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

描述（由申请人提供）：刑事司法罪犯中的艾滋病毒风险很高。感染率比一般人口高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。监狱过度拥挤使罪犯面临更大的艾滋病毒风险，未能成功地从监狱或监狱过渡到社区也是如此。刑事司法机构过度拥挤已陷入危机 比例在美国和任何地方的问题比在加州更糟糕。2006年，该州拥有全国最大的监狱系统，有超过173，000名囚犯，但它只能容纳约100，000人。2011年，美国最高法院裁定，加州的监狱必须释放3万多名罪犯，因为过度拥挤的程度构成了残忍和不寻常的惩罚。目前尚不清楚这些罪犯获释后将住在哪里，也不清楚他们将如何获得在社区取得成功所需的服务。如果不能获得住房、工作和支持向社区过渡所需的服务，艾滋病毒感染和传播的风险就很高，再次被捕和再次监禁的风险也很高。在全国范围内，大约40%的假释犯在释放后一年内再次被捕。借鉴syndemics理论，一种新的干预措施，加强案件管理与动机访谈（动机访谈案件管理[MICM]）将解决艾滋病毒和一系列相关的问题，已知加剧艾滋病毒疾病的刑事司法罪犯。与标准MI的创新差异包括：1）首次对有艾滋病毒风险的罪犯采用基于MI的干预措施。2)使用MI来适应住宅恢复环境。3)使用MI来靶向已知影响HIV的综合征因素（例如，心理健康，医疗和住房不稳定），4）使用MI来增加对假释和缓刑条款的遵守，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)使用MI在药物复发后重建恢复。7)使用MI解决挫折（例如，药物复发，失业）。重点领域的选择是根据罪犯的需要逐案进行的。无毒住房将通过清醒生活网络（SLN），一个组织，认证超过500清醒生活的房子（SLH）在加州访问。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差，艾滋病毒问题没有得到评估。扩大我们目前的艾滋病毒服务赠款，使用MI的男男性行为者和变性人，我们将使用MICM来解决艾滋病毒的风险和综合因素，增加风险。一个样本的330名罪犯在高风险的艾滋病毒谁是进入SLH将被随机分配到一个转介资源（比较）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、物质使用、逮捕和重新监禁以及成瘾严重程度指数问题的测量。结果将验证使用MICM与SLH作为一个廉价和可复制的选择罪犯。

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.