HIV/STD Risk Reduction Interventions in Prison Settings

Abstract

587 WOMEN IN PRISON present both opportunities and challenges for reducing behaviors that create risk of sexually transmitted (STD). From a public health standpoint, incarceration provides an opportunity to reach women who are at exceedingly high risk for STD. Challenges inherent in prison environments also present formidable challenges to intervention and research efforts. This report addresses two issues. First, incarcerated women frequently have a history of health risk behaviors, illustrated in this report by data on the increasing numbers of incarcerated women in the United States, general health characteristics of these women, and their STD risk factors. The second issue is to discuss the personal and institutional challenges of introducing effective behavioral interventions into correction settings, using a current project to provide examples. Current U.S. Bureau of Justice statistics reveal that 84,427 women were in state or federal prisons in 1998, a fourfold increase since 1985 that resulted from a steady increase throughout the 1990s.1 Additionally, 63,800 women are incarcerated in jails. If one includes probation, almost 1% (1 in 109 women) of the female population of the United States over the age of 10 was in some form of correctional status (including probation) during 1998.1 Racial and ethnic minorities are overrepresented at the state and federal levels. Twenty-nine percent of female state prisoners were white (33% in federal prisons), 48% black (35%), and 15% Hispanic (32%). Roughly 88%–91% of female prisoners are aged 25 or older, and 65% had prior convictions.1 Table 1 presents a descriptive profile of a sample from two Southern states. Less than half the women had ever been charged with violent behavior, with 30.1% ever charged with weapons offenses, assault, or homicide/manslaughter. Fewer women had been charged with prostitution (4.5%), but charges for drug offenses (41.2%) and parole violations (58.8%) were common. Being charged with drug offenses and parole violations was related (p , 0.05 by Fisher’s exact test). Jails and prisons across the United States have a vested interest in keeping communicable diseases among their populations to a minimum. Close proximity and communal standards for hygiene (e.g., communal showers) are environmental risk factors for the spread of communicable disease, such as tuberculosis,1 and the health status of women entering correctional facilities creates vulnerability for the acquisition of infectious diseases. Moreover, the rotation of inmates from a prison or jail setting back into society poses a public health risk that necessitates dealing with the disease burden within prisons.3 Nevertheless, corrections screening for communicable diseases is far from universal.4 Concerning STD, 20% of jails screen for Chlamydia infection and 48% screen for syphilis.5 STD prevalence in jails and prisons is influenced by social factors, for example, policies toward incarcerating sex workers, but STD rates among in-