Prevalence and correlates of HIV and STIs among

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Prevalence and correlates of HIV and STIs among drug-involved female offenders under community supervision

Prevalence and correlates of HIV and STIs among drug-involved female offenders under community supervision in New York City Nabila El-Bassel, Louisa Gilbert, Elwin Wu, Dawn Goddard-Eckrich, Mingway Chang, Susan Witte, Matthew Epperson Columbia University Social Intervention Group, New York, NY Introduction HIV/AIDS and criminal justice involvement are critical intersecting public health issues for drug-involved women. Low-income, Black women especially bear the burden of the HIV epidemic and are overrepresented in the U. S. criminal justice system. Accumulating research indicates that incarceration is a major driver of HIV. 1, 2 However, little is known about HIV risks and prevalence of HIV and other sexually transmitted infections (STIs) among drug-involved women on probation and other forms of community supervision. Probation is currently the fastest growing segment of the criminal justice population nationwide. The number of adults on probation in the U. S now represents 1 out of 45 adults. This study aims to examine the prevalence and correlates of HIV among drug-involved women under community supervision. Methods HIV, STIs and sexual risk behaviors: Among the total sample, 13% (N=45) tested positive for HIV (only one participant did not previously know that they were HIV positive) and 26% tested positive for an STI (Chlamydia, gonorrhea, and/or trichomoniasis). High rates of sexual risk behaviors were found among both HIV positive and HIV negative participants as indicated in Figure 2. About one-half of the women (48%) reported having had sex with an outside partner and one-quarter of the women (26%) reported exchanging sex for money or drugs. About two-thirds of the women reported having had unprotected sex in the past 90 days. HIV positive women were more likely to test positive for trichomoniasis than HIV negative women. No significant differences were found between HIV status and STIs or other sexual risks, except HIV positive status was found to be associated with not having had any unprotected sex in the past 90 days. Figure 2: Sexual HIV Risks in the Past 90 Days by HIV status (N=337) Data for this NIDA-funded HIV prevention trial (Project WORTH) were drawn from 337 women offenders under community supervision, who reported using drugs and engaging in one or more HIV risk behaviors in the past 90 days. Trained female research assistants recruited women from probation and other community supervision sites. Participants completed a baseline survey using an audio computer assisted structured interview (ACASI). The Risk Behavioral Assessment was used to measure HIV risk behaviors and drug use. At the end of the baseline interview, participants were tested for HIV and for three STIs (gonorrhea, Chlamydia, and trichomoniasis). Multiple logistic regression analysis was used to examine drug use and criminal justice correlates of HIV after adjusting for socio-demographics (i. e. , age, ethnicity/race, marital status, education, and employment status). 80% 70% 60% 50% HIV + 40% HIV- 30% Results 20% Socio-demographics: The average of women was 41 (SD=10. 4) and only 15% were married. The majority (66%) were Black. Less than one-tenth (9%) were employed. Half (52%) were charged with a drug-related crime. Four-fifths reported ever using crack cocaine and about one-fifth reported using heroin. About one-quarter of the women reported ever injecting drugs. The large majority (90%) had spent time in jail and 41% have been incarcerated in prison. Bivariate analyses indicate that women who tested positive for HIV were more likely to be Black, older, report ever using crack cocaine and be charged with a drug-related offense and less likely to be charged for assault. Table 1: Socio-demographics and Drug Use by HIV (N=337 ) Total HIV Negative Positive 337 292 (87%) 45 (13%) Age 41. 3 (10. 4) 40. 8 (10. 5)* 44. 8 (8. 5)* Black (vs. White as ref group) 221 (66%) 184 (83%)* 37 (17%)* Latina (vs. White as ref group) 57 (17%) 52 (92%) 5 (8%) High School or GED 195 (57%) 167 (57%) 28 (14%) Single 226 (67%) 198 (87%) 28 (13%) Married 52 (15%) 42 (81%) 10 (19%) Employed 31 (9%) 30 (97%) 1 (3%) Homeless (past 90 days) 33 (10%) 28 (85%) 5 (15%) Ever used heroin 70 (21%) 57 (81%) 13 (19%) Ever used crack/cocaine 268 (80%) 224 (83%)** 44 (17%)** Ever used illicit drugs 327 (97%) 282 (86%) 45 (14%) Ever injected drugs 76 (23%) 63 (83%) 13 (17%) N * p<0. 05; ** p<0. 01 Total N Sex w/o condoms >1 partner Sex Trading STI positive Trichomonas Multivariate Analyses: After adjusting for socio-demographics, women who had ever used crack cocaine were more likely to test positive for HIV. History of heroin use, injection drug use and any illicit drug use were not associated with HIV. History of incarceration or spending time in jail were also not associated with HIV. Conclusions The highly concentrated epidemic of HIV and STIs and high rates of sexual risk behaviors including sex trading found among this sample of drug-involved women under community supervision underscores the urgent need to intensify HIV prevention efforts for this population. Targeting a continuum of HIV prevention, testing and treatment strategies for Black women, women with drug -related charges and women who have a history of crack cocaine use in community supervision settings may be critical for stemming this concentrated epidemic. Such community supervision settings present a real opportunity to reach out to women who are extremely high risk for HIV/STIs. Our experience conducting Project WORTH suggests that it is feasible to recruit and engage women from probation and other community supervision settings in HIV prevention efforts. Literature Cited of Justice Statistics Bulletin, NCJ 205333, 1 -11. 2 Spaulding, A. , Stephenson, B. , Macalino, G. , Ruby, W. , Clarke, J. G. , & Flanigan, T. P. (2002). Homan Immunodeficiency Virus in Correctional Facilities: A Review. Clinical Infectious Diseases, 35(3), 305 -312. 3 Bureau of Justice Statistics Correctional Surveys. (2009). The Annual Probation Survey, National Prisoners Statistics Program, Annual Survey of Jails, and Annual Parole Survey. Washington, DC. HIV Negative Positive 337 292 (87%) 45 (13%) Ever in jail 302 (90%) 260 (86%) 42 (14%) Ever in prison 138 (41%) 120 (87%) 18 (13%) Most recent charge (n=331) Property crime (theft, etc. ) 18 (5%) 16 (89%) 2 (11%) Assault or violent crimes 38 (11%) 38 (100%)** 0 (0%)** Drug crimes (possession or use of an illegal drug) 175 (53%) 144 (82%)* 31 (18%)* 16 (5%) 13 (89%) 3 (11%) Prostitution 0% 1 Maruschak, L. M. (2004). HIV in Prisons and Jails, 2002. Bureau Table 2: Criminal Justice Involvement by HIV Status (N=337) 10% Acknowledgments This study is funded by NIDA. We deeply appreciate the time and efforts of all the women who participated in the study. We would also like to acknowledge the Project WORTH team who made this study possible. AIDS 2012 – Washington, D. C. , USA