Criminal Justice and HIV Prevention: Using Epidemiological Methods to Understand the Perils and Promise of a Public Health “Odd Couple”

HIV prevention research has traditionally focused on behavior change at the level of the individual; however, societal-level factors can have profound effects on an individual's ability to modify the behaviors that

put them at risk of HIV infection. This is particularly true for injection drug users (IDUs), who are subject to arrest, incarceration and other criminal justice interventions as a result of their illicit drug use. For them, drug use takes place within a “risk environment”

shaped in large part by policing practices, prison policies and other factors in the realm of criminal justice that influence daily decisions regarding safe injection practices. Notably, these factors often vary across geographic settings, requiring site-specific research to develop a precise elucidation of the local risk environment, its effects on individual behaviors, and appropriate societal-level interventions. Epidemiological methods, long utilized to identify factors that influence health and illness, are uniquely suited for studies of this

nature. This presentation uses specific examples from ongoing research among IDUs in Tijuana, Mexico, to demonstrate how epidemiology can be used to understand the impact of policing practices and incarceration on HIV risk behaviors. Further, it proposes opportunities for

epidemiologists and criminologists to collaborate on HIV prevention research and interventions within the emerging transdisciplinary field of epidemiological criminology.