Abstract
Background:Alcohol use disorders
continue to be a serious public health problem in the U.S. with
more than half of the American population aged 12 years or older
reporting current alcohol use. Crimes associated with alcohol use
range from driving while intoxicated to assault and homicide.
Approximately 40% of the inmates in the U.S report to have been
under the influence of alcohol at the time of offence. A strong
dose-relationship has been reported between alcohol use and
increased high risk behaviors for HIV transmission, and poor
adherences to HIV medication. If alcohol use is associated with
poorer linkage to care upon release from jails, greater efforts to
assess and treat alcohol disorders in jail settings may be
warranted. This research aims at determining if problematic alcohol
use among HIV-infected detainees influences linkage to HIV care in
the community upon release from jails.
Methods: The analysis was conducted
as part of Enhance Link Initiative a multi-site evaluation project
across 10 jail sites. A longitudinal study design was used where
data were collected on 348 HIV infected individuals at study
enrollment, post release and six month after jail release. A
composite score (CS) from the Addiction Severity Index was used to
determine the severity of alcohol and drug use. Multivariate
logistic regression was used to test the hypotheses.
Results: More than half of the
participants reported using alcohol in the past 30 days before
their incarceration. Among them, 40% reported using alcohol with no
drug involvement. There was a trend among the 120 individuals whose
alcohol CS was greater than 0.23 to be less likely to link to care
but the association was not statistically significant. Significant
predictors of linkage included male gender and taking HIV
medication in the 7 days before incarceration.
Discussion:
Findings suggest the need
to treat alcohol use disorders among HIV-infected jail detainees in
order to enhance linkage to community HIV care .Substance abuse
treatment in jail settings tends to focus on availing treatment to
people using drugs. HIV infected individuals who abuse alcohol may
need alcohol specific services to improve rates of linkage to
community health care.
Table of Contents
TABLE OF CONTENTS
BACKGROUND AND LITERATURE REVIEW
........................................................................
1
Alcohol use and risky behaviors'
................................................................................................
2
HIV/AIDS in correctional settings
..............................................................................................
4
Linkage to care interventions in
jails
..........................................................................................
7
Substance abuse treatment in
correctional facilities
.................................................................
11
METHODS
...................................................................................................................................
14
Data collection
.......................................................................................................................
15
Figure 1: The data collection
flowchart
.................................................................................
17
Methods of analysis
...............................................................................................................
18
Dependent variable definition
...............................................................................................
19
Independent variable definition
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19
Statistical
analysis..................................................................................................................
20
RESULTS
.....................................................................................................................................
21
DISCUSSION
...............................................................................................................................
25
REFERENCES
.............................................................................................................................
30
Table1: Baseline characteristics of individuals (N=348) released
before March 2010 ............ 41
Table 2: Comparison of inmate characteristics at baseline and for
those with 6 month follow-
up evaluation (N=223)
..............................................................................................................
42
Table 3: Bivariate associations with
Linkage among HIV-Infected Jail Inmates (N=348) ..... 42
Table 4: Bivariate associations with
Linkage among HIV-Infected jail inmates with severe
alcohol problems (N=120)
........................................................................................................
43
Table 5: Multivariate association with linkage among individuals
with baseline and post-
release evaluation data
..............................................................................................................
45
APPENDICES
..............................................................................................................................
45
About this Master's Thesis
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