Kristen Underhill & Don Operario Department of Community Health

1. Systematic review of HIV prevention programs for adult criminal offenders in incarceration and community settings Kristen Underhill & Don Operario Department of Community Health Brown University, Providence, RI, USA

2. HIV risk among criminal offenders • Elevated HIV prevalence among individuals with a history of criminal justice involvement, both in incarceration and community settings. • Criminal justice system provides opportunities for intervention: arrest, court contact, detention, probation or parole, alternative sentences. • Prior reviews suggest that behavioral intervention can reduce HIV risk in this group, but tend to focus only on incarceration settings and neglect literature outside public health databases. No review to date among all offenders. • Objective of our review: Identify, appraise, and synthesize the evidence for the effectiveness of HIV prevention programs among adult criminal offenders worldwide.

3. Systematic Review Methods • Set inclusion criteria: • Randomized and quasi-randomized controlled trial • All participants are adult criminal offenders, not HIV+ • Intervention aimed to prevent HIV • Trial reports a behavioral/biological outcome • Search for studies: 16 electronic databases, searched gray literature. Total = 27,043 citations. • Identify included studies: 32 papers reporting 23 separate evaluations. • Appraise methodology and synthesize results. • Cochrane systematic review methods.

4. Included Studies • 23 trials enrolling 8239 US or Australian adults, 73% male, primarily ethnic minority, aged ≈33. • Median program dose 6 hours, settings included prisons, jails, probation, community services. • Interventions included testing (2), methadone maintenance treatment (1), behavior change (20). • Facilitators were peers (2 trials), trained professionals (15 trials), or both (4). 2 media-based programs. • 13 programs delivered some or all services outside incarceration settings. Participants were incarcerated (12), on probation/parole/released (9), or mixed (2). • Median follow-up: 6 months. Median attrition: 23%.

5. HIV Prevention Outcomes • 13 trials enrolling n=4832 participants found a significant protective effect on sexual risk behaviors; 2 more found an effect on HIV testing (n=621). • Control groups varied (usual care, other HIV programs, no treatment, non-enhanced programs, attention controls). • 6 trials enrolling n=2495 also found an effect on drug use. • Although 1 trial found iatrogenic effects, programs overall do not cause harm. • Promising strategies: group intervention; peer education; programs that integrate HIV prevention with other needs such as drug use treatment; case management.

6. Conclusions • HIV prevention is feasible and can be beneficial for adult criminal offenders. A variety of strategies both within and outside incarceration facilities have shown promise, with effects on sexual behavior and HIV testing. • Need continued research to identify core components across effective programs. Additional trials are ongoing, including several in community settings. • Possible review limitations: geographical limitations, possible publication bias or missed trials, lack of biological outcomes (1 trial tested for HIV/HCV, no effects), meta-analysis was impossible.

7. Acknowledgements • Internal support from Brown University Department of Community Health, Center for Alcohol and Addictions Studies. • This review did not receive external funding. KU is supported by NIH grant 5T32 AA07459-24. • This review overlaps with our ongoing Cochrane review of HIV prevention programs for criminal offenders in community settings, which is overseen by the Cochrane HIV/AIDS Group. • We are very grateful to the investigators who have responded to our inquiries about unpublished papers.

8. Included Studies 1. Medical Letter on the CDC. 2004:104-105. 2. Medical Letter on the CDC. 2004:39-39. 3. Alemagno SA, Stephens RC, Stephens P, Shaffer-King P, White P. J Correct Health Care. Jul 2009;15(3):210-221. 4. Anglin MD, Longshore D, Turner S. Crim. Justice Behav. 1999;26(2):168-. 5. Anglin MD, Longshore D, Turner S, McBride D, Inciardi J, Prendergast M. Studies of the Functioning and Effectiveness of Treatment Alternatives to Street Crime (TASC) Programs, Final Report. Los Angeles, CA1996. 6. Baxter S. Crime Delinq. Jan 1991;37(1):48-63. 7. Braithwaite RL, Stephens TT, Treadwell HM, Braithwaite K, Conerly R. J Health Care Poor Underserved. Nov 2005;16(4 Suppl B):130-139. 8. Callahan C. The association of criminal justice system involvement on change in high-risk behaviors among urban, crack-cocaine using women, Callahan, Catina: Washington U In St Louis, US; 2008. 9. Dolan K, Shearer J, White B. Sydney, Australia: National Drug and Alcohol Research Centre, University of New South Wales. 2002;51. 10. Dolan KA, Shearer J, MacDonald M, Mattick RP, Hall W, Wodak AD. Drug Alcohol Depend. Oct 24 2003;72(1):59-65. 11. Dolan KA, Shearer J, White B, Zhou J, Kaldor J, Wodak AD. Addiction. Jun 2005;100(6):820-828. 12. el-Bassel N, Ivanoff A, Schilling RF, Gilbert L, Borne D, Chen DR. Soc Work Res. Sep 1995;19(3):131-141. 13. Fish DG, Walker SJ, Singaravelu K, et al. Journal of Correctional Health Care. Oct 2008;14(4):290-298. 14. Grinstead O, Eldridge G, MacGowan R, et al. Journal of Correctional Health Care. Jul 2008;14(3):183-196. 15. Grinstead OA, Zack B, Faigeles B, Grossman N, Blea L. Crim. Justice Behav. Dec 1999;26(4):453-465.

9. Included Studies II 16. Inciardi JA, Surratt HL, Martin SS, O'Connell DJ, Salandy AD, Beard RA. The Prison Journal. Mar 2007;87(1):111-142. 17. Kavasery R, Maru DS, Cornman-Homonoff J, Sylla LN, Smith D, Altice FL. PLoS One. 2009;4(11):e7648. 18. Kavasery R, Maru DS, Sylla LN, Smith D, Altice FL. PLoS One. 2009;4(11):e8056. 19. Leukefeld C, Roberto H, Hiller M, Webster M, Logan TK, Staton-Tindall M. J. Psychoact. Drugs. 2003(4):427-434. 20. Longshore D, Turner S, Anglin MD. Prison J. 1998;78(1). 21. Lurigio AJ, Petraitis J, Johnson BR. AIDS Educ. Prev. Fal 1992;4(3):205-218. 22. Martin SS, Inciardi JA. Prison J. 1993;73(3):319-331. 23. Martin SS, O'Connell DJ, Inciardi JA, Surratt HL, Beard RA. J Psychoactive Drugs. 2003;35(4):435-443. 24. Martin SS, O'Connell DJ, Inciardi JA, Surratt HL, Maiden KM. J Psychoactive Drugs. Dec 2008;40(4):427-436. 25. Martin SS, Scarpitti FR. J. Drug Issues. 1993;23(1):043-059. 26. Needels K, James-Burdumy S, Burghardt J. J Urban Health. Sep 2005;82(3):420-433. 27. Rhodes W, Gross M. Case management reduces drug use and criminality among drug-involved arrestees. Rockville, MD: NIJ/NIDA , 1997. 28. Sacks JY, Sacks S, McKendrick K, et al. Journal of Offender Rehabilitation. 2008;46(3-4):233-261. 29. Stephens T, Braithwaite R, Conerly R. American Journal of Health Studies. 2005. 20: 1/2, 66-71. 30. Vemulapalli CF, Callahan C, Ben Abdallah A, Cottler LB. 68th Annual Scientific Meeting of the College on Problems of Drug Dependence; 2006 June 17-22; Scottsdale, Arizona, USA. 2006. 31. Weir BW, O'Brien K, Bard RS, et al. AIDS Behav. Jun 2009;13(3):509-522. 32. Wolitski RJ. International AIDS Conference Bangkok, Thailand2004. 33. Wolitski RJ. Am J Public Health. Oct 2006;96(10):1854-1861.