Catherine Ingram Fogel

Hard t: The stressful nature of incarceration for women

This descriptive, correlational study explored the stressful life event of incarceration for women prisoners and examined its relationship to selected health outcomes. Interviews with 55 women during their first week of incarceration and after 6 months in prison provided the data for analysis. Specific stresses of incarceration identified by the women included separation from families, worry about their children, and loss of control of their own lives. Psychological stress at time of incarceration was found to be positively related to depression and weight gain after 6 months of incarceration. Strategies to decrease the stressful nature of incarceration and improve the health status of incarcerated women are recommended.

Challenges of a hidden epidemic: HIV prevention among women in the United States.

HIV/AIDS trends in the United States depict a concentrated epidemic with hot spots that vary by location, poverty, race/ethnicity, and transmission mode. HIV/AIDS is a leading cause of death among US women of color; two-thirds of new infections among women occur in black women, despite the fact that black women account for just 14% of the US female population. The gravity of the HIV epidemic among US women is often not appreciated by those at risk and by the broader scientific community. We summarize the current epidemiology of HIV/AIDS among US women and discuss clinical, research, and public health intervention components that must be brought together in a cohesive plan to reduce new HIV infections in US women. Only by accelerating research and programmatic efforts will the hidden epidemic of HIV among US women emerge into the light and come under control.

The Lives of Incarcerated Women: Violence, Substance Abuse, and at Risk for HIV

High rates of human immunodeficiency virus (HIV) infection and sexually transmitted diseases (STDs) are seen in women prisoners. These high rates may be related to the nature of their lives, which may include violence, substance abuse, promiscuity, prostitution, and exchange of sex for drugs--all of which increase their risk for acquiring HIV. The purpose of this study was to examine the HIV-related risk behaviors and protective practices of women prisoners in a rural southern state and factors related to these behaviors. The sample included 57 women incarcerated in a medium-to-maximum security prison. Key findings included high rates of substance abuse, extensive past and current violent experiences including sexual abuse, high percentage of multiple partners, and low use of condoms. Additionally, women in this sample did not perceive themselves to be at risk for HIV infection. Practical suggestions for reducing the HIV risks of incarcerated women are offered.

Factors Influencing Adherence to Antiretroviral Therapy for HIV-Infected Female Inmates

&NA; New HIV cases are increasing among women, especially women of color. Moreover, the rate of infection for incarcerated women is twice that of incarcerated men. With advances in medication therapy, HIV has become a chronic illness that can be successfully treated, provided the patient is able to achieve adherence with the prescribed antiretroviral medication regimen. Incarcerated women, however, frequently come from environments burdened with violence, substance and physical abuse, homelessness, child‐care issues, and mental illness. Such burdens negatively affect the ability of these women to adhere to the medication plan. This study explored incarcerated HIV‐infected womens barriers to and facilitators of adherence to antiretroviral therapy (ART), the role of health care provider relationships in adherence, and the ways in which issues of medical privacy influence ability or desire to adhere while incarcerated. A secondary analysis of an existing set of qualitative interviews with HIV‐infected female inmates was conducted.

Factors Present when Battered Women Kill

Twelve women, imprisoned for killing their abusive male partners, were interviewed to determine factors present in battering relationships that end in homicide. Threats to kill made by the abuser, daily alcohol use by the man, and the presence of a firearm in the home existed in the majority of these relationships. Psychological abuse (e.g., enforced isolation, humiliation, and degradation) was perceived as more devastating than physical abuse. Although an escalation in the severity and frequency of violence, the occurrence of sexual abuse, and womens suicidal threats were also present, subjects indicated that these factors were less important reasons for taking lethal action. Knowledge of these factors may guide nurses as they assess and intervene in dangerous, potentially lethal, abusive situations.

Herbal Therapy Use by Perimenopausal Women

OBJECTIVE Perimenopausal women may be following a trend toward using herbal remedies for their symptoms. Herbal use can affect medical decision making because herbal side effects can mimic medical conditions and herbs can interact with pharmacotherapeutics. Yet, health care providers may not be asking patients about their use of herbals. The purpose of this study was to describe the prevalence of herbal use in a sample of perimenopausal women and to explore disclosure of use to their clinicians. DESIGN Descriptive survey of herbal use utilizing responses from a questionnaire. SETTING Health food grocery, located in the southeastern United States. PARTICIPANTS A convenience sample of 40 women, ages 40 to 65 years. MAIN OUTCOME MEASURES Menopause symptoms, perceived efficacy of hormone or herbal therapy, herbs used, sources of information about herbs, and discussion with health care providers about herbal use. RESULTS Two thirds of the women had used herbs for perimenopausal symptoms. Herb users had experienced more menopausal symptoms than nonusers and had more side effects from hormone therapy. Herb users relied on information about herbs from alternative health care providers, whereas nonusers relied on popular media and peers. Overall, less than half were asked by their health care providers about herbal use. Furthermore, nearly half expressed dissatisfaction with the information given by providers about herbs. Although black cohosh was the most frequently used herb, ginseng and gingko were perceived to be the most effective. CONCLUSION Providers need to become informed about herbal therapy for perimenopausal symptoms to tailor care to the needs, preferences, and philosophies of their patients.

Project Power: Adapting an Evidence-Based HIV/STI Prevention Intervention for Incarcerated Women

Incarcerated women are a critical population for targeted HIV/STI prevention programming; however, there is a dearth of evidence-based, genderspecific behavioral interventions for this population. Systematically adapting existing evidence-based interventions (EBIs) can help fill this gap. We illustrate the adaptation of the HIV/STI prevention EBI, Project Safe, for use among incarcerated women and delivery in prisons. Project POWER, the final adapted intervention, was developed using formative research with prison staff and administration, incarcerated and previously incarcerated women, and input of community advisory boards. Intervention delivery adaptations included: shorter, more frequent intervention sessions; booster sessions prior to and just after release; facilitator experience in prisons and counseling; and new videos. Intervention content adaptations addressed issues of empowerment, substance use, gender and power inequity in relationships, interpersonal violence, mental health, reentry, and social support. This illustration of the adaption process provides information to inform additional efforts to adapt EBIs for this underserved population.

Context of Risk for HIV and Sexually Transmitted Infections Among Incarcerated Women in the South: Individual, Interpersonal, and Societal Factors

Incarcerated women are disproportionately affected by HIV and sexually transmitted infections (STIs) due to risk factors before, during, and after imprisonment. This study assessed the behavioral, social, and contextual conditions that contribute to continuing sexual risk behaviors among incarcerated women to inform the adaptation of an evidenced-based behavioral intervention for this population. Individual, in-depth interviews were conducted with 25 current and 28 former women prisoners to assess HIV/STI knowledge, perceptions of risk, intimate relationships, and life circumstances. Interviews were independently coded using an iterative process and analyzed using established qualitative analytic methods. Major themes identified in the interviews involved three focal points: individual risk (substance abuse, emotional need, self-worth, perceptions of risk, and safer sex practices); interpersonal risk (partner pressure, betrayal, and violence); and risk environment (economic self-sufficiency and preparation for reentry). These findings highlight the critical components of HIV/STI prevention interventions for incarcerated women.

Efficacy of an Adapted HIV and Sexually Transmitted Infection Prevention Intervention for Incarcerated Women: A Randomized Controlled Trial

OBJECTIVES We tested the efficacy of an adapted evidence-based HIV-sexually transmitted infection (STI) behavioral intervention (Providing Opportunities for Womens Empowerment, Risk-Reduction, and Relationships, or POWER) among incarcerated women. METHODS We conducted a randomized trial with 521 women aged 18 to 60 years in 2 correctional facilities in North Carolina in 2010 and 2011. Intervention participants attended 8 POWER sessions; control participants received a single standard-of-care STI prevention session. We followed up at 3 and 6 months after release. We examined intervention efficacy with mixed-effects models. RESULTS POWER participants reported fewer male sexual partners than did control participants at 3 months, although this finding did not reach statistical significance; at 6 months they reported significantly less vaginal intercourse without a condom outside of a monogamous relationship and more condom use with a main male partner. POWER participants also reported significantly fewer condom barriers, and greater HIV knowledge, health-protective communication, and tangible social support. The intervention had no significant effects on incident STIs. CONCLUSIONS POWER is a behavioral intervention with potential to reduce risk of acquiring or transmitting HIV and STIs among incarcerated women returning to their communities.

Risk Profiles of Women Experiencing Initial and Repeat Incarcerations: Implications for Prevention Programs.

Incarcerated women experience myriad individual, interpersonal, and structural factors leading to arrest and rearrest. This study examined risk profiles of women experiencing initial and repeat incarcerations. The sample included 521 women recruited from two prisons in North Carolina and enrolled in a HIV/STD risk-reduction intervention trial. Variables included socio-demographics, structural/economic factors, sexual and substance use behaviors, STDs, victimization history, and depressive symptoms. Bivariate and multivariable analyses identified risk differences. Compared to women incarcerated for the first time, women with repeat incarcerations reported significantly greater economic instability, substance use and sexual risk behaviors, laboratory-confirmed STDs, and victimization during childhood and adulthood. Multivariable logistic regression found women with repeat incarcerations experienced greater unstable housing, injection drug use, crack cocaine use, concurrent sex partners, and childhood sexual victimization. Findings can inform the development of prevention programs by addressing economic instability, sexual risk, and substance use among women prisoners.