HIV Risk Behavior in Drug-Involved Former Inmates

描述（由申请人提供）：刑事司法人口庞大，不断增长，艾滋病毒/艾滋病和物质使用障碍的患病率很高。刑事司法系统中的妇女感染艾滋病毒/艾滋病和吸毒的比例高于男子。从监狱释放到社区后，涉毒的前囚犯有相当大的机会从事高风险行为，使自己和社区成员面临感染艾滋病毒的风险。这些风险行为发生在一系列复杂的过渡挑战的背景下。在这种情况下，艾滋病毒风险行为可能受到监禁前、监禁和重返社会因素的影响，包括社区监督状况和性别。这项拟议的研究试图使用理论驱动的框架来检查与出狱后风险行为相关的因素。Binswanger博士（PI）先前的工作表明，前囚犯，其中大多数有物质依赖，死亡的风险很高，特别是在出狱后的头两周。艾滋病毒风险行为可能反映了死亡率观察到的时间模式，在出狱后的头两周达到高峰，3个月后趋于稳定。社区监督（假释或缓刑）和性别可能影响风险行为。艾滋病毒风险行为也可能与其他健康风险行为有关，如吸烟、危险饮酒和酒后驾驶。本研究的目的是考察吸毒前囚犯的以下目标：1)出狱后随时间变化的HIV风险行为特征；2)检验接受社区监管的吸毒出狱人员的HIV危险行为发生率是否低于未接受社区监管的出狱人员；3)检验女性是否比男性有更高的HIV危险行为流行率；4)确定HIV危险行为是否与其他健康危险行为相关。这些目标将采用前瞻性纵向队列设计，在科罗拉多州的200名男性和女性吸毒前囚犯中随机取样。这项研究的发现将带来有助于设计适当的、有针对性的和最佳时机的干预措施的知识，以减少从监狱释放的涉毒囚犯和他们返回的社区中传播艾滋病毒的风险。

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.