Approximately seven million people are under correctional supervision and two million are in prisons and jails (Maruschack, 2002). As a consequence of high sexual and drug use risk behaviors among people who enter prisons (Altice, et al., 2005; 1998), the HIV prevalence among prisoners is four to seven times greater than in the general population. Because of the high prevalence of HIV infection in correctional institutions, they have become important sentinel sites for the detection of HIV as well as for the introduction of treatment (Altice, et al., 2001; Mostashari, et al., 1998). HIV prevalence varies by geography, with the highest rate in the northeast. Connecticut has the second highest HIV prevalence (2nd only to New York) among prisoners nationally; it houses approximately 20,000 inmates of whom we have demonstrated the HIV sero-prevalence to be 6.1% among men (Mostashari, 1998) and 9.2% among women (Altice, et al., 2005). On any given day, about 1,000 inmates in Connecticut are known to be HIV-infected and receiving care and, of these, over 650 are on HAART. One of the great public health challenges is ensuring that HIV-infected prisoners continue to receive HIV-related care when they are released. In Connecticut, about 150 prisoners are released to the community daily and 9 to 14 of these individuals are aware of their HIV-infected status. While HIV-infected prisoners have been demonstrated to respond extremely well to HAART within the correctional system, the benefit gain is soon lost after release (Springer, et al., 2004). There is an urgent need for HIV focused transition programs that optimize HIV risk reduction and HAART adherence among HIV-infected prisoners upon their release. In this revised R21 application, we propose to create 'Healthy Transition', an evidence- based HIV risk reduction and HAART adherence intervention - and evaluate it as a component of an innovative transition program that has already been funded to provide clinical care to newly released HIV- infected prisoners in Connecticut. This novel approach, if found to be effective, would likely be cost-effective and easy to replicate in areas such as urban centers that currently struggle with the continuity of HIV-related care from the prison to the community. ? ? ?
