Prevalence of HIV infection and AIDS cases is higher among inmates of correctional facilities than among the general population, especially for female inmates. This creates a strong need for effective HIV prevention with this population. Maryland's Prevention Case Management (PCM) program provides individual or group counseling to inmates nearing release to promote changes in risk behavior. Pretest and posttest surveys assess changes in perceived risk, condom attitudes, condom use self-efficacy, self-efficacy to reduce injection drug risk and other substance use risk, and behavioral intentions during participation in the program. Client contact logs, kept by counselors, document the number and duration of sessions, and the specific modules, completed by participants. Over a 4-year period, PCM records identified 2,610 participants in the program. Pre-intervention and postintervention data were available for 745 participants, with client contact log records available for 529 (71%) of these individuals. Significant, positive changes were found in self-reported condom attitudes, self-efficacy for condom use, self-efficacy for injection drug use risk, self-efficacy for other substance use risk, and intentions to practice safer sex post-release. Inmate populations are a crucial audience for HIV/AIDS testing, treatment, and prevention efforts. The Maryland PCM program has documented positive changes in participants' attitudes, self-efficacy, and intentions related to HIV risk, over a 4-year period.

This article describes, compares, and contrasts the contexts, processes, and results of the experiences of Maryland and Massachusetts in diffusing evidence-based interventions. The evolution of first Maryland's, then Massachusetts's, diffusion of effective interventions is described. Both states have extensive experience planning, developing and evaluating individual-, group-, and community-level interventions promoted in the Centers for Disease Control and Prevention's Diffusion of Effective Behavioral Interventions (DEBI) initiative, as well as overcoming many barriers to translate research to practice. This article describes the processes whereby effective interventions were diffused from the planning to evaluation stages. This includes the role of community-planning groups and other local stakeholders in planning, procurement methods, and capacity building approaches. Specific milestones in increasing the evidence basis of program implementation, management, and evaluation are presented. For jurisdictions considering implementing DEBI, the article illustrates core programmatic and infrastructure capacities at the state and vendor level important to success in Maryland and Massachusetts. It also describes how each state's approach to the management and evaluation of prevention programs contributed to the effective diffusion of the behavioral interventions. Finally, this article provides recommendations about remaining gaps in evidence-based interventions to meet "real-world prevention needs" and ways to improve prevention targeting and effectiveness. This article recommends strategies to improve the dissemination of DEBI and other evidence-based interventions nationally.

Purpose: There is growing concern that value-based payment for health care may disadvantage health care organizations that serve populations with social risk. In the broader investigation of social risk factors, including income, education, neighborhood deprivation, and other risks, the focus on race and ethnicity as a risk factor for disparities in health and health care has diminished. Understanding the independent contribution of minority group status is critical to this discussion. This narrative review discusses four concepts—minority stress, resilience, epigenetics, and life course—that may help explain the contribution of minority group status and its association with health disparities.Methods: We briefly describe each concept and the supporting evidence.Results: Our results indicate that all four concepts have potential relevance for understanding and addressing health disparities. The life course perspective emphasizes the importance of understanding explanatory mechanisms and factors that contribute to health—including biological, physical, and social factors—over a person's life span. Both minority stress and resilience may influence health in either a negative or positive manner that potentially underlies health changes. Exposure to these factors and others may interact with and modify epigenetic regulation—biological processes that impact how our genes are expressed. This may increase the risk of disease and negative health outcomes, particularly among groups that may be at disproportionate risk because of social circumstances and environmental exposure over the life course.Conclusion: Despite these concepts' relevance, more research is needed to assess how they may explain the relationship between minority status and disparities in health. Such evidence is needed to focus interventions and to inform the design of delivery and payment models that can spur actions to reduce disparities.

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