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To the Editor: Knowledge of a sexual assailant's human immunodeficiency virus (HIV) status could help determine the need for HIV postexposure prophylaxis (HIV PEP) and the best choice of medications.¹ The HIV prevalence among known sexual assailants may help estimate the seroconversion risk after sexual assault in a given community. Although prior studies have examined the HIV prevalence among prisoners, none have examined sexual assailants.^2-3 Our objective was to determine the HIV seroprevalence among male sexual assailants in Rhode Island.

Methods
We examined the records of all inmates who entered Rhode Island's state prison from January 1994 through December 1999 and were either charged with or convicted of a sexual offense. Sexual offenses were defined as charges of rape; first-, second-, and third-degree sexual assault; first-, second-, and third-degree child molestation; abominable and detestable crimes against nature; and any other charges that included attempted sexual assault. Convicted inmates must submit to HIV antibody testing at the time of incarceration, while charged inmates routinely undergo testing voluntarily.

Results
Sixteen thousand (94% male) adult inmates were admitted to the prison annually. Between January 1994 and December 1999, 1524 men in Rhode Island were charged with a sexual offense and incarcerated at the prison. Of those charged, 524 (34.4%) were convicted of a sexual offense. The remainder were either convicted of other crimes or found not guilty of their sexual offense charges. Of the 1524 charged men, 65% were classified as white, 19% as black, and 15% as Hispanic. Of the 524 convicted men, 71% were classified as white, 18% as black, and 10% as Hispanic. Sixty percent of the charged men and 54% of the convicted men were younger than 40 years. Intake HIV test results were available for 1422 (93.3%) inmates (Table 1).

View this table: [in this window] [in a new window] Table. HIV Seroprevalence of Men Charged With or Convicted of a Sexual Offense: Rhode Island State Prison, January 1994-December 1999*

Comment
The results show a relatively low (~1%) prevalence of HIV among male inmates charged or convicted of a sexual assault and incarcerated at the Rhode Island state prison during 1994 through 1999. Although this sample may not be representative of the general population, this prevalence appears to be higher than the prevalence in the general population of males (0.34%) in the state,⁴ but lower than the overall HIV prevalence for the Rhode Island prison system (3.2%) at the midpoint of the collection period.⁵

It may be reasonable to extrapolate our finding to predict HIV transmission risk following sexual assault in our state, and therefore to guide when to offer or recommend HIV PEP and how many antiviral medications to use. Although this information may be helpful in making HIV PEP decisions, it must be presented with the caveat that the HIV status of the individual assailant and the transmission risk from a particular assault should not be inferred from these data. We further suggest that assessments of the HIV prevalence of populations most likely to engage in sexual offenses may help guide HIV PEP decisions in other communities.

AUTHOR INFORMATION
Acknowledgment: This project was supported by National Institute on Drug Abuse (NIDA) grant K20 DA00268 and by partial support from National Institutes of Health Center for AIDS Research (NIH CFAR) grant P30-AI-42853. Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIDA and NIH CFAR.

Josiah D. Rich, MD, MPH; Grace Macalino, PhD
The Miriam Hospital/Brown Medical School
Providence, RI

Roland C. Merchant, MD
Section of Emergency Medicine
Rhode Island Hospital/Brown Medical School
Providence

Christopher Salas, BS
New York Medical College
Valhalla

Pauline Marcussen, BS
Rhode Island Department of Corrections
Cranston

Maureen Grundy, BA
Brown University
Providence, RI

Anne Spaulding, MD
The Miriam Hospital/Brown Medical School
Providence, RI
Rhode Island Department of Corrections

1. Bamberger JD, Waldo CR, Gerberding JL, et al. Postexposure prophylaxis for human immunodeficiency virus (HIV) infection following sexual assault. Am J Med. 1999;106:323-326. FULL TEXT | WEB OF SCIENCE | PUBMED 2. Sabin KM, Frey RL Jr, Horsley R, et al. Characteristics and trends of newly identified HIV infections among incarcerated populations: CDC HIV voluntary counseling, testing, and referral system, 1992-1998. J Urban Health. 2001;78:241-255. WEB OF SCIENCE | PUBMED 3. Kassira EN, Bauserman RL, Tomoyasu N, et al. HIV and AIDS surveillance among inmates in Maryland prisons. J Urban Health. 2001;78:256-263. WEB OF SCIENCE | PUBMED 4. Rhode Island Department of Health. Comprehensive Plan for HIV Prevention. Providence: Rhode Island Department of Health; 1997. 5. Maruschak LM. HIV in Prisons 1997. Washington, DC: US Bureau of Justice Statistics; 1999. Available at: http://www.ojp.usdoj.gov/bjs/pub/pdf/hivp97.pdf. Accessibility verified June 18, 2002.

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2002;288:164-165.

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