Community-Based Participatory Research with the Justice System to Enhance STI Testing and Treatment

Background: Criminal behavior and sexually transmitted infections are co-occurring social epidemics. Therefore, individuals engaged with the justice system have been prioritized for both HIV and STI prevention and treatment programs. Through a CBPR partnership with the justice system we sought to: 1) understand preferences for STI prevention, screening and care among individuals in the judicial system, 2) improve sentinel surveillance of this community, and 3) assess the feasibility of a court-based STI screening program. Methods: We utilized CBPR to engage stakeholders involved in the Marion County Community Court (Indiana) to collaboratively design an STI screening program and research protocols. An ongoing study resulting from this partnership assesses women's attitudes towards genital herpes (HSV-2) and associations between their attitudes and STI screening- and treatment-related behaviors. Results: Of 28 women accepting no-cost testing for HSV-2, 46.4% were antibody-positive, a rate higher than the national prevalence rate (17%) and the rate from an Indianapolis STD clinic population (22.5%). Factors identified as facilitating and challenging the sustainability of this partnership were related to a) the conceptualization of community within a court-specific setting, b) developing research protocols that reflected mutual interests, c) the ethics of co-conducting data analysis, and d) determining dissemination venues that benefit both the court and court community. Conclusion: Justice-public health collaborations, developed using CBPR, engage highly-vulnerable individuals with research and services in their community and afford important opportunities to develop culturally-relevant interventions. The burden of HSV-2 we detected evidences that this population would benefit from improved access to sexual health services.