HIV and Other Infectious Diseases Among Drug-Involved Offenders 

Table of Contents

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Volume 40, Number 4

December 2008

Editors’ Introduction: HIV and Other Infectious Diseases Among Drug-Involved Offenders  — James A. Inciardi, Ph.D.; Carl G. Leukefeld, D.S.W.; Steven S. Martin, M.Sc. & Daniel J. O’Connell, Ph.D.

Integrating an HIV/HCV Brief Intervention in Prisoner Reentry: Results of a Multisite Prospective Study— Steven S. Martin, M.Sc., M.A.; Daniel J. O’Connell, Ph.D.; James A. Inciardi, Ph.D.; Hilary L. Surratt, Ph.D. & Kristin M. Maiden, M.A.

The Persistence of HIV Risk Behaviors Among Methamphetamine-Using Offenders — Jerome J. Cartier, M.A.; Lisa Greenwell, Ph.D. & Michael L. Prendergast, Ph.D.

Applying Classification and Regression Tree Analysis to Identify Prisoners with High HIV Risk Behaviors — Linda Frisman, Ph.D.; Michael Prendergast, Ph.D.; Hsiu-Ju Lin, Ph.D.; Eleni Rodis, M.S. & Lisa Greenwell, Ph.D.

Substance Use, Mental Health Problems, and Behavior at Risk for HIV: Evidence from CJDATS —Frank S. Pearson, Ph.D.; Charles M. Cleland, Ph.D.; Michael Chaple, M.A.;  Zachary Hamilton, M.A.; Michael L. Prendergast, Ph.D. & Josiah D. Rich, M.D., M.P.H.

Partner Relationships and HIV Risk Behaviors Among Women Offenders — Hannah K. Knudsen, Ph.D.; Carl Leukefeld, D.S.W.; Jennifer R. Havens, Ph.D.; Jamieson L. Duvall, Ph.D.; Carrie B. Oser, Ph.D.; Michele Staton-Tindall, Ph.D.; Jennifer Mooney, M.S.; Jennifer G. Clarke, M.D.; Linda Frisman, Ph.D.; Hilary L. Surratt, Ph.D.; & James A. Inciardi, Ph.D.

Racial Differences in HIV/AIDS Discussion Strategies and Sexual Risk Behaviors Among Drug-Abusing Female Criminal Offenders —Carrie B. Oser, Ph.D.; Jennifer R. Havens, Ph.D.; Jennifer L. Mooney, M.S.; Michele Staton-Tindall, Ph.D.; Hannah K. Knudsen, Ph.D.; Jamieson L. Duvall, Ph.D. & Carl G. Leukefeld, D.S.W.

HCV in Incarcerated Populations: An Analysis of Gender and Criminality on Risk — Anne G. Rhodes, M.S.; Faye S. Taxman, Ph.D.; Peter D. Friedmann, M.D., M.P.H. & Karen L. Cropsey, Psy.D.

Predicting HIV/STD Risk Level and Substance Use Disorders Among Incarcerated Adolescents — Cynthia L. Rowe, Ph.D.; Wei Wang, Ph.D.; Paul Greenbaum, Ph.D. & Howard A. Liddle, Ed.D.

Arrest Histories of High-Risk Gay and Bisexual Men in Miami: Unexpected Additional  Evidence For Syndemic Theory — Steven P. Kurtz, Ph.D.

INDEX —Volume 40 (1-4) 2008

COVER ART — Scrambled Jazz by Rori Ranch Productions

 Abstracts

Integrating an HIV/HCV Brief Intervention in Prisoner Reentry: Results of a Multisite Prospective Study— Steven S. Martin, M.Sc., M.A.; Daniel J. O’Connell, Ph.D.; James A. Inciardi, Ph.D.; Hilary L. Surratt, Ph.D. & Kristin M. Maiden, M.A.

Abstract—Brief interventions to reduce harmful or problem behaviors have become increasingly popular in a variety of health fields, including HIV and hepatitis risk reduction. A central issue in intervention research involves the evaluation of what constitutes an effective “dose” of an intervention. This research examines the relative effectiveness of three alternative brief interventions of varying intensity designed to change the risk behaviors of inmates who are reentering society: a DVD-based, peer delivered intervention; the NIDA Standard HIV Intervention; and a standard practice condition (HIV educational video). All participants randomly received one of the interventions and were tested for HIV and HCV prior to release from custody. Thirty and ninety-day follow-ups examined changes in high-risk behaviors. Results reported here for 343 subjects who have completed the 90-day follow up indicate significant reductions in reported sexual risk behaviors for those participating the DVD intervention, compared to the other two brief interventions. This study is among the first to report any positive impacts on sexual behaviors among a population of inmates returning to the community.

Keywords—drug abuse, HIV, inmates, intervention, prison

The Persistence of HIV Risk Behaviors Among Methamphetamine-Using Offenders — Jerome J. Cartier, M.A.; Lisa Greenwell, Ph.D. & Michael L. Prendergast, Ph.D.

Abstract—Studies have shown that methamphetamine (MA) is rapidly becoming the drug of choice for a large number of substance-abusing offenders and is associated with significantly higher levels of HIV risk behaviors prior to their incarceration. Despite these findings, there has been little follow-up research to determine whether these patterns persist among recently paroled offenders after attendance in an in-prison treatment program. This study uses the self-reported data from 812 substance-abusing offenders in a multisite NIDA-funded project to determine whether, either before incarceration or nine months after release from an in-prison substance abuse program, MA use in the past 30 days was associated with increased HIV risk behaviors. The findings indicate that offenders who used MA prior to and after incarceration and treatment report higher levels of HIV risk behaviors compared with offenders with no MA use. Clinical and policy implications of the findings are discussed.
Keywords—HIV risk, methamphetamine, offenders, treatment

Applying Classification and Regression Tree Analysis to Identify Prisoners with High HIV Risk Behaviors — Linda Frisman, Ph.D.; Michael Prendergast, Ph.D.; Hsiu-Ju Lin, Ph.D.; Eleni Rodis, M.S. & Lisa Greenwell, Ph.D.

Abstract—Among prisoners, past research has associated several factors with HIV risk behaviors, including illicit drug use, engaging in sex trade, older age (for drug-related risk), younger age (for sex-related risk), low education, low income, type of offense, history of abuse, mental health disorders, vulnerability and low self-perceived efficacy. This study employs data collected through the Transitional Case Management study of the Criminal Justice Drug Abuse Treatment Studies collaborative to analyze characteristics of prisoners who engaged in high-risk behaviors prior to incarceration. For the first 787 participants of this study, we employed recursive partitioning techniques to better identify groups at varying levels of HIV risk behaviors. Those more likely to engage in risky needle use were White and either unemployed and less likely to justify their behavior, or employed with poor decision making capacity. Risky sexual behavior was associated with a general tendency toward risk-taking or a history of unstable housing. Those engaging in any type of HIV risk behavior were risk-takers in general and were aged 25 to 47 with a history of unstable housing. Recursive partitioning, a technique seldom used previously, offers a useful method for identifying subpopulations at elevated risk for HIV risk behaviors.

Keywords—drugs, HIV, prisoners, recursive partitioning

Substance Use, Mental Health Problems, and Behavior at Risk for HIV: Evidence from CJDATS —Frank S. Pearson, Ph.D.; Charles M. Cleland, Ph.D.; Michael Chaple, M.A.;  Zachary Hamilton, M.A.; Michael L. Prendergast, Ph.D. & Josiah D. Rich, M.D., M.P.H.

Abstract—This study examined the relationships between substance abuse, mental health problems and HIV risk behavior in offenders discharged from prison and referred to substance abuse treatment programs. Data from 34 sites (n = 1,358) in a federally-funded cooperative agreement, the Criminal Justice Drug Abuse Treatment Studies (CJDATS), were analyzed. Among parolees referred to substance abuse treatment, self reports for the six-month period before the arrest resulting in their incarceration revealed frequent problems with both substance use and mental health. HIV risk behavior was operationalized as either (a) unsafe injection drug use, e.g., sharing needles and/or sharing injection equipment, or (b) unsafe sex, e.g., sex without a condom. The findings were that (1) unsafe injection drug use was associated with unsafe sex and vice versa, (2) unsafe sex behavior was related to frequency of drug use, and (3) unsafe sex behavior was related to frequency of alcohol use. In these samples, mental health problems did not have a significant effect on risk behavior, controlling for other variables. Future research should probe this “nonfinding” using standardized diagnostic and symptom measures to provide greater detail on the mental health problems (e.g., age of onset, frequency, and severity of the problem).
Keywords—co-occurring disorders, criminal justice, HIV risk, mental disorders, offenders, substance use disorders

Partner Relationships and HIV Risk Behaviors Among Women Offenders — Hannah K. Knudsen, Ph.D.; Carl Leukefeld, D.S.W.; Jennifer R. Havens, Ph.D.; Jamieson L. Duvall, Ph.D.; Carrie B. Oser, Ph.D.; Michele Staton-Tindall, Ph.D.; Jennifer Mooney, M.S.; Jennifer G. Clarke, M.D.; Linda Frisman, Ph.D.; Hilary L. Surratt, Ph.D.; & James A. Inciardi, Ph.D.

Abstract—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.

Keywords—HIV risk behaviors. relational model, relationship power women offenders

Racial Differences in HIV/AIDS Discussion Strategies and Sexual Risk Behaviors Among Drug-Abusing Female Criminal Offenders —Carrie B. Oser, Ph.D.; Jennifer R. Havens, Ph.D.; Jennifer L. Mooney, M.S.; Michele Staton-Tindall, Ph.D.; Hannah K. Knudsen, Ph.D.; Jamieson L. Duvall, Ph.D. & Carl G. Leukefeld, D.S.W.

Abstract—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.

Keywords—AIDS discussion strategies, criminal offenders, HIV risk behaviors, race

HCV in Incarcerated Populations: An Analysis of Gender and Criminality on Risk — Anne G. Rhodes, M.S.; Faye S. Taxman, Ph.D.; Peter D. Friedmann, M.D., M.P.H. & Karen L. Cropsey, Psy.D.

Abstract—While studies have explored the prevalence and correlates for hepatitis C (HCV) infection in substance-using and incarcerated populations  these studies have not examined the attributes of criminal histories for those with HCV infection. This study examines the HCV infection rate as it relates to criminal risk factors using baseline data from a randomized trial of re-entering offenders and examines how these risk factors vary by gender. The HCV-positive population had a longer amount of time in confinement (105 vs. 61 months) than those who tested negative. HCV positive men were more likely to currently be receiving drug treatment than women. Criminal risk was positively associated with HCV infection while controlling for major risk factors (OR 1.25, 95% CI: 1.07, 1.46), suggesting that the relationship was not spurious. While criminologists tend to examine risk relative to public safety threats, it appears that the public health needs equally require attention. Policy issues are examined regarding how services can be delivered to treat those with HCV infections within the correctional system and address criminal risk factors.

Keywords—gender, HCV, incarceration, substance use

Predicting HIV/STD Risk Level and Substance Use Disorders Among Incarcerated Adolescents — Cynthia L. Rowe, Ph.D.; Wei Wang, Ph.D.; Paul Greenbaum, Ph.D. & Howard A. Liddle, Ed.D.

Abstract—Incarcerated adolescents are among the most vulnerable groups for STD infection, and substance abuse is prevalent in over half of this population. Substance abuse and HIV/STD-associated risk behaviors are closely linked among juvenile justice-involved youth, but it is unclear whether common antecedents explain these different problems. The current study examined predictors of HIV/STD risk level and substance use disorders, and investigated whether family variables added unique predictive variance for these problems among incarcerated youth. The sample included 154 substance-involved youth ages 13 to 17 recruited in detention facilities in Miami and Tampa, FL and was primarily male (82%) and African-American (58%). Using a comprehensive assessment strategy with data obtained from youth report, parent report, and laboratory confirmed STD testing, the results show that delinquency is a consistent predictor of both HIV/STD risk level and substance use disorders, and also that substance use directly predicts HIV/STD risk level among incarcerated adolescents. Consistent with previous research, family conflict is an important predictor of substance use disorders even after controlling for other factors. The results suggest the need for integrated family-based interventions addressing delinquency, substance abuse, and HIV/STD-associated risk factors with juvenile justice-involved adolescents.
Keywords—adolescents, delinquency, drug abuse, families, HIV risk

Arrest Histories of High-Risk Gay and Bisexual Men in Miami: Unexpected Additional  Evidence For Syndemic Theory — Steven P. Kurtz, Ph.D.

Abstract—Gay and bisexual men continue to suffer the highest burden of HIV/AIDS in the U.S. Since the beginning of the epidemic, substance abuse has been shown to be one of the strongest predictors of sexual risk behaviors and seroconversion among this population. Recent research has focused on additional aspects of health risk disparities among gay and bisexual men, including depression and other mental health problems, childhood sexual abuse, and adult victimization, suggesting that these men are impacted by a syndemic of health risks. The involvement of gay and bisexual men with the criminal justice system is largely absent from the literature. This article describes the nature, extent and predictors of the arrest histories of a sample of gay and bisexual substance users at very high risk for HIV infection and/or transmission. These histories are surprisingly extensive, and are strongly associated with poverty, severe mental distress, substance abuse and dependence, and victimization. The involvement of gay and bisexual men in the criminal justice system deserves a stronger research focus because of the unique challenges facing such men and also because arrests are yet another marker for a host of health risks among them.
Keywords—arrest history, gay men, HIV/AIDS, MSM, syndemic theory