Research That Matters (January 17 - 20, 2008)

PURPOSE: An area of research that has gained considerable recognition over the last ten years is the increasing prevalence of HIV and AIDS in the criminal justice system. It is estimated that 25% of all HIV-infected Americans pass through the U.S. correctional system annually. In response to this phenomenon, criminal justice settings have been identified as a prime opportunity for HIV prevention and treatment. HIV risk for male offenders has been found to be associated with several factors relating to substance abuse. However, few studies have explored the relationship between criminal justice involvement and specific HIV risk behaviors for substance abusing male offenders. This study examines the relationship between criminal justice involvement (history of arrest and incarceration) and drug and sexual HIV risk behaviors among a random sample of men in methadone maintenance treatment programs (MMTP's) in New York City. The study addresses two questions: 1) Does recent criminal justice involvement increase the likelihood of specific HIV risk behaviors among men on methadone? and 2) Is a history of criminal justice involvement associated with increased prevalence of HIV for men on methadone?

METHODS: A random sample was drawn from 2,067 men enrolled in seven MMTP's in New York City, and 356 men completed a 90-minute structured baseline interview. The sample was primarily Latino (45%) and African American (38%), the mean age was 43.6 years, and average years of schooling was 11.6. Measures relevant to this study included socio-demographic variables, past 6 month sexual and substance related HIV risk behaviors, HIV status, and past 6 month and lifetime measures of arrest and incarceration. Logistic regression was used to estimate the association between participant HIV status and criminal justice history, with covariance adjustment for age, ethnicity, and education. Second, we examined the association between recent arrest and incarceration and sexual and drug HIV risk behaviors. The adjusted logistic regression models included one outcome variable and one measure of criminal justice involvement, with covariance adjustment for age, homelessness, time in methadone treatment, and whether the participant used drugs in the past 6 months.

RESULTS: A lifetime history of incarceration was significantly associated with being HIV positive (Adjusted OR=5.08, p≤.01). Recent arrest was associated with unprotected vaginal sex and having multiple sexual partners. Both arrest and incarceration were associated with sex trading, and the strongest association was found between recent incarceration and selling sex (Adjusted OR=5.69, p≤.001). Injection drug use was also associated with recent arrest and incarceration.

IMPLICATIONS: The findings underscore the need for delivery of effective HIV prevention models for substance abusing men who have spent time in correctional settings. The strong association between criminal justice involvement and sex trading highlights a group in great need of focused HIV prevention/education efforts. The development of HIV treatment and prevention models for substance using male offenders must focus on community populations as well as institutional settings. Future research should explore the instrumental variables involved in the increased risk of HIV/AIDS for substance abusing populations in the criminal justice system.