HIV prevention for juvenile and adult criminal offenders in residential correctional facilities: Systematic review of randomized controlled trials

Background: HIV prevention programs in correctional settings can reach critically underserved and high-risk populations. Approximately one-seventh of the HIV-positive U.S. population leaves correctional facilities each year. Criminal offenders are at risk for HIV infection in prison and community settings, and prevention successes in jails and prisons can benefit at-risk communities after participants' release. We synthesized evidence for the effects of HIV prevention programs in residential correctional facilities worldwide. Methods: Two reviewers screened 9153 records from electronic databases and cross-referencing. Included studies met these criteria: randomized or quasi-randomized controlled trial; participants were not known to be HIV-positive; interventions aimed to prevent HIV and took place in a residential correctional facility; results included an HIV-related behavioral or biological outcome. We appraised and synthesized trial findings. Results: Twelve trials enrolling n=3935 adults and seven trials enrolling n=2559 juveniles met inclusion criteria. Seventeen of the 19 trials took place in the U.S. Participant populations were all male (8 trials), all female (4), and mixed (7). Eleven trials among adults and 3 trials among juveniles found a protective intervention effect on at least one outcome of interest, compared to a variety of control groups. Programs did not appear to cause harm. Conclusions: Populations incarcerated in correctional facilities are entitled to minimum standards of health care in the U.S., and there are strong arguments for including HIV prevention programs as part of these services. HIV prevention among incarcerated offenders is feasible and potentially effective, and beneficial interventions can include psychosocial programs, drug treatment, and HIV testing.