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A Critical Review of HIV-Related Interventions for Women Prisoners in the United States

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This article reviews the literature on HIV-related interventions for U.S. women prisoners, with a focus on identifying strategies that enabled women to practice safer sex, reduce drug use, and to avoid recidivism. A comprehensive search indicated that only nine such interventions were evaluated in professional journals between 1994 and 2009. These interventions involved behavioral programs for women at risk for HIV and discharge planning for women releasees who were either infected with or at risk for HIV. Four interventions for incarcerated women achieved successful outcomes regarding self-empowerment and safer sex skills; 3 prison-release interventions resulted in less recidivism if not reduced HIV risk. Each intervention was nominally women-centered, with prison-release programs lacking protocols that were designed specifically for women. Based on evidence that women-centered interventions were desirable for this population, such interventions should be given high priority in criminal justice policy and care provision during the HIV epidemic.

Section snippets

Review of the Literature

This article reviews prison-based interventions for U.S. women that were published in scholarly journals over a 15-year period from 1994 to 2009; we could find no articles published before 1994. In particular, we address intervention outcomes, the degree to which the interventions were tailored to women's needs and circumstances, and whether they addressed relational structures at the intrapsychic, interpersonal, community, and/or macro-social levels. Interventions typically fall into two

Do Women Need Targeted Interventions?

Three review articles on non-prison HIV prevention interventions support the premise that programs for women are more effective if they are gender-specific and targeted to women's needs. First, Exner, Seal, and Ehrhardt's (1997) review of interventions in mixed settings demonstrated that two thirds of women-only interventions had positive effects on sexual risk behavior. Conversely, only one study involving men and women indicated significantly reduced sexual risk in a relational-skills

Do Women Prisoners Need Targeted Interventions?

The statistics on HIV in incarcerated women are alarming—women inmates are 15 times more likely than nonincarcerated women to be infected with HIV (De Groot & Cu Uvin, 2005). In 1996, the HIV rate for incarcerated women was 23 times the national rate, compared to six times the national rate for all prisoners (Dean-Gaitor & Fleming, 1999). Some states have reported HIV rates as high as 41% among women prisoners (e.g., Washington, DC; NMAC, 2003). In all cases, these rates were considerably

Identification of Studies

Two methods were used to identify interventions in published scholarly literature. First, we conducted a search of the entire contents of a 13-year-old HIV Listserv. The Listserv is kept by the second author (R.M.) and is distributed directly to about 5,000 researchers nationwide (http://www.apm.org/sigs/oap/#malow_listserv). Abstracts in the database were considered in scope if they examined behavioral, biological, or psychosocial dimensions of the epidemic, including contextual antecedents,

Final Sample

Nine articles on behavioral interventions and discharge planning involved both HIV-infected and at-risk women prisoners. Seven of these articles were published in the 1990s and eight articles involved women with previous drug histories as a point of intervention. Only one intervention was conducted explicitly with women who were living with HIV. Eight interventions were for women whose HIV status was either not specified or considered irrelevant to the study.

Discussion

This review identified HIV-related interventions for U.S. women prisoners that had measurable outcomes and considerably more training or support services than were available in most prisons. Two basic types of interventions were identified: behavioral interventions with theory-based protocols designed to address the relational needs of women outside prison walls, and re-entry programs primarily designed to provide links to community services such as drug-treatment programs. HIV risk reduction

Limitations

The analysis for this review was based on published information about design, protocols, and outcomes of interventions for women prisoners. In some cases, the protocols thinly described how the term “women-centered” was operationalized in relation to study outcomes. Although impracticable for the present review, study manuals and other materials would have provided greater depth for analysis. The study was also limited by the small number of published interventions for review. While more

Conclusion

This is the first time that HIV-related interventions have been reviewed for women prisoners who are either incarcerated or being released into the community. Significant gaps were identified, including the small number of published studies, the limited success of prison-release programs, and the lack of gender-specific models that could be replicated on a national scale. In reviewing this literature, we made the case for targeted HIV interventions that took account of women's relational

Disclosures

This research was funded in part by RO1 DA11875 from NIDA and RO1 AA11752 from NIAA (Robert Malow, Principal Investigator). Bronwen Lichtenstein disclosed consulting fees from RTI International.

Bronwen Lichtenstein, PhD, is associate professor, Department of Criminal Justice, The University of Alabama, Tuscaloosa, AL., and Research Fellow at the Rural Center for AIDS/STD Prevention, Indiana University at Bloomington.

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    • Cited by (0)

    Bronwen Lichtenstein, PhD, is associate professor, Department of Criminal Justice, The University of Alabama, Tuscaloosa, AL., and Research Fellow at the Rural Center for AIDS/STD Prevention, Indiana University at Bloomington.

    Robert Malow, PhD, ABPP, is professor, Department of Health Promotion & Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL.

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