo
County
Num
ber
of HIV
Dia
gnos
es
Texas Department of State Health Services 18
2008 HIV Diagnosis Rate-Age at Initial Diagnosis
7566
171
203
110
10
35 33 278
0
50
100
150
200
250
14-19 20-29 30-39 40-49 50+
Age Group
HIV
Dia
gn
os
is R
ate
pe
r 10
0,00
0
DX inTDCJ
Not DX inTDCJ
HIV Diagnoses in TDCJ
Median age for people diagnosed in TDCJ: 35Median age for people not diagnosed in TDCJ: 34
Texas Department of State Health Services 19
2008 HIV Diagnosis Rate-Race/Etnicity
256
125110
130
61
9 613
0
50
100
150
200
250
300
Black White Hispanic Other
Race/Ethnicity
HIV
Dia
gn
osi
s R
ate
per
100
,000
DX inTDCJ
Not DX inTDCJ
HIV Diagnoses in TDCJ
Texas Department of State Health Services 20
HIV Diagnoses in TDCJ
2008 Diagnosis Rate-Sex
165
258
394
0
50
100
150
200
250
300
350
400
450
Male FemaleSex
Dia
gn
os
is R
ate
pe
r 1
00
,00
0 DX inTDCJ
Not DX inTDCJ
Texas Department of State Health Services 21
HIV Diagnoses in TDCJ
2008 HIV Diagnoses-Female Age Groups
7%4%
28%44%
29%12%
22%32%
14%8%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
DX in TDCJ (n=50) Not DX in TDCJ (n=923)
Residence at Initial HIV Diagnosis
Pe
rce
nt
of
Ca
se
s 50+
40-49
30-39
20-29
14-19
*One case categorized as “Other” excluded from analysis
Texas Department of State Health Services 22
HIV Diagnoses in TDCJ
2008 Diagnoses-Male Age Groups
4%1%
26%27%
22%
31%
18%32%
9%10%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
DX in TDCJ (n=215) Not DX in TDCJ (n=3,092)
Residence at Initial HIV Diagnosis
Pe
rce
nt
of
Ca
se
s
50+
40-49
30-39
20-29
14-19
Texas Department of State Health Services 23
HIV Diagnoses in TDCJ
2008 HIV Diagnoses-Female Race/Ethnicity
18%30% 2%
0% 21%18%
60%52%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
DX in TDCJ (n=50) Not DX in TDCJ (n=923)
Residence at Initial HIV Diagnosis
Pe
rce
nt
of
Ca
se
s Black
Hispanic
Other
White
Texas Department of State Health Services 24
HIV Diagnoses in TDCJ
2008 HIV Diagnoses-Male Race/Ethnicity
29%21%
2%0%
32%
20%
37%
58%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
DX in TDCJ (n=215) Not DX in TDCJ (n=3,092)
Residence at Initial HIV Diagnosis
Pe
rce
nt
of
Ca
se
s Black
Hispanic
Other
White
Texas Department of State Health Services 25
HIV Diagnoses in TDCJ
2008 Female Mode of Transmission
15%
72%
85%
28%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
DX in TDCJ (n=50) Not DX in TDCJ (n=923)
Residence at Initial Diagnosis
Pe
rce
nt
of
Ca
se
s
Het
IDU
Texas Department of State Health Services 26
HIV/AIDS Prison Population
2008 Male Mode of Transmission*
76%
19%
7%
57%
4%15%
13%9%
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
DX in TDCJ (n=215) Not DX in TDCJ (n=3,092)
Residence at Initial HIV Diagnosis
Pe
rce
nt
of
Ca
se
s
Het
MSM/IDU
IDU
MSM
*One case categorized as “Other” excluded from analysis
Texas Department of State Health Services 27
HIV Diagnoses in TDCJ
2008 Concurrent Diagnoses
20%
34%
0%
5%
10%
15%
20%
25%
30%
35%
40%
0-12 Months
Time Between HIV and AIDS Diagnoses
Per
cen
t o
f C
ases
DX in TDCJ
Not DX in TDCJ
Texas Department of State Health Services 28
Summary
Diagnosis rates much higher than general population
Diagnosis rates differ between cases diagnosed in TDCJ and cases not diagnosed in TDCJ Peaks in later age groups for TDCJ diagnoses Rate disparities between race/ethnic groups not as
great among cases diagnosed in TDCJ
IDU is the dominate mode of transmission for those diagnosed in TDCJ
A smaller proportion of cases diagnosed with HIV in TDCJ progressed to AIDS within one year compared to cases not diagnosed in TDCJ
Texas Department of State Health Services 29
Thank You!
Contact
Jonathon Poe
512-533-3032
Acknowledgements
Connie Adams, LVN III, TDCJ, HIV/AIDS Coordinator
Miranda Fanning, MPH, DSHS, Epidemiologist
Douglas Shehan, UT Southwestern, Senior Research Scientist