Prevention Needs of HIV+ Persons Awaiting Release from Prison

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DESCRIPTION (provided by applicant): HIV affects a disproportionate number of incarcerated persons. Correctional facilities have therefore been targeted by the CDC and HRSA as key settings for HIV prevention and treatment efforts. The impact of known HIV+ prisoners engaging in transmission risk behavior is of clear public health significance, particularly because most will return to the community. However, far less is known about the prevention needs of HIV- positive than of HIV-negative prison inmates. In order to design acceptable, feasible, and effective transmission risk reduction interventions for HIV+ persons leaving prison, the specific prevention needs of this population must be clearly explored and identified, particularly in terms of their risk reduction information, motivation, and behavioral skills strengths and weaknesses. Interventions that begin during incarceration and follow inmates after release are thought to have the greatest chance of impacting behavior over time. However, key questions remain unanswered regarding how best to design and tailor "prevention for positives" programs during and immediately following incarceration. The proposed research is needed to address these issues. We will conduct two formative studies that are conceptually guided by Fisher's Information-Motivation-Behavioral Skills (IMB) Model of HIV prevention. In applying the IMB model to new populations, elicitation research is recommended as the first step in developing tailored interventions and measures. In Study 1, we will conduct individual elicitation interviews with 30 incarcerated HIV+ persons awaiting release from prison to identify specific theory-based risk reduction information, motivation, and behavioral skills strengths and weaknesses. We will also assess the acceptability and feasibility of potential protocols for "prevention for positives" interventions that could be implemented during and following incarceration. A grounded theory approach to qualitative analysis will be used, guided by the IMB model. In Study 2, findings from Study 1 will be used to modify an existing quantitative measure of risk reduction information, motivation and behavioral skills to be culturally appropriate for telephone administration to an HIV+ prison population. The adapted IMB survey will be pre-tested with 20 incarcerated HIV+ persons awaiting release. An expert pre-review process and an iterative cognitive interviewing approach to survey development will be employed. Cognitive interviewing "think aloud" techniques are considered particularly useful for designing surveys that include sensitive or intrusive questions and for lower literacy populations. This formative project will evaluate the prevention needs of HIV+ inmates awaiting release from prison, and will serve to guide the development of culturally appropriate, theory-based intervention and assessment materials tailored to their needs. Gaining a clearer understanding of how to reduce HIV transmission risk behaviors among known HIV-positive prisoners is of great public health significance. This formative project will evaluate the prevention needs of HIV- positive inmates awaiting release from prison, and will serve to guide the development of culturally appropriate, theory-based intervention and assessment materials tailored to their needs. This research focus has the potential for high impact because HIV disease and incarceration co-occur at extremely high rates, with nearly all HIV-positive inmates released back in to the community over time.