HIV Risk Behavior in Drug-Involved Former Inmates

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DESCRIPTION (provided by applicant): The criminal justice population is large, growing and has a high prevalence of HIV/AIDS and substance use disorders. Women in the criminal justice system have a higher prevalence of HIV/AIDS and drug dependence than men. After release from prison to the community, drug-involved former inmates have considerable opportunities to engage in high-risk behaviors that put themselves and community members at risk for HIV. These risk behaviors occur in the context of a complex array of transitional challenges. HIV risk behavior in this context is likely influenced by pre-incarceration, incarceration, and re-entry factors, including community supervision status and gender. The proposed study seeks to examine the factors associated with risk behaviors after release from prison using a theoretically-driven framework. Prior work by Dr. Binswanger (PI) has demonstrated that former inmates, most of whom had substance dependence, were at high risk for death, especially in the first 2 weeks after release from prison. HIV risk behavior is likely to reflect the temporal pattern observed in death rates, reaching a peak in the first 2 weeks after release from prison with stabilization by 3 months. Community supervision (parole or probation) and gender may influence risk behaviors. HIV risk behaviors may also be associated with other health risk behaviors, such as tobacco use, hazardous drinking, and driving under the influence of alcohol. The objectives of this study are to examine the following aims in drug-involved former inmates: 1) characterize HIV risk behaviors over time after release from prison; 2) test whether drug-involved former inmates on community supervision have a lower prevalence of HIV risk behaviors than those released without community supervision; 3) test whether women have a higher prevalence of HIV risk behaviors than men; and 4) determine whether HIV risk behaviors are correlated with other health risk behaviors. These aims will be achieved using a prospective longitudinal cohort design in a random sample of 200 male and female drug- involved former inmates in Colorado. The findings from this study will lead to knowledge that will help design appropriate, targeted and optimally timed interventions to reduce the risk of transmission of HIV among drug- involved inmates released from prison and the communities to which they return. PUBLIC HEALTH RELEVANCE: HIV/AIDS and drug use disorders are common in the criminal justice system. The HIV risk behaviors of drug-involved former inmates have a significant impact on public health because drug-involved former inmates can put themselves and other community members at risk for HIV and other infectious diseases. This proposal is designed to gain a better understanding of the patterns of HIV risk behavior among drug-involved former inmates to develop targeted, timely and appropriate interventions to reduce HIV transmission.