Background. Incarcerated populations are vulnerable to HIV infection and worldwide exhibit a higher prevalence rate of HIV compared to non-incarcerated populations. Interventions to provide HIV testing and treatment services in correctional centers would benefit those who are incarcerated and decrease the risk of transmission to the wider community upon release. Few countries in the developing world have implemented comprehensive HIV services as part of correctional healthcare, and a limited amount of research related to service provision in the correctional center context has been conducted. This dissertation presents data conducted as formative research for a demonstration project to provide HIV/STI testing and treatment services in the largest male correctional center in Jamaica. A prevalence estimate of HIV/STI for this population is presented. Psychosocial and structural factors that influence inmates' perception of and participation in HIV-related services in this context are explored.
Design and methods. This study employed cross-sectional data to address the research aims. Data from the demonstration HIV/STI testing and treatment project was analyzed to determine an estimate of the prevalence of HIV/STI. A quantitative survey was conducted with a stratified random sample of 298 participants prior to their participation in pre-test counseling. Bivariate and logistic regression was employed to analyze the data. Additionally, semi-structured in-depth interviews were facilitated with a purposive sample of 25 inmates. Interviews were analyzed through content analysis.
Results. The prevalence of HIV infection was 3.3% (n=1,017). The prevalence of chlamydia was 2.5% and for trichomoniasis it was 1.8%, but no cases of gonorrhea were found (n=396). Of the 298 participants in the quantitative survey, 60% chose to test for HIV. Multivariate logistic regression results indicate that participants who chose to test for HIV were more likely to report high HIV coping self efficacy (AOR 1.86; 95% CI 1.24-2.78, P value = .003), a perceived risk for HIV (AOR 2.51; 95% CI 1.57-4.01, P value = .000), and low HIV testing stigma (AOR 1.71; 95% CI 1.05-2.79, P value = .032). External HIV stigma and internal HIV stigma were not correlated with HIV test acceptance. However, participants who reported low external and internal stigma were more likely to report high HIV coping self efficacy (AOR 1.28; 95% CI 1.25-1.32, P value = .000; AOR 1.76; 95% CI 1.34-2.30, P value = .000 respectively). Participants who reported high HIV knowledge were also more likely to report high HIV coping self efficacy (AOR 2.33; 95% CI 1.04-5.22, P value = .040). A positive relationship between social support and HIV coping self efficacy was also found (AOR 2.09; 95% CI 1.19-3.68, P value = .010). Stress due to incarceration, limited access to social support, and the constant threat of violence are characteristics of prison life that may prohibit inmates' participation in HIV-related services. Fear of being labeled as a homosexual through participation in HIV services while incarcerated, and subsequent stigma and discrimination, is a major concern for inmates.
Conclusions. There is a need for HIV testing and treatment services in Jamaican correctional centers. The HIV prevalence rate of 3.3% is higher than the rate in the non-incarcerated population, but low enough that provision of treatment and care services would not overburden the correctional health system. Programs to increase HIV coping self efficacy, social support, and HIV knowledge may increase HIV test acceptance. A reduction of HIV/AIDS stigma and discrimination is necessary is also necessary, and should serve as a guiding principle in policy and program development.
|School:||The Johns Hopkins University|
|School Location:||United States -- Maryland|
|Source:||DAI-B 69/04, Dissertation Abstracts International|
|Subjects:||Public health, Psychology, Sociology, Epidemiology|
|Keywords:||AIDS, Correctional health, HIV, Incarceration, Jamaica, Prisons, STI, Stigma, Testing uptake|
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