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INCARCERATION

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Articles and Presentations 

Incarceration, African Americans and HIV: advancing a research agenda.

Harawa N, Adimora A.
Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA. ninaharawa@cdrewu.edu
J Natl Med Assoc. 2008 Jan;100(1):57-62
http://www.ncbi.nlm.nih.gov 
Incarceration is a crisis among African Americans, and the prevalence of HIV/AIDS in incarcerated men and women is 3-5 times that of the general population. We explore the potential implications of the widespread incarceration of African Americans on HIV risk and HIV outcomes in: 1) the current and formerly incarcerated, 2) their sexual partners, and 3) the communities impacted by incarceration. We set forth a research agenda for understanding and ameliorating the negative impacts incarceration and conclude that the African-American population's ability to successfully address the HIV/AIDS epidemic requires a coordinated and evidence-based response to the challenge of effectively preventing, managing and treating HIV in populations affected by incarceration.
PMID: 18277809 [PubMed - indexed for MEDLINE]

Racial differences in HIV/AIDS discussion strategies and sexual risk behaviors among drug-abusing female criminal offenders

Oser CB, Havens JR, Mooney JL, Staton-Tindall M, Knudsen HK, Duvall JL, Leukefeld CG.
Department of Sociology, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40506, USA. cboser0@uky.edu
J Psychoactive Drugs.Author manuscript; available in PMC 2009 March 18. Published in final edited form as: J Psychoactive Drugs. 2008 December; 40(4): 483–492.
http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=19283952
African-American female inmates are disproportionately affected by the human immunodeficiency virus (HIV), with heterosexual contact as the primary mode of transmission. This could be the result of racial differences in the strategies used by women to persuade a potential sexual partner to discuss HIV/AIDS and engage in condom use. Data were collected from 336 female inmates as part of the Reducing Risky Relationships for HIV (RRR-HIV) protocol within the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Bivariate analyses indicated that African-American drug-using women were more likely than Whites to use the rational, withdrawal, and persistence approaches to discuss HIV/AIDS with a sexual partner. Negative binomial regression models were used to identify which interpersonal discussion strategies were significant correlates of the number of the times White and African-American participants had unprotected vaginal sex in the 30 days before incarceration. Results from the multivariate model indicate that White women who are more likely to use the rational discussion strategy were 15% less likely to engage in unprotected vaginal sex; however, these findings were not replicated in the African-American sample. Findings add to the literature on racial differences in HIV/AIDS discussion strategies and sexual risk behaviors among drug-abusing female criminal offenders.
PMID: 19283952 [PubMed - in process]
PMCID: PMC2657220

Characteristics and Behaviors Associated With HIV Infection Among Inmates in the North Carolina Prison System 

David L. Rosen 1*, Victor J. Schoenbach 1, David A. Wohl 2, Becky L. White 2, Paul W. Stewart 1, Carol E. Golin 1
AJPH published April 16, 2009, 10.2105/AJPH.2007.133389 [Abstract] [PDF]
drosen@med.unc.edu
Abstract:
Objectives. We identified factors associated with testing HIV positive in a prison system performing voluntary HIV testing on inmates and estimated the number of undetected HIV cases to evaluate the efficacy of risk-factor–based HIV testing.
Methods. We used logistic regression to estimate associations between HIV serostatus and HIV risk behaviors, mental health, coinfection status, and sociodemographic characteristics for prisoners entering the North Carolina Department of Correction from January 2004 through May 2006. We estimated the number of undetected HIV cases on the basis of age-, gender-, and race-specific HIV prevalences among prisoners and in the state.
Results. Nearly 3.4% (718/21419) of tested prisoners were HIV positive. The strongest risk factors for infection among men were having sex with men (odds ratio [OR]=8.0), Black race (OR=6.2), other non-White race (OR=7.4), and being aged 35 to 44 years (OR=4.1). The strongest risk factor among women was Black race (OR=3.8). Among HIV-positive prisoners, 65% were coinfected with HCV. We estimated that between 24% (223) and 61% (1101) of HIV cases remained undetected.
Conclusions. The associations between HIV serostatus and a variety of factors highlight the potential limitations of risk-factor–based HIV testing in prisons, as do the high number of potential undetected HIV cases.

HIV Sexual Risk Behaviors among Ketamine and Non-Ketamine Using Criminal Offenders Prior to Prison Entry.

Oser C, Havens J, Staton-Tindall M, Wong C, Leukefeld C, Prendergast M.
1531 Patterson Office Tower, Department of Sociology, Center on Drug and Alcohol Research, University of Kentucky, Lexington, KY 40506;cboser0@uky.edu.
Addict Res Theory. 2008;16(3):289-302.
http://www.ncbi.nlm.nih.gov:80/pubmed/19287506?ordinalpos=1&itool=Email.EmailReport.Pubmed_ReportSelector.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed
This study is the first to examine ketamine use and its association with HIV sexual risk behaviors among a criminal offending population in the United States. Data were collected from 716 inmates as part of the Transitional Case Management (TCM) protocol within the Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Bivariate analyses were used to identify differences between ketamine users (n=44) and non-ketamine users (n=672). Three Poisson regression models were used to identify the significant correlates of high risk sexual behaviors in the 30 days prior to incarceration-- (1) number of times had unprotected sex while high, (2) number of times had unprotected vaginal sex, and (3) number of times had unprotected anal sex. Results indicate that ketamine was a significant correlate in all of the Poisson regression models. Findings add to the literature and indicate that ketamine use may be a marker for engaging in HIV risk behaviors among criminal offenders. 
PMID: 19287506 [PubMed]
PMCID: PMC2654764

Partner relationships and HIV risk behaviors among women offenders.

Knudsen HK, Leukefeld C, Havens JR, Duvall JL, Oser CB, Staton-Tindall M, Mooney J, Clarke JG, Frisman L, Surratt HL, Inciardi JA.
Department of Behavioral Science, Center for Drug and Alcohol Research, University of Kentucky, Lexington, KY 40536-0086, USA.hannah.knudsen@uky.edu
J Psychoactive Drugs. 2008 Dec;40(4):471-81
http://www.ncbi.nlm.nih.gov 
The HIV infection rate is increasing among women in general and for female inmates specifically (Maruschak 2004), which makes understanding the correlates of risky sexual behaviors critical for this population. Partner relationships, particularly the extent to which women perceive they have power within the relationship, may be important in modeling risk behaviors. Few studies have considered the association between relationship power and HIV risk behaviors among women offenders. This study examines women's perceptions of their relationships using the Sexual Relationship Power Scale (Pulerwitz, Gortmaker, & DeJong 2000) and NIDA's HIV Risk Behavior Assessment (NIDA 1995). Data were collected from female inmates in four prisons as part of the Reducing Risky Relationships for HIV protocol being conducted through the NIDA's Criminal Justice Drug Abuse Treatment Studies (CJ-DATS) cooperative agreement. Women reported whether they had engaged in five types of unprotected sex in the month prior to incarceration. Logistic regression models of the associations between relationship power and five types of unprotected sex revealed some support for the importance of power as a protective factor in reducing the odds of unprotected sexual behaviors. Implications and findings are presented to add to understanding of partner relationships and HIV risk behaviors.
PMID: 19283951 [PubMed - indexed for MEDLINE]

Accessing antiretroviral therapy following release from prison.

Baillargeon J, Giordano TP, Rich JD, Wu ZH, Wells K, Pollock BH, Paar DP.

Department of Preventive Medicine and Community Health, University of Texas Medical Branch, 301 University Blvd, Mail Route 1007, Galveston, TX 77555, USA. jbaillar@utmb.edu 
JAMA. 2009 Feb 25;301(8):848-57. 
http://jama.ama-assn.org/cgi/content/full/301/8/848     
CONTEXT: Interruption of antiretroviral therapy (ART) during the first weeks after release from prison may increase risk for adverse clinical outcomes, transmission of human immunodeficiency virus (HIV), and drug-resistant HIV reservoirs in the community. The extent to which HIV-infected inmates experience ART interruption following release from prison is unknown. OBJECTIVES: To determine the proportion of inmates who filled an ART prescription within 60 days after release from prison and to examine predictors of this outcome. RESULTS: Among the entire study cohort (N = 2115), an initial prescription for ART was filled by 115 (5.4%) inmates within 10 days of release (95% confidence interval [CI], 4.5%-6.5%), by 375 (17.7%) within 30 days (95% CI, 16.2%-19.4%), and by 634 (30.0%) within 60 days (95% CI, 28.1%-32.0%). In a multivariate analysis of predictors (including sex, age, race/ethnicity, viral load, duration of ART, year of discharge, duration of incarceration, parole, and AIDS Drug Assistance Program application assistance), Hispanic and African American inmates were less likely to fill a prescription within 10 days (adjusted estimated risk ratio [RR], 0.4 [95% CI, 0.2-0.8] and 0.4 [95% CI, 0.3-0.7], respectively) and 30 days (adjusted estimated RR, 0.7 [95% CI, 0.5-0.9] and 0.7 [95% CI, 0.5-0.9]). Inmates with an undetectable viral load were more likely to fill a prescription within 10 days (adjusted estimated RR, 1.8 [95% CI, 1.2-2.7]), 30 days (1.5 [95% CI, 1.2-1.8]), and 60 days (1.3 [95% CI, 1.1-1.5]). Inmates released on parole were more likely to fill a prescription within 30 days (adjusted estimated RR, 1.3 [95% CI, 1.1-1.6]) and 60 days (1.5 [95% CI, 1.4-1.7]). Inmates who received assistance completing a Texas AIDS Drug Assistance Program application were more likely to fill a prescription within 10 days (adjusted estimated RR, 3.1 [95% CI, 2.0-4.9]), 30 days (1.8 [95% CI, 1.4-2.2]), and 60 days (1.3 [95% CI, 1.1-1.4]). CONCLUSION: Only a small percentage of Texas prison inmates receiving ART while incarcerated filled an initial ART prescription within 60 days of their release.
PMID: 19244192 [PubMed - indexed for MEDLINE]

Research in Progress

HIV Risk Among Male Parolees and their Female Partners

http://www.caps.ucsf.edu/research/portfolio/2007/Risk4.pdf
Project Staff: Megan Comfort (PI), Olga Grinstead (Co-PI), Tor Neilands, Philippe Bourgois, Jackie Ramos, Claudia Smith, and Jim Taylor 
Project Description: This study explores HIV risk among men who were released from prison within the last year and are currently on parole (male parolees) and the women who are in sexual relationships with them (female partners). Couples will be recruited from community sites in Oakland, CA for participation in a quantitative survey. Each couple will come to an appointment together but will be interviewed separately. Two hundred couples will participate in the survey. A sub-sample of 40 couples will also be asked to participate in a qualitative interview to provide more in-depth contextual information about HIV risk and risk reduction among couples affected by incarceration. This study is funded by the National Institute of Mental Health (NIMH). 
Our preliminary studies have underscored the complexities of understanding how the context of a man’s incarceration influences couples’ decision-making processes involving HIV risk and risk reduction and have compelled us to undertake couple-level research on this issue. Public-health researchers have identified the necessity of developing and providing population-specific HIV interventions and services for people affected by incarceration both in prison and in their home neighborhoods post-release. This study will yield critical information about HIV risk and risk reduction in dyadic relationships between male parolees and their female partners that potentially can be used to develop population-appropriate and effective interventions for the millions of low-income people of color who experience their own or their partner’s incarceration each year. NBHAAD 2008 Page 6/6

HOLLA: Developing an HIV/Hepatitis C/STD Prevention Intervention for Men Recently Released from Prison

http://www.caps.ucsf.edu/research/portfolio/2007/Prev5.pdf
Project Staff: Janet Myers, Barry Zack, Craig Hutchinson, Isaac Taggart 
Project Description: This is an HIV prevention intervention project aiming to reduce risk and increase testing among men recently released from prison. In the formative research phase of this project, we engaged men and their potential service providers in in-depth qualitative interviews to develop an understanding of their experiences and their community. 
In the intervention phase, we have used the information gained through the qualitative interviews as a guide to choosing and tailoring a proven-effective case management intervention model so that it can address the unique HIV prevention and health care needs of these men. We are currently working to implement and evaluate the tailored intervention in Oakland and Richmond, California. The intervention is modeled on the Healthy Living Project and uses a 5-session design to help improve coping effectiveness, reduce HIV risk and increase HIV testing and receipt of social services.
What have we learned so far?
Interview respondents were parolees and ranged in age from 20 to 62 years. Across the sample there was a mix of severity in the crimes committed and so in the “level” on which men were housed in prison. The average length of stay among the men interviewed was 13 months (with a range from 1 month to 7.5 years). Many had in common chaotic lives, and a family history of crime, drugs, violence or prostitution. Respondents noted that the scope of sex in prison is sensationalized. Most sex is consensual and occurs among men identified as “homosexuals,” “punks,” or “faggots.” Forced sex was reported to be less common but does occur as punishment, when seeking protection, or by a few inmates preying on the weak. Attitudes towards sex among men included disapproval, ridicule, indifference, or tolerance. Twenty-five participants stated that men who have sex with men are gay, regardless of self-identification. Only one respondent talked about his own sexual experience with another man, yet all men said that it happened to others. Respondents considered themselves straight and could not understand why men in prison would have sex unless they were homosexual before prison or “lifers” who could “indulge” because they have nothing to lose. HIV risk in prison was also related to illicit drugs used because of addiction or to escape reality. Most men did not use because of the expense, the risk of being caught, a chance to be clean and sober, and the potential violence (including sexual violence) associated with drugs’ effects or drug-related debts. Inmates do not generally talk about HIV, except in the context of jokes or to know who is infected. Many inmates do not test for HIV, because of concern about their sex or drug history and fear of finding out their status. (Excerpted from a presentation at the 2007 National HIV Prevention Conference, Atlanta, GA, December 2007)
 

Adapting a Family Counseling Intervention for HIV + Men Leaving Jail/Prison

Olga Grinstead, Ph.D., MPH, USCF and Barry Zack, MPH
http://www.oneloveca.org/_files/_files/5253_uscf-men-in-prison-olga.ppt
There are 2.1 million Americans who are currently incarcerated in jails and prisons; 4.6 million more on probation/parole. US has the the highest per capita incarceration rate in the world - 65% of prisoners are people of color; 90% are men; 1/3 of African-American men 20-29 are involved with the criminal justice system.