Journal of Correctional Health Care

While the extent to which HIV/AIDS has entered correctional facilities has been documented, less is known about the prevalence of HIV/AIDS high-risk behaviours among inmates: intravenous drug use, unprotected sex, tattooing, and piercing. The Correctional Service of Canada’s National Inmate Survey provided a unique opportunity to gather this information. Questionnaires were administered to a randomly selected sample of 4,500 male inmates. Results showed that HIV/AIDS high-risk behaviours are widespread in penitentiaries. Tattooing was the most prevalent behaviour (45%), followed by body piercing (17%), injection drug use (11%), and sexual intercourse (6%). The study showed that there were identifiable clusters of high-risk inmates. Younger inmates, parole violators, and those with a long criminal history including robbery/weapons offences had the highest risk for infection. A significant proportion of respondents felt that inmates were at greater risk of infection in prison than in the community.

National (U.S.) estimates suggest that over 210,000 adult felons are released each year with mental illness severe enough to warrant significant attention from prison mental health staff. Previous studies concerning mentally ill offenders have focused on criminological variables such as age and past criminal history to explain recidivism rates of 65-80 percent. This retrospective study examined the influence on recidivism of variables such as pre-release planning elements (mental health treatment, financial assistance, and housing), post-release coordination of elements, and acquisition of community resources among a sample of mentally ill felons released to the community. Subjects (n=25) were drawn in a stratified random manner to ensure inclusion of women (n=5; 20%), and were followed from six to 18 months.

Correctional health care systems regularly standardize many aspects of patient care. However, the care of those with chronic illnesses seldom is standardized, but is left entirely to the discretion of individual practitioners. In such a situation, staff turnover and inmate transfers result in a wide variety of patterns of care and management criteria, and a chance of serious omissions in the care of this high risk, problem-prone group. A system is described for the standardization of the basic elements of adequate care of those with the common chronic illnesses, using practice guidelines. When these guidelines are stated in simple, objective, measurable terms, they can be incorporated into flow sheets and also into quality improvement monitoring tools. The guidelines can be augmented easily to meet patients’ special needs for individual treatment plans. This system has been shown to facilitate the responsible management of patients with chronic medical conditions.

Why women, compared to men, utilize health services at a consistently higher rate within or outside prison confinement is not well known or studied. Health needs and stress factors of 67 imprisoned women and their interrelatedness and impact on health service use were examined. Subgroups with histories of attempted suicide (HAS) and absence of drug use/abuse evolved, scoring significantly higher health service use, misconduct infractions, and injuries compared to the non-HAS and history of drug abuse (HDA) groups. Histories of abuse in childand adulthood were significantly more prevalent among the subgroups. Trauma history and development of vulnerability profiles may better explain gender-specific health service utilization.

The public’s concern for adolescent violent crimes in its communities has sparked a national trend of legislative action to send these juveniles to adult court to stand trial. The adult criminal justice system already is overburdened with adult offenders. Adult jail facilities often are ill-equipped to handle the emotional, medical, and mental health needs of this special population of offenders. Existing medical and psychiatric programs must be very creative and flexible in their approach to providing services to this population. The issue created by transfer of violent juvenile offenders to adult court are reviewed. Recommendations and approaches to caring for these children are outlined.

HIV/AIDS knowledge and HIV-related risk behavior perform a critical role in the planning and implementation of jail-based risk reduction programs. Building on Becker’s (1974) health belief model, which indicates that decreased risk behavior accompanies increased risk education, we measured risk orientation of 264 incarcerated women by examining knowledge of HIV transmission, pre-arrest risk behavior, self perceptions of risk, and risk management. Findings did not lend support to Becker’s model, which purports that decreased risk behavior follows increased risk education. Consequently, it appears that increased risk education would not decrease risk behavior in this population. Theoretical, methodological, and programmatic implications of the findings are discussed.