Availability is Not Access: Recently Incarcerated Women, HIV Risk, and Substance Use Disorders

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Women recently released from incarceration are rapidly growing in number and suffer from syndemic risk of HIV, substance use disorders (SUD), trauma, medical problems, and recidivism. In uncontrolled studies in a research setting, our gender and trauma-specific intervention grounded in the Self-Determination Theory of motivation, Women's Initiative Supporting Health (WISH), shows promise in engaging women into needed treatment. This proposed randomized control trial will examine the feasibility and acceptability of WISH in a community health setting to improve health of women recently released from incarceration. Recruitment sites include court, jail, transitional housing, and community service settings. Our prior work lays the foundation for us to collaborate with community partners and examine implementation of this project in a larger scale future study. The specific aims include engaging women in behavioral and medication treatment to prevent HIV infections and address SUD, mental health, and intimate partner violence. WISH is culturally-specific because it is delivered by a trained formerly incarcerated peer who both enhances patients' choice and feelings of competence to change behaviors and helps them navigate the complex medical system. In addition to the other health risks noted, stress and mental health problems which recently released women experience put them at risk of immune dysfunction that can lessen their ability to fight infection. We will also examine whether participants' immune markers in their blood are impacted by WISH. To understand how WISH works, we will also examine participants' Self-Determination Theory-based mediation measures regarding changes in health behavior, along with any behavior changes. Since both individual and structural barriers prevent recently released women from being healthy, WISH operates on both levels. Individually, WISH sessions are one-on- one between the woman and her peer community health worker. Structurally peers inform providers regarding women's treatment needs and readiness, and help women navigate linkage with needed services and overcome systemic barriers to care. Women in the control group will be randomized to enhanced treatment as usual with assistance linking to primary care but will receive HIV prevention information in lieu of the WISH intervention. If successful among recently released women, WISH has potential for success with women under community corrections with similar risk factors and is potentially cost-saving. Our proposal is responsive to new NIH HIV/AIDS research guidelines: we will examine feasibility and acceptability of WISH to help providers identify people at HIV risk, and promote entry and adherence to HIV prevention; while examining biological and behavioral mechanisms of changes in HIV risk, we will develop community and training infrastructures which will reduce disparities in HIV acquisition. Our structural and individual Self-Determination Theory-based intervention uniquely addresses HIV, serves recently released women, has trauma-specific practices, utilizes peer navigation, and examines immunologic biomarkers as potential mediators.