Prison
Linked to Higher HIV Risk for Homeless
SUMMARY
Homeless individuals who have spent time in prison have
a high likelihood of engaging in HIV-related risk behaviors
including alcohol and drug use. |
By
Liz Highleyman
Incarceration
and homeless are 2 socioeconomic factors known to be associated
with elevated prevalence of HIV infection. It is currently
estimated that about 2 million people are in jail or prison
in the U.S.
As described in the February
2011 issue of AIDS and Behavior, Angela Hudson
from the University of California Los Angeles School of Nursing
and colleagues examined how these factors interact.
This was a subanalysis of a larger study evaluating the effectiveness
of interventions to encourage completion of the hepatitis
A and B vaccine series. There are currently no effective vaccines
for hepatitis C virus (HCV) or HIV, which share transmission
routes with hepatitis B.
The present analysis included 664 homeless adults living in
shelters or on the streets in the Skid Row section of Los
Angeles. Most were men and people already infected with hepatitis
B virus (HBV) were not included. Data were collected between
September 2003 and June 2006.
Participants were classified as either recently discharged
from prison (out less than 1 year), released from prison at
least 1 year ago, or never incarcerated. The researchers assessed
socio-demographic characteristics including drug and alcohol
use, sexual activity, mental health, and use of public assistance.
Results
 |
More
than one-third of homeless people (38%) reported ever
spending time in prison. |
|
16%
had been recently discharged from prison. |
|
Recently
released individuals were younger, more likely to be men,
and more likely to have a history of lifetime drug use,
especially cocaine and methamphetamines. |
|
About
20% of recently released individuals reported daily use
of drugs and alcohol over the past 6 months. |
|
Among
people released at least 1 year ago, however, nearly half
used drugs and alcohol daily. |
|
More
than half of those discharged in the past year spent time
in a residential substance use treatment program during
the previous 6 months. |
|
No
differences were noted across the 3 groups with regard
to number of sexual partners. |
|
Depressive
symptom were common overall -- reported by at least 16%
-- but were not significantly different across the 3 groups.
|
These
findings led the study authors to conclude, "As risk
for HCV and HIV co-infection continues among homeless ex-offenders,
HIV/HCV prevention efforts are needed for this population.
"Among those discharged at least 1 year ago, there was
generally more past 6 months daily drug and alcohol use compared
to recently-released inmates," they elaborated in their
discussion. "This finding suggests that, given time to
readjust from prison life, drug and alcohol use continues
after discharge from prison...Drug treatment is especially
salient after release from prison, because it has been found
to reduce recidivism rates among former inmates who received
treatment compared to those who did not."
"Individuals
with a dual history of incarceration and homelessness are
at greater risk of engaging in behaviors, e.g. substance abuse,
that increase their chance for HIV infection," they continued.
"Both drug and alcohol treatment and increased stability
via financial support can reduce risk for HIV infection and,
thereby, improve health outcomes in this population, one of
society's most vulnerable and marginalized."
Investigator
affiliations: School of Nursing, University of California,
Los Angeles, CA; Division of Infectious Diseases, University
of California, Los Angeles, CA; Family Medicine, University
of California, Los Angeles, CA.
5/24/11
Reference
AL Hudson, A Nyamathi, D Bhattacharya, et al. Impact of
prison status on HIV-related risk behaviors. AIDS and Behavior
15(2):340-346 (free
full text). February 2011.
