Intervention of HIV, Drug Use and the Criminal Justice System in Malaysia

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DESCRIPTION (provided by applicant): Despite a wide array of HIV prevention approaches and related research, there is a decade-long trend of 11,000 new HIV diagnoses each day globally. Injection drug users (IDUs) remain a target population as they represent a significant vector for the transmission of new HIV infections, which occur through preventable drug- and sex- related HIV risk behaviors. The criminal justice approach to addressing chemical dependency has primarily been incarceration, resulting in concentration of HIV+ in prison settings. A number of evidence-based HIV risk reduction interventions are now widely available as complete behavioral intervention packages. Very few evidence-based interventions have been designed and adapted for HIV+ prisoners transitioning from the prison to the community setting. None have used integrated models. Methadone maintenance treatment (MMT), an evidence-based pharmacological approach to treating opioid dependence, has also not been widely implemented as a secondary HIV risk reduction intervention for released prisoners. MMT has been demonstrated to reduce drug- related injection risks, but arguably has little influence on sexual risk-taking. Public health authorities struggle to implement best practice interventions to intercede with HIV transmission among IDUs, who routinely interface with criminal justice system. As part of our specific aims, we propose: 1) to create a new prison-release behavioral counseling intervention, "Positive Transitions" (PT), by adapting the Holistic Health Recovery Project for HIV+s (HHRP+) for prisoners released to the community and within the Malaysian context in order to improve health outcomes and reduce HIV transmission behaviors; and 2) using a 2x2 multi-factorial design, to conduct a prospective, randomized controlled trial of HIV+ prisoners who meet DSM- IV criteria for opioid dependence to compare prison-release as usual (control group) versus Positive Transitions alone, MMT alone, or the combination of MMT plus Positive Transitions to determine the optimal prison-release intervention. Results from this trial will inform public health authorities about how to best reduce HIV transmission among released HIV+ prisoners with opioid dependence. A team of U.S. and Malaysian investigators with significant previous collaboration and expertise with prisoners, HIV infection, substance abuse treatment and behavioral intervention research pools their collective experience to assist in answering important public health questions regarding evidence-based interventions for released HIV+ prisoners. PUBLIC HEALTH RELEVANCE: HIV+ prisoners with opioid dependence figure greatly in fueling the 11,000 new daily HIV infections globally. Effective prison-release programs that target HIV risk reduction for HIV+s have not been developed or studied using rigorous methodologies. This 2x2 multifactorial, randomized controlled trial of methadone maintenance treatment and an evidence-based behavioral intervention for HIV+s (Holistic Health Recovery Project) will advise public health authorities about how to best intervene with HIV+ prisoners who are transitioning from prison to the community.