Journal of Correctional Health Care - April 2023 - 156

Journal of Correctional Health Care
Volume 29, Number 2, 2023
ª The Author(s) 2023
DOI: 10.1089/jchc.20.05.0032
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RESEARCH ARTICLE
Implementing Opt-Out HIV Testing in the Alameda
County Jails
Samantha Feld, MPH,1 Jessica Steele, MPH,2 Shailey Klinedinst, MPH,3 Holvis Delgadillo, MPH,4
Jonathan Garcia, BSN, RN,4 Lorenzo Hinojosa,5 and Amanda Winters, MPA, MPH6*
Abstract
Incorporating routine opt-out HIV testing in correctional settings is a critical component of an effective
strategy to end the HIV/AIDS epidemic. Between 2012 and 2017, Alameda County jails implemented
opt-out HIV testing to identify new cases, link those who were newly diagnosed to care, and reengage
those who were previously diagnosed but not in care. Over a 6-year period, 15,906 tests were conducted,
with a positivity rate of 0.55% for both newly diagnosed cases and previously diagnosed but out of care.
Nearly 80% of those who tested positive were linked to care within 90 days. The high positivity and successful
linkage and reengagement with care underscores the need to support HIV testing programs in correctional
settings.
Keywords: HIV testing, linkage to care, reengagement with care, correctional setting, jail
Background
Approximately 1.3% of the 2.3 million people incarcerated
in jail or prison in the United States has HIV or
AIDS, about five times the prevalence of HIV in the general
population (Maruschak & Bronson, 2017; Valera
et al., 2017). HIV/AIDS in correctional facilities disproportionately
affects Black men and women; according to
an analysis of correctional facility data, Black men who
are incarcerated are about two times more likely to
have an HIV diagnosis than incarcerated White men.
Among incarcerated women, Black women are five
times as likely to have an HIV diagnosis compared to
their White counterparts (Spaulding et al., 2009).
Incarcerated individuals often come from medically
underserved communities, and many have overlapping
1Sonoma County Probation Department, Santa Rosa, California, USA.
2Uplift Family Services, Campbell, California, USA.
3Cardea Services, Oakland, California, USA.
4Alameda County Santa Rita Jail, Oakland, California, USA.
5Alameda County Public Health, Office of HIV Prevention, Oakland, California, USA.
6Cardea Services, Seattle, Washington, USA.
*Address correspondence to: Amanda Winters, MPA, MPH, Cardea Services, 1809 7th Avenue, Suite 600, Seattle, WA 98101, USA, Email: awinters@cardeaservices.org
156
risk factors for HIV/AIDS such as substance use disorder,
mental illness, poverty, housing instability, and homelessness
(Dumont et al., 2013; Health Resources and
Services Administration, 2007; Koblin et al., 2015). Furthermore,
behaviors that put individuals at an elevated
risk for contracting HIV (e.g., commercial sex work
and intravenous drug use) are also behaviors that tend
to be criminalized, resulting in an incarcerated population
that already has a disproportionately high risk for HIV.
Stigma and fear can lead to nondisclosure of HIVpositive
status in correctional settings, where high rates
of unprotected consensual and nonconsensual sexual behavior,
tattooing, and illicit drug use can further increase
the risk of infection (Butler et al., 2013; Muessig et al.,
2016; Valera et al., 2017). However, previous research

Journal of Correctional Health Care - April 2023

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