HIV/AIDS Research and Policy Institute

1. HIV/AIDS Research and Policy Institute Adedeji S. Adefuye May 10, 2007

2. Institute Background • Illinois African-American HIV/AIDS Response Act (Public Act 094-0629) • HB2578 on February 18, 2005. On May 28, 2005, both houses passed the bill and the governor signed the bill on August 19, 2005 • Purpose: • To address the specific issue of the crisis of HIV/AIDS in the African American Community. • What It Does: • The legislation creates a new act and also amends the Illinois Public Aid Code, Unified Code of Corrections, and the County Jail Act.

3. Key Features of Act • Creates a special fund in the State Treasury for HIV prevention • Establishes the position of “African American Response Officer” in the Office of the Governor, DHS, IDPH and IDOC • Allows the Department of Public Aid to seek federal approval to expand health care to people living with HIV/AIDS through Medicaid waivers • Expands HIV testing and counseling in correctional settings • Provides for a study to examine the correlation between incarceration and HIV infection • Study at Chicago State University to investigate the links between imprisonment and HIV infection risks • Expands availability of counseling and testing through state agencies that serve high-risk populations

4. Study Background • As of June 30 2004, there were 2.1 million prisoners in Federal or State prisons or local jails in the United States (90% were male and 10% female) • Among men aged 25-29, an estimated 12.6% of Black males, 5.2% Hispanic males and 1.7% White males in the United States were in jail or prison in June 2004 • As of June 2004, the Illinois Department of Corrections had an adult prison population of 44, 379 • In 2003, approximately 600,000 inmates were released from State or Federal prisons

5. Study Background • The AIDS rate is estimated to be about 3.5 times higher in state and federal prisons than in the general population. • At the end 2003, 23,659 prison inmates were HIV positive (se, 20060 were males and 2131 female • Overall, 2.8% of all female State prison inmates were HIV positive, compared to 1.9% of males • In 2003, 282 prisoners died from AIDS-related causes (268 State inmates and 14 Federal inmates) • A study of newly identified cases of HIV in correctional facilities nationwide found that 59% were black, 22% Hispanic and 17% white • Illinois ranks 12th in the nation in the number of inmates with HIV infection (551); and • 17th in the percent of inmates with HIV infection (1.3%) • Approximately 20-26% of people living with HIV/AIDS in the US have spent time in the correctional system

6. Study Background • Documented activities that increase the risk of HIV infection among prison inmates include sexual activity between male inmates, homosexual rape, sharing injection equipment, tattooing using unsterile instruments and fights involving lacerations, bites and bleeding. • Although education on HIV/AIDS risk reduction is available in some prison systems it is not clear how effective it is • HIV preventive mechanisms are not readily available in most prisons (condoms, clean injection equipment and bleach are contraband; and needles used to make tattoos are difficult to obtain)

7. The Concerns • The increasing rates of HIV infections in communities of color and the disproportionate rates of incarceration of people of color make the problem of HIV transmission in prisons a great concern for communities of color • Because most inmates spend a relatively short time in prison and then return to their communities • Empirical evidence on the transmission of HIV among inmates in US prison systems is (legal, ethical and philosophical research issues) • The few documented HIV transmission rates among male inmates range between 0.17- 0.41% annually (none on women)

8. The Incarceration Study • Objective To study the correlation between incarceration and HIV transmission in Illinois prisons • Research Questions • What are the identifiable risk behaviors for HIV infection among inmates in Illinois prisons • To what extent do those behaviors form part of a patter that can be categorized as a correctional sub-culture • To what extent does a correctional sub-culture that may contribute to HIV transmission exist in Illinois prisons

9. The Incarceration Study • Hypothesis • High risk HIV behaviors occur among inmates of Illinois prisons • High risk behaviors for a sub-cultural pattern that increases the risk of HIV transmission among Illinois prison inmates • Research Design • Cross-sectional design

10. Methodology (Study Process) • Developed collaborative agreement with IDOC • Human subjects protection – IRB approval • Ascertain psychometric properties of the questionnaire (pilot testing and standardization of questionnaire) • Sample selection • Survey administration • Data entry and analysis

11. Sample Selection • Stratified prisons in Illinois by security level • Randomly selected 17 prison facilities • Random selected inmates from the selected prison facilities • Adjusted for an estimated 10% transfer rate, 5% participation refusal rate, and 10% unusable surveys (25%) • Increased oversampling to 50% in later stages of data collection

12. Data Collection • Varied slightly from facility to facility • Carried in groups of 20-30 • Verbal consent group read • Completed surveys submitted in sealed envelopes • Incentives given • Total of 1454 surveys completed (1,110 needed; 457 female & 653 male)

13. Next Steps • Prospective cohort study of inmates due for release within 6 months • In-depth interviews with inmate in prison before release • In-depth interviews with inmate and spouse/partner after release from prison • 3 year follow-up • Study to include HIV and STI testing • Counseling and referrals when necessary

14. Pending and Future Funding • Illinois African-American HIV/AIDS Response Act funding by State Assembly • Grant to NIH to study the social and cultural contexts of African American men’s sexual behavior and implications for HIV prevention (submitted May, 7, 2007) • Health Disparities and HIV/AIDS with focus on African Americans (September 7, 2007)

15. Risk Behaviors and Risk Perceptions for HIV among College Students: Preliminary Results

16. Table 1: Highlights of Sociodemographic Characteristics of Respondents • Total no. of Students: 330 • Gender: Male- 29.8%; Female- 70.2% • Mean Age (SD): 23.1(+7.04) years • Marital Status: Single: 85.2% • Ethnicity: Black: 80.5% • Black: 80.5% • Hispanic: 7.9% • White: 6.7%

17. Substance Use

18. Table 2: Substances Ever Used by Respondents

19. Table 3: Substance Use in the last 30 days

20. Sexual Behavior

21. Table 4: Sexual Behavior of Respondents

22. Table 5: Number of Heterosexual Partners

23. Table 6: Number of Same Sex Partners

24. Figure 1: Condom Use in the past 30 Days Percentage

25. Figure 2: Condom Use during Last Sexual Intercourse Percentage

26. Table 7: HIV Risk Perception of Respondents

27. Relationship of Risk Behaviors to Risk Perception (Females)

28. Table 8: Relationship between No. of Sexual Partners Last 3 Months and HIV Risk Perception (Females)

29. Table 9: Relationship between Condom Use Last Sexual Intercourse and HIV Risk Perception (Females)

30. Table 10: Relationship between Alcohol Use Last Sexual Intercourse and HIV Risk Perception (Females)

31. Table 11: Relationship between Alcohol Use and Condom Use during Last Sexual Intercourse (Females)

32. Relationship of Risk Behaviors to Risk Perception (Males)

33. Table 12: Relationship between Condom Use Last Sexual Intercourse and HIV Risk Perception (Males)

34. Table 13: Relationship between Alcohol Use and Condom Use during Last Sexual Intercourse (Males)

35. Preliminary Conclusions • High Risk Behaviors for HIV among College Students include Multiple Sexual Partners and Inconsistent Condom Use. • Despite this, Risk Perception for Acquiring HIV is very poor • There is an urgent need to institute HIV prevention programs for the student population • Further qualitative study is required before designing an intervention

36. Prevalence of Risk Factors for HIV among Incarcerated Persons in Illinois PrisonsPreliminary Results

37. Table 1: Sociodemographic Characteristics

38. Table 1: Sociodemographic Characteristics Contd:

39. Table 2: Prevalence of Tattoos among Respondents

40. Figure 1: Place of Tattoo Acquisition prior to Incarceration (n=507) Percentage

41. Table 3: Prevalence of Body Piercing among Respondents

42. Figure 2: Place of Body Piercing Acquisition prior to Incarceration (n=434) Percentage

43. Table 4: Prevalence of Illicit Drug Injection among Respondents

44. Table 5: Prevalence of Needle Sharing among Respondents

45. Figure 3: Comparison of Needle sharing among Respondents Percentage

46. Table 6: Comparison of Respondents’ Gender and No. of Sexual Partners in the 6 Months before Incarceration (Anal Sex)

47. Table 7: Comparison of Respondents’ Gender and the No. of Sexual Partners in the 6 Months before Incarceration (Vaginal Sex)

48. Figure 4: Respondents’ Condom use during Anal Intercourse in the 6 months before Incarceration Percentage

49. Figure 5: Respondents’ Condom use during Vaginal Intercourse in the 6 months before Incarceration Percentage

50. Table 8: Condom Use during Last Sexual Intercourse