Reducing Offenders' HIV Risk: MI Enhanced Case Management with Drug-Free Housing

描述(申请人提供)：刑事司法罪犯感染艾滋病毒的风险很高。感染率高达一般人口的10倍，所有艾滋病毒感染者中有25%与刑事司法系统有过接触。监狱和监狱人满为患使罪犯感染艾滋病毒的风险增加，而未能成功地从监狱或监狱过渡到社区也是如此。刑事司法机构人满为患已到了危机 美国的比例，没有哪个地方的问题比加州更严重。2006年，该州拥有全国最大的监狱系统，有超过17.3万名囚犯，但只能容纳约10万人。2011年，美国最高法院裁定，加利福尼亚州的监狱必须释放3万多名罪犯，因为过度拥挤的程度构成了残酷和不同寻常的惩罚。目前尚不清楚这些罪犯一旦获释将住在哪里，也不清楚他们将如何获得在社区取得成功所需的服务。如果不能获得支持向社区过渡所需的住房、工作和服务，艾滋病毒感染和传播的风险很高，再次逮捕和再次监禁的风险也很高。在全国范围内，约40%的假释犯在获释后一年内再次被捕。根据合并论理论，一种通过激励性访谈加强案件管理的新干预措施(动机访谈案例管理[MICM])将解决艾滋病毒和一系列已知会加剧刑事司法罪犯中艾滋病毒疾病的相关问题。与标准MI的创新区别包括：1)首次对有艾滋病毒风险的罪犯使用基于MI的干预。2)使用MI来适应住宅恢复环境。3)使用MI来针对已知的影响艾滋病毒的共同因素(例如，心理健康、医疗和住房不稳定)，4)使用MI来提高对假释和缓刑条款的遵从性，5)使用MI来寻找和维持工作，6)使用MI来获得服务和保持保留。6)用MI重建药物复吸后的康复。7)使用MI来解决挫折(例如，吸毒复发、失去工作)。根据犯罪者的需要，根据具体情况选择要重点关注的领域。无毒品住房将通过清醒生活网络(SLN)进入，这是一个在加利福尼亚州认证500多个清醒生活房屋(SLH)的组织。我们最近对SLH的研究表明，居民在酒精和药物使用、工作、逮捕和精神问题方面有所改善。然而，刑事司法罪犯的情况比其他居民更糟糕，艾滋病毒问题也没有得到评估。在我们目前对男男性行为者和变性者使用MI的艾滋病毒服务赠款的基础上，我们将使用MICM来应对艾滋病毒风险和增加风险的因素的共同组合。进入SLH的330名艾滋病毒高危罪犯的样本将被随机分配到转诊资源(对照)或MICM(干预)条件。结果将在基线、6个月和12个月进行评估，包括艾滋病毒检测和风险、药物使用、逮捕和重新监禁以及成瘾严重程度指数问题的衡量标准。结果将验证MICM与SLH的使用作为罪犯的一种廉价和可复制的选择。

DESCRIPTION (provided by applicant): HIV risk among criminal justice offenders is high. Rates of infection are up to 10 times higher than the general population and 25% of all HIV infected persons have contact with the criminal justice system. Overcrowding of jails and prisons puts offenders at increased risk for HIV as does a failure to successfully transition from prison or jail into the community. Overcrowding of criminal justice institutions has reached crisis proportions in the U.S. and nowhere is the problem worse than in California. In 2006 the state had the largest prison system in the nation with over 173,000 inmates, but it only had capacity for about 100,000. In 2011 the U.S. Supreme Court ruled that prisons in California must release over 30,000 offenders because the extent of overcrowding constituted cruel and unusual punishment. It is not clear where these offenders will live once they are released or how they will access services they need to succeed in the community. Without access to housing, work and services needed to support transition to the community the risk for HIV infection and transmission is high as are risks for re-arrest and re-incarceration. Nationwide, about 40% of offenders on parole are re-arrested within one year of their release. Drawing on syndemics theory, a new intervention that enhances case management with motivational interviewing (Motivational Interviewing Case Management [MICM]) will address HIV and a host of related problems known to exacerbate HIV disease among criminal justice offenders. Innovative differences from standard MI include: 1) Using an MI based intervention for the first time with offenders at risk for HIV. 2) Using MI to adapt to a residential recovery environment. 3) Using MI to target syndemic factors known to affect HIV (e.g., mental health, medical, and housing instability), 4) Using MI to increase compliance with terms of parole and probation, 5) Using MI to find and maintain work, 6) Using MI to access services and maintain retention. 6) Using MI to reestablish recovery after drug relapse. 7) Using MI to address setbacks (e.g., drug relapse, loss of work). Selection of areas to focus on is made on a case by case basis depending on offender needs. Drug-free housing will be accessed through the Sober Living Network (SLN), an organization that certifies over 500 sober living houses (SLHs) in California. Our recent study of SLHs showed residents improved in terms of alcohol and drug use, work, arrests, and psychiatric problems. However, criminal justice offenders fared worse than other residents and HIV issues were not assessed. Expanding on our current HIV service grants that use MI for MSM and transgenders, we will use MICM to address HIV risk and the syndemic mix of factors that increase risk. A sample of 330 offenders at high risk for HIV who are entering SLHs will be randomly assigned to a referral resources (comparison) or MICM (intervention) condition. Outcomes will be assessed at baseline, 6, and 12 months and include measures of HIV testing and risk, substance use, arrests and re-incarceration, and problems on the Addiction Severity Index. Results will validate the use of MICM with SLHs as an inexpensive and replicable option for offenders.