Trauma-Informed HIV Re-Entry Programs: Assessing Childhood Trauma and History of Substance Abuse Among Recently-Released, Female Offenders

Purpose: The number of women entering and leaving state and federal prisons is increasing. At the same time, this population often reports traumatic childhood experiences such as sexual abuse and physical abuse.  Problems associated with childhood sexual abuse (CSA) and other traumas include, low self-esteem, post-traumatic stress disorder, depression, and substance abuse or dependency.  Further, research demonstrates a link between CSA and adult risk for sexually transmitted infections. Women with CSA history have a sevenfold increase in HIV-related, sexual risk behavior. Relatedly, substance abuse may impair judgment and negotiation skills and increase the likelihood of trading sex for money, sex without condoms, and multiple partners.  Despite the documented relationships between childhood traumas, substance abuse and HIV infection, few HIV re-entry programs assess women for past trauma; fewer still, integrate such information into the program components. Researchers sought to answer the question: What is the extent and nature of women’s childhood trauma and history of substance abuse for one sample of released female offenders.

Methods: A total of 59 recently-released female offenders were recruited to participate in a mandated 6- week HIV intervention program. To understand how to adjust program components to meet women’s needs around past trauma, all participants were assessed for childhood trauma (i.e. sexual, emotional, verbal and physical abuse), age of first childhood trauma, age at first substance use, and frequency of events using an interactive pictorial Healing Me Timeline Activity facilitated by trained public health counselors.  This activity asked the women to draw and express their experiences using color-coded graphs on a timeline.

Results: Fifty-nine women completed the Healing Me Timeline Activity. The women ranged in age from 21 to 58 years with between 1 to 9 convictions; sentences ranged from 9 months in state jails to 18 years in Texas Department of Criminal Justice with a mean age of 24.4 on first offense. The participants reported their race as White 22 (37.3%), Black or African American 28 (47.5%), and Latino 9 (15.3%). Of the 59 participants, 83% reported a history of childhood abuse, 93% reported substance abuse occurring concurrent to the early childhood traumas, and 24 (40.7%) reported contracting HIV along the Timeline. 

Implications:The literature notes that most reentry programs fail to meet the needs of post-incarceration women, lack integrated services and fall short of meeting the needs stemming from women’s complex histories. Uncovering and addressing the childhood traumatic abuse experiences was important to the women, most of whom had never received mental health counseling for childhood abuse, whether physical, emotional or sexual. The data derived from the timelines yielded information that was utilized in tailoring program components. Along with the 6-week program, women also received case management, medical and substance abuse services within the first six months after release from prison or jail.  Re-entry program facilitators should assess women for CSA and physical trauma as well as its relationship to substance and HIV-related sexual risk among this population.