High Risk HIV Transmission Behaviors in Prison: Does a Fatalistic Model Exist?

1. High Risk HIV Transmission Behaviors in Prison: Does a Fatalistic Model Exist?  TitilayoAbiona, MD, FMCPH ; Adedeji Adefuye, MD, MPH, FRIPH; Joseph Balogun, PT, PhD, FACSM ; Patricia Sloan, EdD, RN, FAAN College of Health Sciences, Chicago State University Recommendations Program development to reduce boredom among inmates on long/life sentences Continuation of HIV prevention interventions during incarceration Provision of substance abuse treatment for addicted inmates Mental health services to help inmates cope with their frustrations General Perceptions : Risk Behaviors Occur in Prison “They get them… the majority (inmates) comes out with the tattoos on them” (Male) “There's a lot of sex still going on out there (in prison)” (Female) “Yeah…from my experience, at least 20 to 30 percent of the population is having sex” (Male) Risk Behaviors- Importation “people use (drugs) because they were using when they came in” (male) “Yeah, they… they adapted to. That's their lifestyle” (female) Background • Inmates engage in unprotected sexual intercourse, inject drugs, & share injection equipment in prison (Abiona TC et al. Journal of Women’s Health 2009 in press) • Thorough understanding of the context within which risk behaviors occur in prison is required for effective HIV prevention programs Risk Behaviors- Importation “that would use inside… it’s because we used to use it outside, you know” (female) Person who’s gay before.. will be sleeping with a man inside (in prison)” (male) Study Objectives Describe the perceptions and knowledge of recently released inmates about the occurrence of risk behaviors in prison Examine risk behaviors against the deprivation and importation models of inmate behaviors General Perceptions: Risk Behaviors reducing in prison • “It (sex) doesn’t happen as much now as it used to, but it used to be” (female) • “They been cut down a lot. It's kind of hard, you know. when I was in there, quite a few people got busted bringing stuff (drugs)in” (male) Future Research Studies of the association between length/type of sentence and engagement in risk behaviors Study of inmates perceptions on programs to reduce boredom during incarceration Risk Behaviors- Fatalism? (sex ): “They… they know they got a long time…” (male) (sex): “And if you got time, you know you doing a long time…” (female) (Injection drugs): “… they got to flip 35 calendars over, you know, whatever they can get their hands on, some already they don’t' care” (male) (risk behaviors)“…they just don’t care (lifers); they know they are not going anywhere”(male) “(About sex, injection drugs) “You ain’t never going home, so what they gonna say to you? What they gonna do?” (female) Methods • Focus group discussions with male and female ex-offenders (Four per gender) • Study Population • Recently released inmates (< 6 months prior) • 18 years of age or older • Structured questionnaire- demographic information • Data Analysis- Nvivo 7 • Study protocol approved by the CSU IRB Risk Behaviors- Deprivation “…some of ‘em just get turned on into it (drugs); you know, ‘cause that’s (prison) a boring place to be. Imagine yourself in a cell, just looking at a wall for 24 hours a day. Some people will go crazy….” (male) “A person being… uh… have sex with you for commisary.”(female) “Someone of them's doing it (sex) for the other one to take care of them” (male) Acknowledgements IL State Representative Constance Howard, research assistants, IDOC officials Funding: Illinois General Assembly and the Illinois Department of Public Health. The information or content and conclusions are those of the authors and should not be construed as the official position or policy of, nor should any endorsement be inferred by the Illinois Department of Public Health. Risk Behaviors- Frustration • “……the same reason people do alcohol or other drugs…. They got stuff weighing on they mind and they want to get their mind off that problem…” (female) • “I had 30 years before, and anything that made me not remember that I had 30 years, or let me get away from the moment – that’s what I did” (male) Conclusions Inmates engage in risk behaviors during incarceration Occurrence of risk behaviors in prison is reducing- Illinois Department of Correction (IDOC) efforts Reasons for risk behaviors support the importation and deprivation models A fatalistic model may apply for injection drug use and sexual intercourse Results Participants: 27 women & 20 men African-American or Black: 87% Never married: 57.4% Incarcerated > 2 times: 51% Completed high school or GED: 55.3% Quotes presented to support themes