At-risk behaviors with regard to HIV and addiction among women in prison

Treating incarcerated women: gender matters

Research on incarcerated women has shown they have a high degree of comorbid psychopathology, including substance dependence, posttraumatic stress disorder (PTSD), antisocial personality disorder (ASPD), and major depression. Incarcerated women differ from their community peers by having more symptoms related to addiction, ASPD, and PTSD. At the same time, incarcerated women are every bit as likely as incarcerated men to be dependent on drugs and almost as likely to be dependent on alcohol. What emerges is a picture of the incarcerated woman far more likely to have had traumatic experiences, including early sexual and physical abuse, than her male peers but every bit as likely to have substance dependence and, in some correctional populations (eg, sentenced felons), antisocial personality disorder. Central to the discussion of how best to treat female offenders is the need to address how programs would best be structured for women with severe substance dependence, substantial trauma histories, and personality pathology, including ASPD. Incarcerated women are a population with complex medical and mental health needs and are likely to be high users of services within the correctional system. This poses challenges to a system already stretched thin in caring for these complex inmates. This article emphasizes that gender differences need to be appreciated, and that service delivery to male and female inmates needs to be structured with gender in mind. The article recommends case management, treatment in highly structured therapeutic communities, and emphasizing abstinence from substances and development of skill sets to engage in healthy relationships.A major future challenge lies in researching treatment interventions for women in the correctional system. There are few existing trials of treatment efficacy and, as previously noted, the incarcerated female population differs from populations of incarcerated men and women in the community. Opiate-dependent women undergoing treatment in the community may prove to be a reasonable comparison group in beginning to develop evidence-based treatment for female offenders in prisons and jails. Ultimately, the development of services for incarcerated women will consider gender, race, and psychopathology in determining treatment setting and modalities. We are on new ground. It is a promising and exciting time to be involved with treatment of female offenders.

Educational attainment but not literacy is associated with HIV risk behavior among incarcerated women

PURPOSE

To identify the educational factors associated with HIV risk behaviors among incarcerated women.

METHODS

We evaluated a cohort of female detainees at The Rhode Island Adult Correctional Institute between July and September 2004. Among the 423 women who participated in the study, 55% did not have a high school diploma, 29% had < or = 8th grade reading capacity, 32% had a learning disability, 37% had problem drinking, and 61% (257/423) reported HIV risk behavior.

RESULTS

In multiple logistic regression, participants who had completed high school had the lowest likelihood of HIV risk behavior (adjusted odds ratio [OR] 0.35, 95% confidence interval [CI] 0.12-1.00). There was no association between participants? literacy level and HIV risk behavior (adjusted OR 2.02, 95% CI 0.83-4.92).

CONCLUSIONS

Correctional education programs to reduce HIV risk behavior should focus on those with low educational attainment irrespective of literacy skills.

Toxicomanie et maternité

La plupart des études traitant de la toxicomanie des mères ont jusqu’à maintenant été axées sur les effets des produits, ou de l’environnement autour de la consommation, sur les enfants. Peu ont traité de la situation des mères elles-mêmes, de leurs trajectoires de vie, de leur désir d’enfant, de leurs besoins dans le développement des compétences parentales. L’article présente les résultats d’une recherche menée auprès d’un échantillon de mères toxicomanes ayant récemment accouché, en faisant ressortir plus particulièrement les divers événements qui ont ponctué leurs trajectoires de consommation et comment la maternité s’inscrit dans ces parcours. Trois principaux types de facteurs associés à l’initiation, au maintien, à la progression mais aussi à l’arrêt de la consommation ont été relevés : facteurs contextuels (consommation familiale, facilité d’accès aux produits, contacts dans le milieu de la drogue, conformité au groupe de pairs) ; facteurs relationnels (partenaire amoureux consommateur) et facteurs intrinsèques (automédication, besoin d’oublier et fuite de la réalité). L’arrivée de l’enfant, rarement planifiée, constitue un moment privilégié pour inverser la trajectoire et un facteur important dans la diminution de la consommation ou son abandon. Mais, elle peut également devenir une source de stress conduisant à des rechutes surtout dans le contexte où les conditions environnantes sont difficiles et où elles ont peu de contrôle sur leur avenir. L’étude des trajectoires permet de mieux comprendre la toxicomanie maternelle et de proposer des pistes pour l’intervention.