High Risk HIV Transmission Behavior in Prison: Does a Fatalistic Model Exist?

Background: Following a survey of HIV risk behaviors of inmates, a qualitative study was conducted among recently released ex-offenders to further explore the findings. The objectives were to determine the perceptions and knowledge of participants regarding the occurrence of HIV risk behaviors in prison that were identified in the survey based on their experiences while incarcerated.

Methods: The study was conducted at a community-based organization that provides care for recently released ex-offenders. Four focus group discussions (FGDs) each were conducted with purposive samples of male and female ex-offenders who met the set eligibility criteria. FGDs were tape-recorded and transcribed. Data were analyzed using the NVivo 7 software.

Results: Participants agreed that all the HIV risk behaviors reported in the survey, i.e., injection drug use, sexual intercourse including tattooing and body piercing did occur. Reasons given to explain inmates' involvement in these behaviors supported the deprivation and importation models. However, a striking recurring response was the association of inmates on life sentences with injection drug use and sexual intercourse. The focus group participants described attitudes on the part of “lifers” that can be inferred as fatalistic, exemplified by statements such as “…they just don't care; they know they are not going anywhere”.

Conclusions: In addition to the other models used to describe HIV risk behaviors of inmates, a fatalistic model may apply, especially among inmates on life sentences. Further studies are required to examine this model. If proven, the fatalistic model has programmatic implications for HIV prevention among incarcerated populations.