Abstract
IntroductionHIV in the United States is concentrated in the South, an impoverished region with marked health disparities and high rates of incarceration, particularly among African Americans. In the Deep South state of Alabama, a policy directive to reduce prison overcrowding has diverted large numbers of convicted felons to community supervision. Probation and parole offices have yet to provide the HIV education and testing services that are offered in state prisons. This study sought to implement on-site HIV services for probationers and parolees through an intersectoral programme involving law enforcement, university and HIV agency employees. The three main objectives were to (1) involve probation/parole officers in planning, execution and assessment of the programme, (2) provide HIV education to the officers and (3) offer voluntary pretest HIV counselling and testing to probationers and parolees.MethodsThe partnered programme was conducted between October and December 2015. Offenders who were recently sentenced to probation (“new offenders”), received HIV education during orientation. Offenders already under supervision prior to the programme (“current offenders”) learned about the on-site services during scheduled office visits. Outcomes were measured through officer assessments, informal feedback and uptake of HIV services among offenders.ResultsA total of 86 new and 249 current offenders reported during the programme (N=335). Almost one-third (31.4%) of new offenders sought HIV testing, while only 3.2% of current offenders were screened for HIV. Refusals among current offenders invoked monogamy, time pressures, being tested in prison, fear of positive test results and concerns about being labelled as gay or unfaithful to women partners. Officers rated the programme as worthwhile and feasible to implement at other offices.ConclusionsThe partnership approach ensured support from law enforcement and intersectoral cooperation throughout the programme. HIV training for officers reduced discomfort over HIV and fostered their willingness to be active agents for referral to HIV services. Voluntary testing was enhanced by the HIV employee's educational role, particularly during orientation sessions for new offenders. The almost one-third success rate in HIV testing among new offenders suggests that future efforts should concentrate on this group in order to maximize participation at the probation and parole office.
Highlights
HIV in the United States is concentrated in the South, an impoverished region with marked health disparities and high rates of incarceration, among African Americans
The United States has the highest rate of incarceration in the world, a distinction that disproportionately affects men of colour who are at elevated risk of HIV/AIDS [1]
Setting and demographics The programme was conducted from October to December 2015 at the Tuscaloosa County Probation and Parole Office, one of 61 state offices in Alabama
Summary
HIV in the United States is concentrated in the South, an impoverished region with marked health disparities and high rates of incarceration, among African Americans. Probation and parole offices have yet to provide the HIV education and testing services that are offered in state prisons. Compared to state prisons, which offer HIV prevention education and testing for inmates, community correctional offices lack such programmes and are illequipped to provide HIV services in the face of increasing demand. An underserved population lacks access to HIV services even though public health authorities have urged ‘‘people who work in communities to play an active role in implementing the [national prevention strategy] to reduce HIV rates in high-risk groups’’ [4]. The two trends Á prison diversion programmes for convicted offenders and federal goals to reduce HIV rates in the South Á have created high demand for on-site HIV services at probation and parole offices in Alabama as an underserved state
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