An exploratory study of mental health and HIV risk behavior among drug-using rural women in jail.

Abstract

Objective Rural women, particularly those involved in the criminal justice system, are at risk for HIV due to the increasing prevalence of injection drug use, as well as limited services. Research on HIV risk correlates, including drug use and mental health, has primarily focused on urban women incarcerated in prisons. The purpose of this exploratory study is to examine dual HIV risk behavior by three different mental health problems (depression, anxiety, and PTSD) among drug-using women in rural jails. Methods This study involved random selection, screening, and face-to-face interviews with 136 women from rural jails in one Appalachian state. Analyses focused on the relationship between mental health and HIV risk among this sample of drug-using women. Findings Nearly 80% of women self-reported symptoms of depression, and more than 60% endorsed symptoms consistent with anxiety and PTSD symptoms. Mental health was significantly correlated with severity of certain types of drug use, as well as risky sexual activity. In addition, for women experiencing anxiety and PTSD, injection drug use moderated the relationship between mental health and risky sexual activity. Implications Based on these rates of drug use, mental health problems, and the emergence of injection drug use in rural Appalachia, the need to explore the relationships between these issues among vulnerable and understudied populations, such as rural women, is critical. Due to service limitations in rural communities, criminal justice venues such as jails provide opportune settings for screening, assessment, and intervention for drug use, mental health, and HIV education and prevention.

Partner Relationships and Injection Sharing Practices among Rural Appalachian Women

“…Women in this study were recruited from local jails in three Appalachian counties in one southern state. The jails were located in counties designated as some of the most economically distressed rural areas of the country (ARC, 2017) in a region that has been devastated by the recent prescription opioid epidemic, high rates of drug overdose, and increasing prevalence of HCV (Staton-Tindall et al, 2015; Suryaprasad et al, 2014; Zibbell et al, 2015). Coupling these public health concerns with the notion that rural women in Appalachia suffer from some of the most distinct health disparities in the country (American College of Obstetricians and Gynecologists, 2014), research is critically needed on this vulnerable and underserved population.…”

“…Considering the significance of these health issues for women, research is needed on factors which underlie routes of disease transmission among women in underserved areas – such as rural Appalachia. Limited studies have suggested that women living in rural Appalachia may face unique vulnerabilities for disease transmission associated with drug use (Staton-Tindall et al, 2015). The Appalachian region has experienced an increase in prescription opioid use (Keyes, Cerda, Brady, Havens, & Galea, 2014), injection drug use (IDU) (Staton-Tindall et al, 2015), rates of overdose (Rudd, Aleshire, Zibbell, & Gladden, 2016), and HCV (Zibbell et al, 2015).…”

“…Limited studies have suggested that women living in rural Appalachia may face unique vulnerabilities for disease transmission associated with drug use (Staton-Tindall et al, 2015). The Appalachian region has experienced an increase in prescription opioid use (Keyes, Cerda, Brady, Havens, & Galea, 2014), injection drug use (IDU) (Staton-Tindall et al, 2015), rates of overdose (Rudd, Aleshire, Zibbell, & Gladden, 2016), and HCV (Zibbell et al, 2015). Thus, research with rural women drug users in Appalachia is critically important, yet challenging due to geographic isolation and lack of trust of outsiders.…”

Anxiety symptoms and disorders among adults living with HIV and AIDS: A critical review and integrative synthesis of the empirical literature

“…Results also indicated that injection drug use was significantly predictive of increased unprotected sexual acts with seronegative partners. More recently, Staton-Tindall et al (2015) examined 136 HIV+ incarcerated substance-using women, indicating that anxiety symptoms were related to injection drug use. Additionally, women endorsing higher anxiety symptoms and higher substance use reported significantly more male sexual partners than those women with lesser anxiety symptoms.…”

Violent Victimization and Substance Dependency: Comparing Rural Incarcerated Heterosexual and Sexual Minority Women

“…From the sampling frame, study staff randomly selected participants for screening using the Research Randomizer computer-based program (www.randomizer.org). Recruitment and screening procedures are further described by Staton-Tindall and colleagues (2015).…”