Anne G. Rhodes

Money Boys, HIV Risks, and the Associations between Norms and Safer Sex: A Respondent-Driven Sampling Study in Shenzhen, China

Money boys (MBs) are male sex workers who sell sex to men who have sex with men (MSM). This study estimates the proportion of MBs in the Chinese MSM, compares HIV risks between MBs and non-MB MSM, and examines the associations between practicing safer sex and peer norms of condom use. Respondent-driven sampling (RDS) was used to sample 351 MSM in the city of Shenzhen in 2007. The RDS-adjusted proportion of MBs among MSM was 9%. Compared to non-MB MSM, more MBs reported having had multiple male and female sexual partners. Half of MBs and non-MB MSM had consistently used condoms. Both descriptive and subjective norms were positively associated with condom use. The MB proportion of 9% in MSM implies a relatively large population of MBs in China. The association between peer norms and consistent condom use can assist with the development of culturally competent HIV interventions that promote safer sex.

Egocentric Networks of Chinese Men Who Have Sex with Men: Network Components, Condom Use Norms, and Safer Sex

Research on risk behaviors among men who have sex with men (MSM) is often based on individualistic models of health behavior, but sexual behavior is inherently social in nature and often determined by constituents of social networks. The objective of this study was to examine relationships among social networks, network norms of condom use, and safer sex. A respondent-driven sampling study recruited 350 MSM in the Shenzhen region of China between November and December 2007 and collected information on network components (relations, structures, and functions) and HIV risk behavior among egos (those interviewed) and their network alters. A total of 2385 alters were nominated by the 350 egos. Egos reported an average of 4 nonsexual relation alters and 2 sexual-partner alters. Egos perceived receiving more tangible and emotional support from nonsexual relation alters than from sexual-partner alters. Two thirds (69%) of egos consistently used condoms. Sixty-seven percent of egos reported having 1 or more alters who always encouraged egos to use condoms, 84% had 1 or more alters who consistently used condoms, and 55% had 1 or more alters who insisted on condom use. Both subjective and descriptive norms were positively associated with consistent condom use. Network components were associated with the levels of the two norms. These findings suggest that social network components may activate or strengthen condom use norms within networks, which, in turn, determine consistent condom use among MSM. HIV behavioral interventions need to target the promotion of safer sex practices through enhancing peer norms of condom use within networks.

Construct and Predictive Validity of Criminal Thinking Scales

Tools to assess the concept of criminal thinking have not often been tested in community corrections populations. This article examines the psychometric properties of the Texas Christian University Criminal Thinking Scales (CTS) in a sample of drug-using probationers (n = 250) participating in a randomized trial. A confirmatory factor analysis found that three of the subscales may not be measuring distinct concepts and that most of the subscales do not distinguish between male and female offenders despite large differences in offending histories in these populations. Concurrent and predictive validity results demonstrated a limited ability of the CTS to correlate with known predictors of recidivism or with follow-up data on criminal activity. The CTS scores did correlate with predictors of treatment processes, including treatment readiness and self-efficacy, indicating that those with higher levels of criminal thinking may be more difficult to engage in treatment and services. Measurement tools of criminal thinking are important to the field, and further work is needed to strengthen the existing tools.

Adding positive reinforcement in justice settings: Acceptability and feasibility

Although contingency management (CM) approaches are among the most promising methods for initiating drug abstinence (S. T. Higgins, S. M. Alessi, & R. L. Dantona, 2002; S. T. Higgins, S. H. Heil, & J. P. Lussier, 2004), adoption and implementation of CM protocols into treatment programs are both challenging and infrequent. In criminal justice agencies, where roughly 70% of clients report substance abuse issues (F. S. Taxman, K. L. Cropsey, D. W. Young, & H. Wexler, 2007), CM interventions are virtually nonexistent. The Justice Steps (JSTEPS) study uses a longitudinal, mixed-method design to examine the implementation of a CM-based protocol in five justice settings. This article presents qualitative data collected during Phase 1 of the JSTEPS project regarding the acceptability and feasibility of CM in these justice settings. The study finds a level of acceptability (find CM tolerable) and feasibility (find CM suitable) within justice agencies, but with some challenges. These challenges are reflected in the following: (a) incorporating too many desired target behaviors into CM models; (b) facing intraorganizational challenges when designing CM systems; and (c) emphasizing sanctions over rewards despite the evidence-base for positive reinforcers. These findings have implications for advancing the dissemination, adoption, and implementation of evidence-based treatments (and CM in particular) in criminal justice settings.

HCV in Incarcerated Populations: An Analysis of Gender and Criminality on Risk‡

Abstract While studies have explored the prevalence and correlates for hepatitis C (HCV) infection in substance-using and incarcerated populations these studies have not examined the attributes of criminal histories for those with HCV infection. This study examines the HCV infection rate as it relates to criminal risk factors using baseline data from a randomized trial of re-entering offenders and examines how these risk factors vary by gender. The HCV-positive population had a longer amount of time in confinement (105 vs. 61 months) than those who tested negative. HCV positive men were more likely to currently be receiving drug treatment than women. Criminal risk was positively associated with HCV infection while controlling for major risk factors (OR 1.25, 95% CI: 1.07, 1.46), suggesting that the relationship was not spurious. While criminologists tend to examine risk relative to public safety threats, it appears that the public health needs equally require attention. Policy issues are examined regarding how services can be delivered to treat those with HCV infections within the correctional system and address criminal risk factors.

Adaptability of contingency management in justice settings: survey findings on attitudes toward using rewards.

Contingency management (CM) is widely recognized as an evidence-based practice, but it is not widely used in either treatment settings or justice settings. CM is perceived as adaptable in justice settings given the natural inclination to use contingencies to improve compliance to desired behaviors. In the Justice Steps implementation study, 5 federal district court jurisdictions agreed to consider implementing CM in specialized problem-solving courts or probation settings. A baseline survey (N = 186) examined the acceptance and feasibility of using rewards as a tool to manage offender compliance. The results of the survey revealed that most of the respondents believe that rewards are acceptable, with little difference between social and material rewards. Survey findings also showed that female justice workers and those who were not probation officers were more accepting of material rewards than their counterparts. Findings are consistent with prior research in drug treatment settings where there is little concern about using rewards.

A Continuum of Care Model for HIV in Correctional Settings

The rates of HIV and Hepatitis C (HCV) in prisons in the United States exceed those among the general population. Prisoners represent some of the highest risk groups for HIV and HCV, notably injection drug users, sex workers, and substance-addicted persons. The high risk for disease transmission among prison inmates prior to their incarceration, as well as the relative ease in accessing these populations, underscores the importance of implementing HIV/HCV prevention/intervention services in incarcerated settings. An HIV/HCV Continuum of Care that includes testing, linkage to care for those who test positive, and prevention efforts prior to inmate release, provides a useful model. This chapter presents an overview of this model, as well as an example of a research project focused on one of its components: prevention among inmates just prior to their release. First, HIV/HCV in prisons is discussed. Second, existing HIV/HCV intervention and prevention packages geared towards inmates are reviewed. Next, an HIV Continuum of Care model is presented, which includes various recommendations based on the immediate needs of the inmates, as well as evidence from a case study from the prevention aspect of the model. A discussion on the implications of the HIV Continuum and other similar programs concludes the chapter.

Multisite Trials in Criminal Justice Settings: Trials and Tribulations of Field Experiments

Multisite trials present challenges due to sociopolitical environment of the study, site preparation issues and research management protocols. This paper uses two case studies from complex multilevel innovations involving two or more operating agencies to assess how research processes affect the internal and external validity of the study. This paper highlights the need to extend the discussion regarding experimental design into assessments of fidelity and adherence, or the common implementation issues, that continually affect the integrity of the experiment. The case studies highlight the typical, often confounding, decisions that researchers must make in a study to adapt to the study environment. The case studies serve to provide a discussion of issues regarding the design and conduct of multisite trials. We conclude by providing lessons learned in conducting or being involved in multisite trials including the use of CONSORT charts as a tool to assess impact of implementation decisions on experimental integrity.