HIV PREVENTION IN CRIMINAL JUSTICE POPULATIONS
HIV/AIDS and the Criminal Justice System
Theodore M. Hammett, Ph.D.
This presentation summarizes the intersection of the epidemics of substance abuse, HIV/AIDS, and incarceration in the United States, showing how the “war on drugs” has led to an explosion in correctional inmate populations in the past 20 years. At least 80 percent of all correctional inmates have some form of a substance abuse problem, whether or not they are incarcerated for a drug-related crime. The large-scale incarceration of injection drug users and other drug users has also led to the disproportionate prevalence and burden of HIV/AIDS and hepatitis among prison and jail inmates. About one-quarter of all people living with HIV in the United States, and about one-third of all people living with hepatitis C virus (HCV), in a given year pass through a correctional facility that same year.
As a result of this epidemiologic situation, correctional facilities are critical settings for interventions to prevent, diagnose, and treat HIV, HCV, and other infectious diseases. Although there have been substantial improvements in these and other correctional health interventions in recent years, the important related opportunities to improve the health of inmates and their partners and families and to advance the public health have by no means been fully exploited.
A Multisite HIV Prevention Protocol for Drug-Involved Offenders Returning to the Community
James A. Inciardi, Ph.D.
Recent estimates suggest that HIV and hepatitis seropositivity rates in correctional populations are roughly 8 to 10 times higher than those in the general population. These high rates are related to risky drug-using and sexual behaviors prior to incarceration. Importantly, many offenders resume these risk behaviors after release from the institution, attempting to "make up for lost time." Thus, reentry is a pivotal period for prevention, yet effective programs for drug-involved offenders in transitional correctional settings are lacking.
Using focus groups and interviews, an HIV/hepatitis protocol was developed that addresses the risk-reduction issues and barriers of concern to community corrections populations. The targeted intervention consists of an interactive, 2-session, DVD-based risk-reduction module facilitated by a peer interventionist and adapted for race/ethnic and gender appropriateness. The targeted intervention was designed to speak to correctional clients in their own language through the use of both virtual (DVD-based) and real “peers” (interventionists) and to coincide with reentry. By integrating the relevant intervention messages into an engaging, interactive format appropriate for different learning styles, the program seeks to provide the maximum impact in a brief intervention. The effectiveness of this intervention is being tested in a multisite field trial with community corrections clients.
HIV Testing Strategies and Linkage To Care for Criminal Justice Populations
Timothy P. Flanigan, M.D.
It is estimated that 20 percent of all HIV-infected individuals pass through the correctional system. Correctional institutions present an ideal opportunity to implement routine testing for HIV both to improve diagnosis and to link to care and initiative-prevention counseling.
In Rhode Island over a 10-year period, the routine testing of HIV within the correctional facilities identified 28 percent of all positive tests within the State. HIV testing, when linked to medical care, can result in a decrease in the rate of AIDS within the correctional setting, which in the long run results in cost savings. Since the advent of effective antiretroviral therapy, the rate of AIDS within the correctional settings in New York and other States has dropped dramatically. Rapid testing is feasible; can be easily implemented in different jail settings with good acceptance; and can be done through oral testing, which avoids exposure to blood. HIV testing within jails and prisons offers an important public health opportunity for HIV prevention, diagnosis, and linkage to care and can have enormous impact, particularly among African-American men, who suffer from the highest rates of HIV.