HIV prevention in community supervision for adults with substance use and mental disorders: Effects on knowledge, attitude and behavior

Background: Approximately 60-80% of those arrested are drug involved and 15% have a serious mental illness; the majority of these offenders have co-occurring mental and drug disorders along with co-morbid medical problems. About 5% of substance using and 18% of mentally ill substance using detainees have HIV/AIDS in New York City jails. Criminal justice diversion posits reducing criminal justice recidivism through increased access to and retention in community-based treatment, which treatment is believed to reduce targeted substance abuse, mental health and criminal justice symptoms and behavior. It was hypothesized that in addition to expected diversion outcomes those receiving the added HIV prevention would demonstrate decreased risk behaviors and increased knowledge, attitudes toward protective practices and access to medical and prevention services. Methods: Six and 12-month outcomes, derived through standardized self-report and administrative services, urinalysis and criminal justice data are described from a NIDA-funded longitudinal comparison study of 1000 adults with substance use or co-occurring mental disorders under community criminal justice supervision, with group differences equalized through propensity matching. Results: Preliminary multivariate regression findings suggest reduction in drug and sexual risk behavior, positive attitude change toward safe sex practices, increased HIV knowledge and increased receipt of HIV services. Differential effects by gender and by co-occurring mental illness versus substance use only disorders will also be presented. Conclusions: Relevant to researchers, practitioners and program administrators, implications of initial findings indicate public health in addition to public safety benefits to targeting offenders' risk behaviors along with mental health and substance use problems.