Holly Swan

The Impact of Intimate Partner Violence on Women’s Condom Negotiation Efficacy:

HIV prevention efforts promote the use of condoms to prevent the spread of HIV and other STDs. Thus, a woman’s agency to practice healthy sexual behaviors necessarily involves negotiation with another person. This poses unique challenges for women who have limited power in relationships. The current study explores how the experience of intimate partner violence (IPV) impacts a woman’s confidence in her ability to negotiate condom use with a sexual partner (i.e., condom use self-efficacy), using data from incarcerated females in three states, who were interviewed just prior to release back into the community. The direct effect of experiencing IPV as an adult, controlling for other risk factors, on condom use self-efficacy has not previously been empirically tested. Results show that IPV experiences among women significantly decreases their confidence in negotiating condom use with a partner, putting them at a higher risk of HIV infection than women who do not report having recently experienced IPV.

THE EFFECT OF A LOCAL CHANGE TEAM INTERVENTION ON STAFF ATTITUDES TOWARDS HIV SERVICE DELIVERY IN CORRECTIONAL SETTINGS: A RANDOMIZED TRIAL

The National Criminal Justice Drug Abuse Treatment Studies research program conducted cluster randomized trials to test an organizational process improvement strategy for implementing evidence-based improvements in HIV services for preventing, detecting, and/or treating HIV for individuals under correctional supervision. Nine research centers conducted cluster randomized trials in which one correctional facility used a modified Network for Improvement of Addiction Treatment (NIATx) change team approach to implementing improved HIV services and the other facility used their own approach to implement the improved HIV services. This paper examines whether the intervention increased the perceived value of HIV services among staff of correctional and community HIV organizations. Baseline and follow-up measures of the perceived acceptability, feasibility, and organizational support for implementing HIV service improvements were collected from correctional, medical, and community HIV treatment staff. Results indicated that the perceived acceptability and feasibility of implementing HIV services improved among staff in the facilities using the modified NIATx change team approach as compared to staff in the comparison facilities.

HIV Stigma in Prisons and Jails: Results from a Staff Survey

With numerous HIV service gaps in prisons and jails, there has been little research on HIV stigma attitudes among correctional staff. Such attitudes may undermine HIV services for inmates at risk of or infected with HIV. This HIV stigma attitudes survey among 218 correctional staff in 32 US facilities (1) provides an overview of staff’s stigma attitudes, (2) reports psychometric analyses of domains in Earnshaw and Chaudoir’s HIV Stigma Framework (HSF), and (3) explores differences in stigma attitudes among different staff types. Overall, correctional and medical staff expressed non stigmatizing attitudes toward people living with HIV/AIDS, but perceived that stigma and discrimination exist in others. Factor analyses revealed a three factor structure capturing two mechanisms of the HSF (prejudice, discrimination). Few factor score differences were found by staff type or setting. Implications for correctional HIV services and future research on HIV stigma attitudes are discussed.ResumenAunque existen numerosas brechas en los servicios de VIH en las prisiones y cárceles, existe poca investigación sobre las actitudes estigmatizantes hacia el VIH entre el personal correccional. Tales actitudes pueden socavar los esfuerzos para mejorar los servicios de VIH para las personas confinadas infectadas o en riesgo de infectarse con el VIH. Este cuestionario sobre las actitudes estigmatizantes hacia el VIH entre 218 empleados correccionales de 32 instalaciones en todo los EE.UU trató de (1) proveer una visión general del nivel de estigmatización entre el personal correccional, (2) reportar los análisis psicométricos preliminares de los dominios del ‘Marco de Estima propuesto por Earnshaw y Chaudoir’ (HSF por sus siglas en inglés) y (3) explorar las diferencias en el nivel y los mecanismos de estigma entre los diferentes tipos de personal. En general, el personal correccional y médico expresó actitudes no-estigmatizantes y de apoyo con respecto a las personas que viven con el VIH/SIDA, pero perciben que el estigma y la discriminación están presentes en otros. El análisis factorial reveló una estructura de tres factores que capturó dos mecanismos del Marco de Estigma hacia VIH (prejuicios, la discriminación). Encontramos pocas diferencias en las tres puntuaciones de los factores como función del tipo de personal o el escenario organizacional. Se discuten las implicaciones para los servicios de VIH en los escenarios correccionales y las futuras investigaciones sobre las actitudes de estigma hacia el VIH.

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.

Understanding the sustainability of implementing HIV services in criminal justice settings

BackgroundIn the growing field of implementation science, sustainability is a critical component of the implementation process of moving evidence-based treatments to regular practice. This paper is intended to extend our understanding of factors that influence the sustainability of HIV services in correctional settings following an organization-level intervention designed to implement improvements in preventing, detecting, or treating HIV for persons under correctional supervision.MethodsUsing semi-structured interviews to elicit perceptions from the principal researcher and executive sponsor at each of nine participating sites, this study explores the variations in the sustainability of HIV services in these criminal justice settings following the experimental implementation intervention.ResultsIn six of the nine sites, changes in HIV services implemented as a result of the organizational intervention were sustained six to nine months following the end of project implementation. Organizational endorsement at multiple levels is likely the principal factor that facilitates sustainability.ConclusionsThe factors that result in the sustainability of changes to health services in correctional organizations include elements internal and external to the organization. Implementation strategies, such as the change team model strategy used in this study, are also sustainable and can be used to identify other changes that could be made, or improve other aspects of service delivery.

Evaluating Fidelity to a Modified NIATx Process Improvement Strategy for Improving HIV Services in Correctional Facilities

In a study aimed at improving the quality of HIV services for inmates, an organizational process improvement strategy using change teams was tested in 14 correctional facilities in 8 US states and Puerto Rico. Data to examine fidelity to the process improvement strategy consisted of quantitative ratings of the structural and process components of the strategy and qualitative notes that explicate challenges in maintaining fidelity to the strategy. Fidelity challenges included (1) lack of communication and leadership within change teams, (2) instability in team membership, and (3) issues with data utilization in decision-making to implement improvements to services delivery.

Improvements in Correctional HIV Services: A Case Study in Delaware.

This article describes the experience and outcomes of the National Institute on Drug Abuse-funded Criminal Justice Drug Abuse Treatment Studies HIV Services and Treatment Implementation in Corrections protocol in the state of Delaware. The protocol was designed to test the effectiveness of a change team model in improving HIV services in correctional settings. In Delaware, a team was created with representatives from correctional and community agencies to work on improving linkage to HIV care for individuals released from incarceration. The team made improvements in the entire HIV service continuum: linkage to HIV care, HIV education, and HIV testing. The experiences in Delaware and the findings from this study suggest that the use of a change team model is a viable method for making organizational change in correctional settings.

Defining Success: Insights From a Random Assignment, Multisite Study of Implementing HIV Prevention, Testing, and Linkage to Care in U.S. Jails and Prisons.

In the emerging field of implementation science, measuring the extent to which a new or modified healthcare program or practice is successfully implemented following an intervention is a critical component in understanding how evidence-based treatments become part of regular practice. This paper is intended to expand our understanding of factors that influence the successful adoption of new or modified HIV services in correctional settings. The nine-site project developed and directed an organization-level intervention designed to implement improvements in preventing, detecting, and treating HIV for persons under correctional supervision. Using semi-structured interviews to elicit perceptions from Senior Researchers and Executive Sponsors at each of the nine sites, this paper presents their views and observations regarding the success of the experimental intervention in their criminal justice setting. Within the areas of focus for implementation (either HIV prevention, testing, or linkage to community treatment) the complexity of programmatic needs was very influential with regards to perceptions of success. An organizations pre-existing characteristics, staffing, funding, and interorganizational relationships contributed to either the ease or difficulty of programmatic implementation. Results are discussed pertaining to furthering our understanding of why new or modified healthcare interventions achieve success, including whether the intervention is a modification of existing practice or is a new intervention, and the choice of implementation strategy.

Efficacy of Structured Organizational Change Intervention on HIV Testing in Correctional Facilities

This article presents findings from a multisite cluster randomized trial of a structured organizational change intervention for improving HIV testing services in jails and prisons. Matched pairs of prison and jail facilities were randomized to experimental and control conditions; all facilities received baseline training about best practices in HIV testing and other HIV services and selected an area of HIV services on which to focus improvement efforts. The experimental facilities formed local change teams and were provided external coaching based on the Network for the Improvement of Addiction Treatment (NIATx) process improvement model. Difference-indifference analyses indicate a significant relative increase in HIV testing in the experimental compared to the control condition. Meta-analyses across the matched pairs indicated a small to medium effect of increased testing overall. The results indicate that the local change team model can achieve significant increases in HIV testing in correctional facilities. Implications for HIV testing policies and challenges for expanding testing are discussed.

A Qualitative Examination of Stigma Among Formerly Incarcerated Adults Living With HIV

The over-representation of people with stigmatized characteristics in the U.S. criminal justice population, including adults living with HIV, makes formerly incarcerated adults susceptible to multiple stigmas. Yet, the experience of HIV-related stigma, especially among individuals who have an additional compromising status in society (i.e., a criminal record) is understudied. This study used qualitative data from 30 interviews with formerly incarcerated adults living with HIV to explore the contexts within which one of these statuses becomes more salient than another for these individuals. Anticipated stigma was the primary barrier to disclosure of either status. The salience of anticipated stigma depended on the context within which disclosure may occur, including social interactions, employment, and engaging in HIV care. Communities with a high prevalence of HIV and incarceration, and health care providers within those communities should be targeted for stigma reduction efforts. Practitioners should work to empower individuals living with HIV, especially in the face of multiple potential stigmas.