Recidivism in HIV-Infected Incarcerated Adults: Influence of the Lack of a High School Education

Abstract

Recidivism is a pervasive problem facing the incarcerated. Incarcerated persons who are human immunodeficiency virus (HIV)-infected often have multiple risk factors associated with initial incarceration and recidivism, in particular, injection drug use. Yet, some jails provide case management for HIV-infected inmates to provide continuity of health care, which might have positive effects on reentry into the community. We sought to measure recidivism and factors related to recidivism in an HIV-infected cohort in an urban county jail with an active case management program. Fifty-two inmates surveyed in 1999 at the San Francisco County Jail were followed for rearrests through 2006. In follow-up, 73% were re-incarcerated on an average of 6.8 times for 552 days. Risk factors included nonwhite ethnicity, history of homelessness and crack use, common risk factors for incarceration. Less than high school education was associated with recidivism, shorter time to reincarceration, and more incarcerations. HIV-infected inmates spend a high proportion of time in multiple incarcerations, a reflection of the cyclical nature of incarceration despite comprehensive case management. Well-known risk factors for incarceration were associated with recidivism; in addition, lack of high school education played a prominent role. Education should be explored as a way to make further progress on breaking the cycle of incarceration.

Understanding the Revolving Door: Individual and Structural-Level Predictors of Recidivism Among Individuals with HIV Leaving Jail

“…An estimated one in six HIV-infected persons in the U.S. spend time in a jail or prison every year [1]. In a 6-year follow-up study of an HIV-infected cohort in an urban county jail, 73 % of individuals were re-incarcerated an average of 6.8 times over 552 days [2]. While recidivism has been widely studied in the criminal justice population, this phenomenon is still not well understood among individuals with HIV, particularly among those leaving jail, and has yet to be examined in a large cohort.…”

“…Despite the significant impact of recidivism on health and health behaviors, few health interventions for individuals with HIV who are involved in the criminal justice system have addressed recidivism directly as a predisposing factor for poor health outcomes. Additionally, few interventions have achieved conclusive reductions in recidivism or have assessed this outcome [2]. Health interventions for this population have largely focused on directly modifying HIV risk behaviors or enhancing linkage to HIV treatment and care [2, 19–27].…”

“…Additionally, few interventions have achieved conclusive reductions in recidivism or have assessed this outcome [2]. Health interventions for this population have largely focused on directly modifying HIV risk behaviors or enhancing linkage to HIV treatment and care [2, 19–27]. Some have argued that to elicit more sustainable health outcomes, such interventions should also address risk for recidivism [2, 9, 28–30] and target modifiable individual and structural-level risk factors for recidivism.…”

Education, empowerment and community based structural reinforcement: An HIV prevention response to mass incarceration and removal

“…Recent research on how to reduce this HIV risk is less focused on behavior of individuals before, in, and after jail and prison, and more focused on the resources available through social networks and opportunity in communities on the outside (Edlin et al, 1994; Freudenberg, Galea, & Vlahov, 2005; Marlow, White, Tulsky, Estes, & Menendez, 2008). This undergirds a shift away from individualizing interventions to structural interventions, which are premised on the concept of fundamental cause, as cogently elucidated by Link & Phelan (Blankenship, Friedman, Dworkin, & Mantell, 2006; Link & Phelan, 1995).…”

Social policy, imperiled communities and HIV/AIDS transmission in prisons: a call for zero tolerance

“…African-American communities have been damaged historically in the United States by health, economic, corrections, and other social policies that have severely compromised the ability of families living at low or minimum wage to survive, thrive and remain united [1,2]. These policies have affirmatively excluded the poor, most significantly poor, single adults that are disproportionately African-American men, and have had a cumulative effect on individual and family poverty [3].…”