Community Legal Systems: Targeting PrEP and HIV Education to Decrease Risk of HIV Transmission

Abstract

The southern U.S. has both high HIV and incarceration rates in comparison to its population. As in the rest of the country, HIV prevention is based on education, behavior change, and biomedical efforts, such as pre-exposure prophylaxis (PrEP). This study examined the implementation of an educational intervention and supportive services to obtain PrEP in a population of individuals (N = 218) involved in an Adult Drug Court (ADC) or on probation or parole (P-P). Nearly all ADC and P-P participants self-reported risk behaviors linked to HIV acquisition. Results supported the acceptance and usefulness of the intervention as rated by participants. Participants showed increased knowledge of HIV risks and testing post-education. In multivariate analysis, predictors of interest in using PrEP included low stigma beliefs, specifically their level of prejudice views, high depressive symptoms, and white race. The intervention shows promise. Given the high risk documented for ADC and P-P individuals, HIV prevention is a critical component for increased protective behaviors.

Health Equity Considerations: HIV Intervention Adaptation for Black Women in Community Corrections

“…Three-fourths of a recent sample of 243 African-American women in carceral settings reported a drug problem (Oser et al, 2016), when compared with 45% of all women on probation (The Pew Charitable Trusts, 2018) and 15% among women in the general population (NIDA, 2020). Largely attributed to intersecting individual, interpersonal, and highly racialized systemic risks, those who face these challenges concurrently also report significantly higher levels of system mistreatment (Whiteside-Mansell et al ., 2021). They are far more likely to be unfairly targeted by racialized drug laws, aggressive- and over policing, and disproportionately high criminal legal system sentences (Whiteside-Mansell et al, 2021).…”

“…Largely attributed to intersecting individual, interpersonal, and highly racialized systemic risks, those who face these challenges concurrently also report significantly higher levels of system mistreatment (Whiteside-Mansell et al ., 2021). They are far more likely to be unfairly targeted by racialized drug laws, aggressive- and over policing, and disproportionately high criminal legal system sentences (Whiteside-Mansell et al, 2021). Identified as key social and structural drivers of the HIV/sexually transmitted infections (STI) epidemic (Seeley et al, 2012), these racialized criminal-legal risks are also positively associated with high levels of system distrust (Dyson et al, 2017), a decreased desire to engage in prevention and intervention services (Hoff et al, 2022), and are believed to be significantly associated with lags in the U.S.’ efforts to attain health equity goals among BIPOC women (McCree et al, 2016).…”

Trauma, Mental Health Distress, and Infectious Disease Prevention Among Women Recently Released From Incarceration

“…PTSD is associated with low engagement in care among male and female populations transitioning from jail (41). Conversely, depressive symptomology is significantly associated with greater (not less) interest in a pre-exposure prophylaxis (PrEP) intervention (42). Given these associations between incarceration, accumulated trauma, and both depressive and post-traumatic stress symptomology, these latter findings suggest that women transitioning from jails and prisons may encounter even greater difficulty when attempting to adhere to HIV treatment and engage in care.…”