Incarcerated women in geographic areas characterized by poverty, drug use, and high rates of sexually-transmitted diseases (STD's) are at risk for HIV infection as a result of drug use and unprotected sex as commercial and non-commercial partners. Reported HIV seroprevalence rates among incarcerated women across the country vary from a low of 3.2% to a high of 35%, with higher percentages reported from areas that have high rates of STD's and HIV infection associated with injection drug or crack use and heterosexual transmission. Data from prisons and jails across the US also reveal that female inmates are seropositive at higher rates than their incarcerated male counterparts. In this revised application the Principal Investigator proposes to: (1) implement and evaluate an eight-session HIV-risk reduction intervention based on Social Cognitive Theory (SCT) and the Theory of Gender and Power (TGP) with 150 incarcerated women; (2) compare the intervention against a parallel life skills (LS) intervention that is focused on the same skills but is targeted on drug use with an equivalent sample of 150 incarcerated women; (3) assess diffusion into a sample of 150 women who do not receive either intervention but are housed in proximity to women who participate in the experimental interventions; (4) compare outcome against an information-only control group of 150 incarcerated women; and (5) conduct a longitudinal evaluation by following the women for 18 months after their release from prison to assess the comparative impact of the interventions during the women's reintegrations into the community. The Investigator hypothesizes that the HIV risk reduction intervention based on SCT/TGP will (1) increase the women's knowledge of HIV/AIDS, self-efficacy, attitudes toward prevention, attitudes favoring condom use, perceptions of social support for precautionary behavior, perceptions of vulnerability, and condom use skills, (2) lower perceptions of barriers to condom use; (3) produce greater exchange of condom redemption coupons at the prison infirmary; and (4) lower rates of unprotected sexual activity during their incarceration and after their release back into the community through an 18-month follow-up period to a greater extent than the LS, Diffusion, or Information conditions. In addition, the Investigator predicts (1) improved social competency skills assessed in role play simulations for the SCT and LS participants relative to the diffusion and information-only conditions, and (2) diffusion into the prison population that is reflected by changes of lower magnitude on paper-and-pencil measures completed by women housed in proximity to the women receiving the experimental interventions. Additionally, she hypothesizes that both the SCT/TPR and LS interventions will lower scores on the Million Impulse Control subscale and reduce needle-sharing to a greater extent than either the diffusion or information only conditions. By experimentally evaluating the impact of a theoretically-driven risk reduction intervention, comparing its outcome against a parallel skills training intervention unrelated to HIV or AIDS and an information-only control condition, the researchers in this study will assess the extent to which programs delivered in correctional facilities generalize into the prison population. Finally, in their longitudinal assessment for 18-months after prison release the researchers will identify the extent to which participation in each condition is associated with risk reduction behavior after release back into the community.
| St Lawrence, J; Eldridge, G D; Shelby, M C et al. (1997) HIV risk reduction for incarcerated women: a comparison of brief interventions based on two theoretical models. J Consult Clin Psychol 65:504-9 |
