HIV, Sexually Transmitted Infections, and Staphylococcus Aureus Co-Infection among New York State Prison Inmates

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Acknowledgement

I would take this opportunity to thank my research supervisor, family and friends for their support and guidance without which this research would not have been possible.

DECLARATION

I, [type your full first names and surname here], declare that the contents of this dissertation/thesis represent my own unaided work, and that the dissertation/thesis has not previously been submitted for academic examination towards any qualification. Furthermore, it represents my own opinions and not necessarily those of the University.

Signed __________________ Date _________________

Acknowledgementii

DECLARATIONiii

iv

List of Figuresvi

List of Tablesvii

Chapter 1: Introduction1

Background of the study1

Problem Statement4

Conceptual Framework5

Research Aims and Objectives8

Significance of the Study9

Rationale of the study16

Nature of the study28

Summary36

Chapter 2: Literature Review37

Introduction37

HIV Epidemic37

HIV/AIDS in the United States38

Sexually Transmitted Infections in the United States39

MRSA in the United States42

Infections in United States Prisons48

HIV Transmission Processes51

Inmate Risk Factors52

TDCJ53

Case Study- HIV Positive Prisoners In Italy56

Levels of Knowledge and Risk Perceptions About HIV/AIDS Among Female Inmates70

The need for HIV/AIDS interventions in prisons78

Recommendations for Changes in Prison HIV Care80

Summary83

Chapter 3: Methodology85

Specific Aims85

Research Design85

Parent Study85

Setting and Sample86

Recruitment87

Data Collection Procedures88

Microbiological and Molecular Epidemiological Techniques89

Consideration of Human Subjects90

Study Variables and Instruments Variables90

Interview questionnaire93

Medical record extraction form93

Data Management94

Power Analysis94

Data Analysis95

References99

List of Figures

Figure 1.1………………………………………………………………………………………6

List of Tables

Table 2.1………………………………………………………………………………………40

Table 3.1 ………………………………………………………………………………………57

Table 3.2 ……………………………………………………………………………………61-62

Chapter 1: Introduction

Background of the study

Infection with Staphylococcus aureus (S. aureus), and more specifically, methicillin-resistant S. aureus (MRSA) has become increasingly more prevalent in community settings. Once exclusively associated with hospital and long-term care facilities, MRSA outbreaks have been reported in diverse populations such as athletic teams, children attending daycares, and prisoners (Adcock, et al., 1998; Campbell, et al., 2004; Centers for Disease Control and Prevention, 2003a, 2003b; Herold, et al., 1998; Kazakova, et al., 2005). These populations lack the traditional risk factors for MRSA infection, including recent hospitalization and broad-spectrum antibiotic use (Lowy, 1998; Naimi, et al., 2003). Moreover, while much attention is given to the increasing rates of MRSA, methicillin-susceptible S. aureus (MSSA) is also a pathogen capable of causing severe disease in infected individuals (Miller, et al., 2007). MRSA has long been a significant cause of morbidity in hospitalized patients and is becoming increasingly more widespread (Cosgrove, et al., 2003; Friedman, et al., 2002; Seybold, et al., 2006). In 1974, MRSA accounted for 2% of all healthcare-associated S. aureus infections (Centers for Disease Control and Prevention, 2010d) a number which reached 64% by 2003 (Klevens, et al., 2006), highlighting the exponential increase in MRSA prevalence. While MRSA continues to plague hospital settings, recent years have seen the emergence of community-associated MRSA (CA-MRSA) strains among non-hospitalized persons without established risk factors for MRSA infection. Recent research has identified a significant number of patients entering hospitals already colonized with MRSA, suggesting acquisition of MRSA in the community setting (Hidron, et al., 2005). Among the 7% of patients identified as entering the hospital colonized with MRSA, significant risk factors for colonization included residence in alternative housing, HIV infection, history of MRSA infection/colonization, incarceration, and antimicrobial use or hospitalization in the previous 12 ...