Preventing HIV among criminal offenders in community settings: Evidence from a systematic review of randomized controlled trials

Background: Criminal justice populations are at heightened risk for HIV, with risk factors including poverty, drug use, risky sexual activity, and STIs. Although HIV prevention research among criminal offenders frequently focuses on prisons, community supervision and alternatives to incarceration account for a growing proportion of this group. Offenders in community settings lack access to HIV prevention services and healthcare provided in prisons. We assessed the effectiveness of HIV prevention strategies among criminal offenders outside residential correctional facilities.

Methods: Cochrane review methods were used. Two reviewers examined 9153 records from electronic databases and cross-referencing. Included studies met these criteria: randomized or quasi-randomized controlled trial; all participants had prior criminal justice involvement; participants were not known to be HIV-positive; interventions aimed to prevent HIV and took place in a community setting (or began in prisons but continued post-release); results included HIV-related behavioral or biological outcomes.

Results: Nine trials enrolling n=2949 adults and n=860 juveniles met inclusion criteria, along with five studies that were ongoing and/or lacked outcome data. Study samples were all male (1 study), all female (3), or mixed (5). Six studies found a protective intervention effect on at least one outcome, compared to controls receiving usual care, testing, or a standard prevention program. One study also found short-term indications of increased post-intervention risk behavior; no other study observed harms.

Conclusions: Criminal justice contacts offer opportunities and obligations to deliver HIV prevention services to an at-risk, underserved population. Community-based prevention with criminal offenders is feasible, and various strategies show promising effects.