Evaluating HIV Prevention for Incarcerated Women

1. Evaluating HIV Prevention for Incarcerated Women An evaluation of the Women Moving Ahead Program An HIV Prevention and Self-Empowerment Program for Women at Century Regional Detention Facility Conducted by: Traci Bivens-Davis, Lisette Cardenas, Norlyn Asprec, Carmen Johnson, Cathy Olufs, and Precious Jackson UCLA Center for Community Learning Civic Engagement 105SL- Client-based Program Evaluation

2. Approximately 25% of people with HIV pass through a correctional setting each year. As of December 2004, there were 2,131,180 persons incarcerated in State and Federal prisons in the U.S. (27,000 HIV+) Seroprevalence is 8 to 10 times higher in correctional settings. Incarcerated women are 2.8 times more likely to be HIV infected than their male counterparts. Data Source: Bureau of Justice Statistics report December 2004. Facts about HIV/AIDS in the Correctional Setting

3. SPA 1: Antelope Valley SPA 2: San Fernando SPA 3: San Gabriel SPA 4: Metro SPA 5: West SPA 7: East SPA 6: South SPA 8: South Bay Los Angeles County • Square Miles: 4,086 • Population: 9.9 Million • Latino/a 45.7% White 31.0%Asian/PI 13.2%African-American 9.7%Native American 0.3% • Proportion of California Population: 29% • Proportion of California AIDS Cases: 35% • Proportion of U.S. AIDS Cases: 5% • Living with HIV/AIDS: 60,500 (Estimated)

4. HIV in LA County • As of December 31st, 2006 a total of 51,780 adults had been diagnosed with AIDS in Los Angeles County since the beginning of the epidemic (36% of all cumulative cases in California) • Current number of people estimated to be living with HIV or AIDS in LA County60,500 • Blacks are the most disproportionately impacted racial/ethnic group (23% of all new HIV cases) yet they only comprise slightly less than 10% of the population

5. There are an average of 18 to 20 thousand people incarcerated in the L.A. County Jails on any given night. Avg. of 400 known positives in the system per day About 30 of these are female Testing in jails is voluntary, so actual stats are unknown. African American and Latino/as disproportionately impacted by HIV and incarceration HIV in the local jails

6. Founded in 2000 (formerly called Center for Health Justice- The Corrections HIV Education and Law Project) Mission to improve the treatment and care of HIV positive inmates, reduce the spread of HIV in prisons and jails, empower inmates to make healthier choices. Annual budget $650k Offices located in West Hollywood Agency Motto: Prisoner Health is Public Health About the agency:

7. Center for Health Justice Staff

8. Center for Health Justice Programs in LA County Jails In 2006, CHJ provided educational and support services to over 2000 incarcerated persons-- living with, or at risk for HIV infection. • HIV Harm Reduction Counseling and Classes • Women-specific Prevention Services • HIV Treatment Education (one-on-one and group) • Hotline (accepts collect calls) • Condom Distribution program • Advocacy at local and state levels • Post-release programs • Limited Pro Se legal assistance with grievances • Collaboration with community partners • Policy leaders on HIV and incarceration

9. About Women Moving Ahead • WMA was funded by the United States Conference of Mayors in September 2006 as a year-long demonstration project aimed at reducing the rates of new HIV infections among women (particularly women of color). • It’s the only program of its kind inside the local jails. • WMA focuses on the “whole woman” concept; (one that addresses HIV risk within the multi-faceted context of woman’s life in today’s society)

10. Core Elements of WMA • Self-Esteem • Assertive Communication Skills • Safer-sex Negotiation • Healthy Relationships HIV/AIDS Awareness

11. Program Structure WMA consists of a four-part workshop series combined with one-on-one counseling and pre/post release support services. WMA addresses the needs of the target population in a culturally relevant manner, by helping women to identify their risk, adopt appropriate reducing risk-behaviors, increase personal self-esteem and develop effective communication skills. For many participants, this is often their first introduction into some of the concepts presented.

12. Research Question How effective is the Women Moving Ahead program at increasing HIV/AIDS knowledge and improving self-esteem among incarcerated women in the Los Angeles County Jail?

13. Where did we begin? Literature Review: Hammet TM, Harmon P, Maruschak L. Issues and Practices in Criminal Justice 1996-1997. Update: HIV/AIDS, STD’s, and TB in correctional facilities. Washington, DC: US Department of Justice, 1999. Harrison P, Beck A. Prison and Jail Inmates at Mid-year 2004. 2005. U.S. Department of Justice, BSJ. NCJ 208801 Zaitow B. Whose Problem is it Anyway?Women prisoners and HIV/AIDS. Int J Offender Ther Comp Criminol. 2001;45 (6):673-690 De Groot A. HIV infection among incarcerated women: Epidemic behind bars. AIDS Read 2000; 10(5):287-296 McClelland G, Teplin L, Abram K, Jacobs N. HIV and AIDS risk behaviors among female jail detainees: Implications for public health policy. AM J Public Health. 2002;92(5):818-825.

14. What ?’s did we ask? • How are these interventions impacting participant’s knowledge, attitudes, and behaviors around HIV? • What are the factors in women’s lives outside of jail that put them at risk for HIV, and for returning to jail? (substance use, family violence, sex work, poverty) • What are the characteristics of the women who participate in the program? (race, age, zip code) • What do women identify as the barriers to staying out of jail? Protecting themselves? • What do they see as the critical unmet educational needs for women in (and transitioning out of) the jail system in LA County?

15. Focus Groups (2) With currently incarcerated program participants (16) One-on-One Interviews With previously incarcerated program participants (8) Staff Interviews (2) Qualitative Methods

16. Quantitative Methods • # of participants in each of two interventions • Racial/ethnic data • Age • Zip code • Substance use data (type of drug used w/in last six months) • # of participants demonstrating a minimum of 15% HIV knowledge increase from pre/post tests

18. Antelope Valley San Fernando San Gabriel Metro West East South South Bay Most Frequently Represented Zip Codes 90044 (13%) 90013 (11%) 90003 (6%) 90059 (6%) 90002 (5%) 90047 (5%) 90602 (4%) 90022 (4%) 90250 (4%) 90037 (4%) 90201 (4%) 90006 (4%) 90011 (4%)

19. Most Commonly Used Substances

20. Age of Participants

21. % Change in HIV Knowledge Pre/Post

22. Highlights of Focus Group Discussions What did participants like the most? • Communication • Relationships What did they learn? • Transmission of HIV via oral sex • HIV+ women can have babies • Statistics regarding women and HIV stood out What made the program successful? • Having an HIV+ lead the class • Staff were kind and non-judgmental What would they like to learn more about? • Drugs • Self-esteem • Communication

23. What would improve the program? Longer classes Add Hepatitis C, STD’s, and Substance Use What challenges do they foresee in the future? Attitude (#1) Self-esteem (#2) Relapse on drugs Relationships Housing What are the major issues that prevent women from being successful? Same as above and lack of education and job skills What programs would be helpful in the future? Post-release support activities Buddy programs

24. What did the staff have to say? Staff were asked: What did they like best about their job? What could be improved? What are the biggest challenges to working with the women? What are the barriers to success for clients when they get out of jail? Bring in guest speakers

25. What about the released women? • Eight women interviewed • Four in drug treatment since jail • Two reported relapse on drugs (one actively using crack) • Three sexually active women reported using condoms each time they had sex • Three had no sex at all since jail • Two reported sex with primary partner w/o condom • One took an HIV test since being released (-) • Five reported practicing self-esteem exercises daily • Most commonly retained HIV information from classes - HIV stats among women and safer-sex demonstration • What they liked the most about the program- -nice staff, self-esteem, communication, certificates, opportunity to learn while in jail.

26. Recommendations for the agency • Make program longer (expand to six or eight sessions) • Expand upon communication/self-esteem components • Add more information for lesbians, IV drug users in HIV session • Add sessions on STD’s and Hep C • Add peer mentoring component for women who have completed all sessions and still have significant time to serve. (perhaps as peer trainers) • Enhance post-release services to include a “buddy program” (ie. Informal case management to assist women at time of release) • Create support activities for women to access after release • Bring in speakers from the community on various topics

27. Next Steps • Staff and guards to announce class as Women’s Empowerment Class (rather than “HIV Class”) —less stigmatizing • Strong need for additional services in the jails targeting women (particularly pre-release preparation) • There are few resources for women who are not HIV-infected (need far exceeds availability) • Encourage LASD to allocate time/space for additional services • Expand current HIV testing (rapid testing) • Need for additional research to determine long-term effectiveness of in-custody programs • Seek political support for increased funding