Reducing risky relationships: a multisite randomized trial of a prison-based intervention for reducing HIV sexual risk behaviors among women with a history of drug use

Abstract

Women involved in the criminal justice system, particularly those with a history of drug use, are at elevated risk of HIV infection, yet few HIV prevention interventions have been tailored for delivery to incarcerated women. Drawing on the Relational Model, the Reducing Risky Relationships for HIV (RRR-HIV) intervention was developed and evaluated in a multisite randomized clinical trial. Women with weekly drug use prior to incarceration (n = 444) who were incarcerated within correctional institutions in four states were randomized to (1) the RRR-HIV intervention consisting of an HIV educational video, five group sessions, and one postrelease booster session or (2) a control condition consisting of the HIV educational video. The RRR-HIV intervention combined didactic and interactive content regarding seven “thinking myths” about intimate relationships that may result in decisions to engage in risky sexual behaviors. Data were collected while women were still incarcerated and approximately 90 days following release from prison by trained interviewers. A negative binomial regression (NBR) model of unprotected sexual behaviors at the 90-day follow-up indicated that RRR-HIV participants reported fewer unprotected sexual behaviors than women in the control condition once the analysis was adjusted for study site. Future studies should examine the sustainability of the RRR-HIV intervention's effect on risk reduction. Implementation research is needed to determine whether delivery of this intervention by correctional staff or peers, rather than research staff, yields similar reductions in unprotected sexual behaviors.

Keywords:

• HIV prevention intervention
• HIV sexual risk behaviors
• women
• criminal justice
• drug use

Acknowledgements

This study was supported through a cooperative agreement (2U01 DA16205) from the US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute on Drug Abuse NIH/NIDA, as part of Criminal Justice Drug Abuse Treatment Studies (CJ-DATS). The CJ-DATS cooperative agreement also received support from the Center for Substance Abuse Treatment (CSAT) of the Substance Abuse and Mental Health Services Administration (SAMHSA), the Centers for Disease Control and Prevention (CDC), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), and the Bureau of Justice Assistance within the US Department of Justice. The authors gratefully acknowledge the collaborative contributions of NIDA, the Coordinating Center (George Mason University and University of Maryland at College Park), and the Research Centers participating in CJ-DATS, particularly those Research Centers that participating in the RRR-HIV protocol (Brown University, Lifespan Hospitals and Memorial Hospital of Rhode Island; Connecticut Department of Mental Health and Addiction Services; University of Delaware, Center for Drug and Alcohol Studies; University of Kentucky, Center on Drug and Alcohol Research). The contents of this manuscript are solely the responsibility of the authors and do not necessarily represent the views of the funding agencies or other CJ-DATS participants, including the correctional institutions from which study participants were recruited.