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HIV and Corrections—An International Perspective

This paper explores the intersection of HIV/AIDS and the correctional system, highlighting the unique challenges faced by incarcerated individuals. It provides data on HIV prevalence rates among state prison inmates compared to the general population and emphasizes the crucial role of harm reduction strategies. Through analysis of substance use trends, particularly methamphetamine (MA) and injection drug use (IDU), the paper discusses the effectiveness of post-release interventions, medication adherence, and education in reducing HIV transmission. It advocates for better implementation of harm reduction principles in correctional settings.

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HIV and Corrections—An International Perspective

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  1. HIV and Corrections—An International Perspective David Farabee, Ph.D. Department of Psychiatry & Biobehavioral Sciences University of California, Los Angeles

  2. World Map

  3. Annual Reports of New HIV/AIDS Cases in Taiwan

  4. Diffusion of HIV Among IDUs HIV Prevalence Rate (%) Stimson (1996)

  5. Vectors of HIV Transmission for General and Correctional Populations Dean-Gaitor & Fleming (2000) UCLA-ISAP

  6. Methamphetamine & HIV

  7. Injection-Related HIV Risk • Injected in the Past 6 Months: • MA Users: 37.1% • Non-MA Users: 1.1% • Of these— • 24% used “dirty” syringes • 30% shared cookers, rinse water, etc. Farabee et al., 2002 UCLA-ISAP

  8. Sex-Related HIV Risk (Odd Ratios of MA Users vs. Non-MA Users) UCLA-ISAP

  9. Sex-Related HIV Risk (Comparing MA Users vs Non-MA Users)

  10. Prevention Opportunities in the Criminal Justice System • The prevalence of HIV infection in the U.S. is > 5 times higher among state prison inmates (1.9%) than for the general population (0.37%) (Maruschak, 2006) • IDUs who pass through the CJS are no more likely than non-arrested IDUs to have ever been tested or given harm-reduction materials/information (Farabee et al., 2002) UCLA-ISAP

  11. Domains of Harm Reduction Institutional Post-release

  12. Harm Reduction in the Institution

  13. Provision of Bleach & Syringes • Syringes not available in any U.S. correctional system; bleach offered in 2 U.S. jails. • Several European prison systems offer syringes; bleach is offered in about half (of 20 surveyed). Kantor, (2003) UCLA-ISAP

  14. The Hindlebank Experiment UCLA-ISAP

  15. Distribution of Condoms • Available in less than 1% of US jails and prisons (May & Williams, 2002) • WHO survey found that 23 of 52 systems surveyed have distributed condoms since 1991 • None has reversed this policy (Kantor, 2003; WHO, 1992) • In Canada, 10% of staff reported condoms posed a problem, primarily due to their use as water balloons (Kantor, 2003) UCLA-ISAP

  16. Harm Reduction Following Release Secondary risk prevention Medication adherence

  17. Secondary Risk Prevention

  18. Do Prevention Interventions Reduce HIV Risk among HIV+ People ? • Crepaz et al. (2006) meta-analysis: • Studies published from 1988-2004 • 12 met inclusion criteria • Must have at least 3-month behavioral/ biological outcomes

  19. Meta-Analysis Results

  20. Critical Elements of Effective Interventions • Specifically designed to change HIV transmission behaviors • Delivered by health care professionals • Delivered to individuals • Intensive (# sessions/duration) • Delivered in settings where PLWH receive routine care

  21. Medication Adherence After Release

  22. CD4 Lymphocyte Counts by Incarceration Status Stephenson et al. 2005

  23. Released Inmates Filling ART Prescriptions • Undetectable viral load • Released to community supervision • Received pre-release planning/linkages Baillargeon et al. 2009

  24. Strategies for Improving Adherence • Behavioral interventions (Kripalani et al., 2007) • Dosing • Modified supervision requirements • Designated guardian (Farabee et al., 2002) • OST platforms (Moatti et al., 2000)

  25. Summary & Conclusions • IDU role in the spread of HIV is especially prominent in corrections • Other drugs (MA) also show a strong relationship • The CJS is a critical point of contact for HIV prevention and treatment, but underused

  26. Summary & Conclusions • Prison-based harm-reduction approaches tend to be viewed positively and are rarely rescinded • Secondary prevention interventions can reduce odds of unprotected sex (OR=.57) and STD acquisition (OR=.20) • Post-release HAART adherence is a problem

  27. Summary & Conclusions • Behavioral interventions, designated “guardians,” and OST (methadone, buprenorphine) platforms significantly improve adherence rates in the community.

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