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Prevalence and Correlates of HIV Risk Behaviors of Inmates in a State Prison System

Prevalence and Correlates of HIV Risk Behaviors of Inmates in a State Prison System. Titilayo Abiona, MD, FMCPH Adedeji Adefuye , MD, MPH, FRIPH Joseph Balogun, PT, PhD, FACSM Patricia Sloan, EdD , RN, FAAN College of Health Sciences, Chicago State University. Background.

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Prevalence and Correlates of HIV Risk Behaviors of Inmates in a State Prison System

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  1. Prevalence and Correlates of HIV Risk Behaviors of Inmates in a State Prison System Titilayo Abiona, MD, FMCPH AdedejiAdefuye, MD, MPH, FRIPH Joseph Balogun, PT, PhD, FACSM Patricia Sloan, EdD, RN, FAAN College of Health Sciences, Chicago State University

  2. Background • Higher HIV/AIDS rates among inmates vs. general population • HIV prevalence ~ 4 & 10x higher among inmates than in the general population • What is the exact mechanism linking incarceration with HIV infection?

  3. Conceptual Model

  4. Background • Inmates engage in risk behaviors before, during & after incarceration • Examining risk behaviors of inmates is essential for understanding the role of incarceration in HIV infection

  5. Specific Objectives • Describe pre-incarceration risk behaviors of inmates • Identify and quantify risk behaviors during incarceration • Determine the socio-demographic characteristics associated with risk behaviors during incarceration

  6. Methods • Study Location • 17 randomly selected Illinois Correctional Facilities • Study Design • Cross-Sectional Descriptive • Study Population • Male and female inmates • 18 years of age or older • Continuously incarcerated for at least six months • Able to speak and write English

  7. Methods • Sample Size Determination • Computer Programs for Epidemiologists (PEPI) version 4.0 • A minimum sample size of 1025 was calculated • Over-sampling done to adjust for non-participation • 2,000 inmates finally selected • Multi-stage sampling technique • Data collected with a structured questionnaire • Statistical Analysis: SPSS 15. Descriptive and Inferential Analysis done • Study protocol approved by the CSU IRB

  8. Results • 1,819 participants: 1, 293 (71.1%)men and 526 (28.9%) women completed the survey • Response rate = 91% • Overall average response rate to survey questions = 96% • Number of participants that responded to each question varied • 71% (1293)of participants were men

  9. Table 1: Socio-demographic Characteristics of Participants

  10. Table 1: Sociodemographic Characteristics of Participants Cont’d

  11. Table 2: Pre-Incarceration Risk Behaviors

  12. Figure 1: % of Respondents who never/rarely used Condoms in the 6 Months before Arrest P < 0.05

  13. Figure 2: % of Respondents who did not use Condoms during last Sexual Intercourse Percentage

  14. Figure 5: % of Respondents who had ever Injected Drugs Percentage

  15. Figure 9 % of Respondents who obtained Tattoos and Body Piercing from non-professional artists Percentage

  16. Table 3: Risk Behaviors during Incarceration

  17. Figure 10: Types of Sexual Intercourse during Incarceration (n=158) Percentage

  18. Figure 11: Context of Sexual Intercourse during Incarceration (n=158)

  19. Table 4: Characteristics and Behaviors Associated with Sexual Intercourse during Incarceration P < 0.001; P <0.05

  20. Table 4: Characteristics and Behaviors Associated with Sexual Intercourse during Incarceration Cont’d P < 0.001

  21. Conclusions • Inmates engage in risk behaviors before and during incarceration • Longer duration of stay in prison, non heterosexual orientation and receiving a tattoo in prison were associated with sexual intercourse in prison • Findings support both the importation and deprivation models of inmate behavior

  22. Recommendations • HIV prevention interventions should be commenced as soon as possible after incarceration • Current policies about risk reduction mechanisms in prison need review

  23. Study Limitations • Possible Underreporting- Social Desirability Bias • Use of a self administered questionnaire and Social desirability bias may affect results and generalizability of findings • Non response to questions may be a source of bias • The small numbers of inmates reporting HIV risk behaviors in prison prevented the identification of independent risk factors for some behaviors • Inmates who were selected but refused to participate in the study may differ significantly from those who participated. This may have affected the prevalence of the risk behaviors reported.

  24. Future Research • The role of tattooing in HIV transmission: risk marker or mode of transmission? • Risk behaviors of partners of inmates • Spatial analysis of inmate residencies after release, distribution of HIV cases, and HIV prevention services in Illinois

  25. Acknowledgements • Illinois General Assembly and the Illinois Department of Public Health- Funding • Dr. Mainza Lukobo-Durrell- contribution to conceptualizing the study • Research assistants –Josie McDonald, Wayne Scott-Williams, Jerry Goldstein and Emmanuel Osunkoya- for their dedication throughout the period of the study • State Representative Constance Howard- co-sponsoring the bill which created the African American HIV/AIDS Response Act and for her personal involvement in establishing the collaboration between the Institute and IDOC • IDOC officials-support in facilitating data collection

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