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Prisoners with HIV engaged in many risky behaviors before they were imprisoned
HIV-infected people imprisoned in North Carolina had high rates of alcohol use, drug use, and high risk sexual activity within the six-month period before their incarceration, according to a new study.
The study’s purpose is to randomize released HIV-positive inmates to receive a standard of care in discharge planning versus those who are teamed with a bridging case manager, says Lisa B. Hightow, MD, MPH, an assistant professor in the department of medicine at the University of North Carolina in Chapel Hill, NC.
About 85% of the inmates surveyed were African American, and the median age was close to 40 years. The median number of incarcerations was three.1
"One third of subjects have had a mental health diagnosis, including depression, schizophrenia, psychosis disorders, etc.," Hightow says.
A large portion of the inmates had never been on antiretrovirals before their incarceration, Hightow notes.
"Many of these men and women are diagnosed in prison or get started on the medication in prison, but when they leave the medication stops," Hightow says. "Everything falls apart, and then they get re-incarcerated, and it’s a vicious cycle."
The bridging case manager works one-on-one with inmates for three months before their release and three months afterward, Hightow says.
"The bridging case manager works extensively with that person to assist with housing, food stamps, making clinic appointments, substance abuse programs, and community release programs," Hightow says. "They’ll work with the person to build self esteem and self-efficacy."
The study will enroll 150 HIV-positive participants from prisons across North Carolina when recruitment is complete, Hightow says.
Early data show striking amounts of alcohol use, Hightow notes.
"When we looked at 60 inmates, we found that 33%were drinking alcohol every day in the three months prior to incarceration," Hightow says.
"And of those who were drinking alcohol, 27% were drinking five or more drinks every day," Hightow says. "That’s a significant use of substances, and that’s something we don’t often talk about."
Also, 71%of the men and 74% of the women reported using drugs in the three months prior to incarceration, Hightow says.
"The most common drug for men was marijuana, and for women it was crack," she adds.
Most of the subjects reported knowing their HIV status prior to the current incarceration, so the substance use reflected activities they were engaged in while they knew they were HIV positive, Hightow notes.
"When we look at sexual behaviors, and this is in the six months prior to incarceration, one of the interesting things to me is that the women tended to have more sex partners than the men, for a mean of 6.7 sexual partners," Hightow says. "And the men had a mean of 3.6 sex partners."
About 15% of the men and none of the women reported injection drug use, Hightow says.
All of the women said they had acquired HIV through heterosexual sex, although only 68%of the women said they had sex with men only, and 95% of the men said they had sex with women only, Hightow says.
"I think we need to remember the incarcerated population is a community population, and our prevention efforts need to incorporate all aspects of the person, including the medical, substance use, and mental health aspects," Hightow says. "This is some sort of vicious cycle where they get arrested, get treated, and then go out and engage in the same activities that got them arrested in the first place."
Then the HIV positive inmates stop taking their medications consistently when they’re released, so they develop antiretroviral drug resistance, which is a huge concern from a public health perspective, Hightow adds.
Another way bridging case management might help is with getting inmates into the AIDS Drug Assistance Program (ADAP) if they’re not already enrolled, and having them stay in the program, Hightow says.
In North Carolina, ADAP has a long waiting list, which will impact this population, she notes.
While there are some substance use and HIV prevention programs provided to inmates, states always can do more, especially after they’re discharged, Hightow says.
"When they’re incarcerated they get on medications and do very well," Hightow says. "So it’s not that period in prison where they need an intensive intervention."
The problem is that once inmates are released they have competing needs and so they stop focusing on their own health, Hightow says.
"I’m hopeful that bridging case management will improve the quality of life and decrease some of these risky behaviors and improve their ability to avoid re-incarceration," Hightow says. "That’s the hope of this study."
Reference:
- Hightow LB, et al. Drugs, alcohol and risky sex: life prior to incarceration among HIV-infected North Carolina prison inmates. Presented at the 43rd Annual Meeting of the Infectious Diseases Society of America, Oct. 6-9, 2005, in San Francisco, CA. Abstract: 752.
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