Drug Policy, Incarceration, Community Re-entry, and Race Disparities in HIV/AIDS

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DESCRIPTION (provided by applicant): This application is a revision of an application submitted last year in response to PAR-07-379, "Behavioral and Social Science Research on Understanding and Reducing Health Disparities." We will analyze the interconnections between coercive mobility (the massive migration between the criminal justice [CJ] system and the community) produced by US drug policies and race disparities in HIV-related sexual risk among a sample of drug offenders in Connecticut (CT). Further, we will examine whether the association between coercive mobility (CM) and HIV-related sexual risk is affected by the degree of social disorganization in the communities in which these offenders reside. We also will study the feasibility of recruiting and following sexual partners of these individuals to better understand the impacts of CM on partners' HIV-related risk. We hypothesize that CM produces race disparities in HIV risk in a number of distinct ways: 1) Blacks are more likely than Whites to be incarcerated, so HIV-related sexual risk associated with CM can produce race disparities in HIV risk even if the effects of CM are the same for both Blacks and Whites; 2) Blacks are more likely than Whites to reside in communities experiencing the disorganizing impacts of CM, so to the extent that social disorganization exacerbates the effects of CM, it will affect the HIV risks of Blacks to a greater degree than Whites; 3) The sexual partners of Blacks are more likely to come from these same socially disorganized communities, furthering the negative impacts of CM for both returning inmates and their partners, and contributing to race disparities in HIV risk among women; and 4) Blacks are more likely to be penalized by drug policies in ways that increase their movement between prison/jail and the community and their vulnerability to its associated harms. We also hypothesize that we will be able to recruit and retain the sexual partners of study participants and conduct exploratory analyses of the impact of CM on their HIV-related sexual risk. An active Community Advisory Board including policymakers and program administrators will assist us in identifying structural interventions to reduce race disparities in HIV based on study findings. PUBLIC HEALTH RELEVANCE: This research will examine the interconnections among drug policies in the US, coercive mobility (massive migration in and out of the criminal justice system), and race disparities in HIV-related sexual risk. It will suggest potential structural interventions for addressing the movement between prison/jail and the community, including drug policy reforms, with the potential to reduce race disparities in HIV/AIDS.