Tito: An Education and Empowerment Based HIV Prevention Intervention for People Leaving Jail

BACKGROUND AND PURPOSE: Jails are a key intervention point for HIV prevention. Jails also present unique challenges. Lengths of stay can be only days longs, while interventions are based on longer term engagement. Effective intervention includes both jail in-reach coupled with outreach outside jail, thus bridging the jail release. Teach Inside Teach Outside (TITO) is a group based education and empowerment HIV prevention intervention that begins inside jail and continues in community settings. We hypothesize that TITO would be more effective encouraging follow up with the intervention after jail release than currently accepted prevention interventions that are based on one-on-one counseling. METHODS: In a NIDA funded RCT individuals are recruited from the intake units of the a large city jail and randomized to TITO or an individual counseling-based HIV safety and prevention intervention based on CDC guidelines, which, like TITO, is offered both inside and outside jail by the same providers. Data are collected by face to face interviews in jail, and  at 30 days, 60 days and 6 months after release. Also included is an intensive ethnographic study of TITO and the participants’ experiences of jail detention and jail release. This paper presents results on community based follow up among participants in the in-jail phase of the intervention. RESULTS: Among the first 337 participants released from jail, 91 showed up after jail release to participate in the follow up intervention within the first six months. In a test for experimental TITO vs. Control Condition effects on post-release follow-up, we found none. We conducted a forward stepwise logistic regression to determine which combination of variables had the strongest predictive value of post-release follow up. The final model predicting follow up after jail included a lower jail quality of life score (B=-.056, SE = .013, p < .001), an older age of a first psychiatric hospitalization (B = .017, SE = 008, p < .05) and having received any visits from family or friends while in jail (B = 1.80, SE = .937, p = .05. Ethnographic results illustrate how the jail recruitment site appears to be an especially productive window of opportunity for a select group of aging, vulnerable detainees who seek any friendly services regardless of their format and attend regularly. Qualitative data suggests that the boundaries between the two intervention are blurred upon graduation and as especially active TITO participants self-select as peer volunteers at the Teach Outside service site, seeking extra sessions of the CDC-model ongoing individual-level counseling while participating in the TITO program. CONCLUSIONS AND IMPLICATIONS: Positive, educational, and empowerment-based intervention supplemented by voluntary as-needed access to informal individual counseling among a jail population serves a role in engaging a vulnerable population of people in jail who express a need for help. Further dialogue between the RCT results and ethnographic results may shed light on interactions between this intervention model and specific social, economic, and health related characteristics of participants, including age, ethnic/political identification, pattern of previous arrests and kin-based support networks.