HIV Risk Behavior in Drug-Involved Former Inmates

描述(由申请人提供)：刑事司法人员数量庞大，人数不断增加，艾滋病毒/艾滋病和药物使用障碍的流行率很高。在刑事司法系统中，妇女的艾滋病毒/艾滋病和药物依赖的流行率高于男子。从监狱释放到社区后，与毒品有关的前囚犯有相当大的机会从事将自己和社区成员置于艾滋病毒风险中的高风险行为。这些危险行为发生在一系列复杂的过渡性挑战的背景下。在这种情况下，艾滋病毒危险行为可能受到监禁前、监禁和重返社会因素的影响，包括社区监督地位和性别。这项拟议的研究试图使用一个理论驱动的框架来检验出狱后危险行为的相关因素。Binswanger博士(PI)之前的工作表明，前囚犯，其中大多数有物质依赖，死亡风险很高，特别是在出狱后的头两周。艾滋病毒危险行为可能反映了死亡率的时间模式，在出狱后的头两周达到峰值，并在3个月后稳定下来。社区监督(假释或缓刑)和性别可能会影响危险行为。艾滋病毒危险行为也可能与其他健康危险行为有关，如吸烟、危险饮酒和酒后驾车。这项研究的目的是检验涉及毒品的前囚犯的以下目的：1)表征出狱后一段时间内艾滋病毒危险行为的特征；2)测试社区监管下涉及毒品的前囚犯的艾滋病毒危险行为是否低于没有社区监督的囚犯；3)测试女性的艾滋病毒危险行为是否高于男性；以及4)确定艾滋病毒危险行为是否与其他健康危险行为相关。这些目标将通过前瞻性纵向队列设计在科罗拉多州随机抽样200名男性和女性涉及毒品的前囚犯中实现。这项研究的结果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，以减少从监狱获释的涉毒囚犯及其返回的社区中艾滋病毒的传播风险。 与公共卫生有关：艾滋病毒/艾滋病和药物使用障碍在刑事司法系统中很常见。涉及毒品的前囚犯的艾滋病毒危险行为对公共健康具有重大影响，因为涉及毒品的前囚犯可能会使自己和其他社区成员面临感染艾滋病毒和其他传染病的风险。这项建议旨在更好地了解涉及毒品的前囚犯的艾滋病毒危险行为模式，以制定有针对性的、及时和适当的干预措施，以减少艾滋病毒的传播。

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.