Effects of incarceration on risky Sex: focus group data from Two New England states

Abstract

BackgroundHuman Immunodeficiency Virus (HIV) risk and interpersonal violence are interconnected public health problems facing incarcerated women. Prison may provide an opportune time to conduct HIV prevention activities with high-risk women.MethodsThis study used qualitative analysis to explore how incarceration affected women’s experiences of and thoughts about sex and sex risk. Twenty-one incarcerated women who had engaged in unprotected sex with a male in the 90 days prior to incarceration and experienced interpersonal violence in their lifetime participated in semi-structured focus groups at four women’s prison facilities in two New England States.ResultsThemes that emerged from these focus groups include: a) incarceration increased sexual desire for some women but decreased it for others, b) education and exposure to women with HIV during incarceration increased women’s intentions to use condoms after release, c) women recognized that partners were often unfaithful while women were incarcerated, d) women felt empowered by mental health/substance use treatment and sobriety in prison, and e) practical difficulties of re-entry challenged women’s resolve to practice safe sex after release.ConclusionThemes illuminate possible directions for public health interventions for this population at high risk for HIV.Electronic supplementary materialThe online version of this article (doi:10.1186/2194-7899-2-8) contains supplementary material, which is available to authorized users.

Feasibility of an HIV/STI Risk-Reduction Program for Incarcerated Women Who Have Experienced Interpersonal Violence

“…Women’s level of general perceived emotional support (as measured by the MSPSS) did not change. Given that incarceration itself can produce temporary reductions in risky behavior (i.e., risky sex, substance use) immediately following release (Knudson, Staton-Tindall, Oser, Havens, & Leukefeld, 2014; Peabody et al, 2014), a randomized controlled trial (RCT) is needed to establish the efficacy of this tailored intervention. However, given that IV victimization and perpetration, distress tolerance, and access to resources often worsen (Johnson et al, in press; Kellett & Willging, 2011; Richie, 2001) as women are released to the community from prison, and PTSD and depressive symptoms stay roughly the same (Johnson & Zlotnick, 2012; Zlotnick, Johnson, & Najavits, 2009), the observed positive trends for these variables from within prison to after release in the current sample are encouraging.…”

“…First, we included affect management skills. Affect dysregulation (i.e., impulsivity, reactivity, dissociation, avoidance) is a salient feature in the lives of women with IV (Herman, 1992; van der Kolk et al, 1996; Kuo et al, in press) and appears to present significant challenges to their safe sex behaviors (Becker-Lausen, 1995; Sterk, 2006). For example, avoidant behaviors may compromise women's ability to assess risk, to successfully negotiate condom use, and to engage in self protective behaviors.…”

“…Positive social support has been found to be important for HIV prevention for women (El-Bassel, Ivanoff, Schilling, Borne, & Gilbert, 1997; van Empelen et al, 2003), for reducing IV and its mental health sequelae (Coker et al, 2002; Mitchell & Hudson, 1983; Van-Wyk, Benson, Fox, & DeMaris, 2003), and for successful community re-entry after incarceration (Benda, 2005; Parsons & Warner-Robbins, 2002). We conducted one set of focus groups (Kuo et al, 2013; Peabody et al, 2014) to outline barriers and facilitators to safe sex at re-entry to the community from prison, and then incorporated population-specific details and narratives into the intervention. After all intervention components were integrated, we conducted a second set of focus groups to assess the acceptability of the draft intervention and made changes based on the feedback.…”

Evidence-based recommendations to improve reproductive healthcare for incarcerated women

“…In addition to diagnosis and treatment, the criminal justice system should provide an opportunity for education and re-entry planning to reduce STI risk (Peabody et al , 2014). Programs that emphasize STI education combined with skills training, housing, and employment have been shown to decrease HIV-risk behavior and have been successful at linking HIV-positive individuals into care in the community (Wolitski and Group, 2006).…”

Justice-involved women’s preferences for an internet-based Sexual Health Empowerment curriculum

“…Women with criminal justice histories have increased risk for many sexual health-related problems such as increased prevalence of sexually transmitted infections (STIs), high rates of unintended pregnancy, cervical cancer, and low rates of up-to-date cervical and breast cancer screening (Javanbakht et al , 2014; Wiehe et al , 2015; Ramaswamy et al , 2017; Pickett et al , 2018; Binswanger et al , 2009; Clarke et al , 2006). As women transition back into the community, they are confronted with a host of competing priorities like seeking stable housing, reconnecting with children, reinstating state assistance, finding employment and meeting other probation and parole requirements (Peabody et al , 2014; Freudenberg et al , 2008). Their sexual health does not always factor high in the list (Ramaswamy, Upadhyayula, Chan et al , 2015), though the need for information, resources, and connections to care persist.…”