文章基本信息

标题：HIV Prevention for Adults With Criminal Justice Involvement: A Systematic Review of HIV Risk-Reduction Interventions in Incarceration and Community Settings
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作者：Kristen Underhill ; Dora Dumont ; Don Operario 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2014
卷号：104
期号：11
页码：e27-e53
DOI：10.2105/AJPH.2014.302152
语种：English
出版社：American Public Health Association
摘要：We summarized and appraised evidence regarding HIV prevention interventions for adults with criminal justice involvement. We included randomized and quasi-randomized controlled trials that evaluated an HIV prevention intervention, enrolled participants with histories of criminal justice involvement, and reported biological or behavioral outcomes. We used Cochrane methods to screen 32 271 citations from 16 databases and gray literature. We included 37 trials enrolling n = 12 629 participants. Interventions were 27 psychosocial, 7 opioid substitution therapy, and 3 HIV-testing programs. Eleven programs significantly reduced sexual risk taking, 4 reduced injection drug risks, and 4 increased testing. Numerous interventions may reduce HIV-related risks among adults with criminal justice involvement. Future research should consider process evaluations, programs involving partners or families, and interventions integrating biomedical, psychosocial, and structural approaches. Since the inception of the HIV epidemic, populations with criminal justice involvement have experienced an urgent need for HIV prevention and care services. Much of the research in this area to date has focused on HIV risk and prevention in incarceration settings, including both prisons and short-term jails. Incarcerated individuals face overlapping risks for HIV infection: infections are primarily attributed to pre- and postincarceration risk behaviors, 1,2 but risks may also include behaviors in prison (e.g., injection drug use [IDU], sexual activity, tattooing, violence), 3 elevated prevalence of other sexually transmitted infections (STIs), and sociodemographic risk factors such as poverty, racial discrimination, and living in underserved or socially marginalized communities. 3,4 In the United States, approximately 1 in 7 HIV-infected individuals is released from an incarceration facility each year. 5 A recent systematic review of HIV prevalence among prisoners in 152 low- and middle-income countries found prevalence estimates greater than 10% in 20 countries, 6 and a survey of global evidence found elevated HIV prevalence among prisoners worldwide. 3 The population of incarcerated individuals is a large target for intervention; according to the United Nations Office on Drugs and Crime, approximately 10 million people worldwide are held in prison at any one time, and 30 million are incarcerated each year. 7 Nonincarcerated adults with a history of criminal justice involvement are also at elevated risk of HIV infection because of these same risk factors, and studies have documented high rates of HIV, sexual risk taking, and substance use among probationers and parolees. 8,9 Individuals returning from incarceration to community settings tend to report high rates of condomless sexual activity and drug use, 9–11 compounded by relationship disruptions 12 and difficulty accessing medical services and fulfilling other basic needs. 13,14 The postrelease period is especially characterized by elevated risk taking, 13,15,16 return to preincarceration behaviors, 17 and high HIV incidence. 18 The population of nonincarcerated adults involved with the criminal justice system is also sizeable; in the United States, for example, approximately 4.8 million individuals in the community were under supervision by adult correctional authorities in 2011 (approximately 2% of the population). 19 Published research supports the need for HIV risk-reduction efforts for individuals with criminal justice involvement in both incarceration and community settings. Combining evidence from both settings in a single systematic review is valuable given the overlap between incarcerated and nonincarcerated individuals, the return of incarcerated individuals to the community, high rates of recidivism and reincarceration, and the design of HIV prevention interventions that include both incarceration-based and postrelease services (e.g., case management, booster sessions). Although previous reviews have examined intervention effectiveness in this population, an up-to-date and rigorous review is needed. Limitations of previous reviews include the lack of systematic search methods, 20,21 the inclusion of a wide range of study designs, or focus on only a subset of studies, such as opioid substitution therapies (OSTs), 22–25 treatment of alcohol use disorders, 26 needle-exchange programs, 27 interventions for women in prison, 28 or interventions in incarceration but not community settings. 3,29,30 We aimed to summarize and appraise the most methodologically rigorous evidence for the effectiveness of HIV prevention efforts among adults with criminal justice involvement, including both incarceration and community settings.