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Preexposure prophylaxis (PrEP) is underused in persons who use drugs and justice-involved persons. In an ongoing randomized controlled trial in 4 US locations comparing patient navigation versus mobile health unit on time to initiation of HIV medication or PrEP for justice-involved persons who use stimulants or opioids and who are at risk for or living with HIV, we assessed HIV risk factors, perceived HIV risk, and interest in PrEP. Participants without HIV (n = 195) were 77% men, 65% White, 23% Black, and 26% Hispanic; 73% reported a recent history of condomless sex, mainly with partners of unknown HIV status. Of 34% (67/195) reporting injection drug use, 43% reported sharing equipment. Despite risk factors, many persons reported their risk for acquiring HIV as low (47%) or no (43%) risk, although 51/93 (55%) with PrEP indications reported interest in PrEP. Justice-involved persons who use drugs underestimated their HIV risk and might benefit from increased PrEP education efforts.

From 1980 to 2014, the number of incarcerated persons in the United States increased from 501 886 to 2 224 400—an increase of 343%. In 2014, about 1 in 110 adults were incarcerated in prisons and jails, and an additional 4.7 million adults were on probation or parole. In the same year, 636 346 persons were released from state and federal prisons, and an estimated 11 million persons cycled through local jails. More than 95% of incarcerated persons eventually return to their communities. Given the high rates of incarceration and subsequent release to the community, a large segment of the US population is involved in the criminal justice system. In this article, the terms “criminal justice involvement” and “justice-involved” refer to persons who have had contact with the criminal justice system in 1 or more of the following capacities: arrest, booking, charging, sentencing, incarceration in jail or prison, probation, or parole. This commentary examines justice involvement measures in federally funded, national population-based surveys. Building on a study that examined the absence of data on incarceration in 36 studies included in the Society of General Internal Medicine database on general health, we examined the available national population-based studies financed by the federal government that examine health outcomes. We provide an overview of the national population-based surveys that were selected for inclusion in this commentary and describe items in each survey that pertain to justice involvement and health among persons who have a history of incarceration and their family members. Our commentary further expands on the previous study by describing what studies have been conducted using these data sets and which questions could be answered given the domains that are included. We then summarize research questions that have recently been answered using these surveys. Finally, we outline future directions and offer recommendations for how national population-based surveys could best be used to understand the health status and health needs of the justice-involved population.

Background Persons with an opioid use disorder (OUD) who were incarcerated face many challenges to remaining abstinent; concomitantly, opioid-overdose is the leading cause of death among this population, with the initial weeks following release proving especially fatal. Extended-release naltrexone (XR-NTX) is the most widely-accepted, evidence-based OUD pharmacotherapy in criminal justice settings, and ensures approximately 30 days of protection from opioid overdose. The high cost of XR-NTX serves as a barrier to uptake by many prison/jail systems; however, the cost of the medication should not be viewed in isolation. Prison/jail healthcare budgets are ultimately determined by policymakers, and the benefits/cost-offsets associated with effective OUD treatment will directly and indirectly affect their overall budgets, and society as a whole. Methods This protocol describes a study funded by the National Institute of Drug Abuse (NIDA) to: evaluate changes in healthcare utilization, health-related quality-of-life, and other resources associated with different strategies of XR-NTX delivery to persons with OUD being released from incarceration; and estimate the relative “value” of each strategy. Data from two ongoing, publicly-funded, randomized-controlled trials will be used to evaluate these questions. In Study A, (XR-NTX Before vs. After Reentry), participants are randomized to receive their first XR-NTX dose before release, or at a nearby program post-release. In Study B, (enhanced XR-NTX vs. XR-NTX), both arms receive XR-NTX prior to release; the enhanced arm receives mobile medical (place of residence) XR-NTX treatment post-release, and the XR-NTX arm receives referral to a community treatment program post-release. The economic data collection instruments required to evaluate outcomes of interest were incorporated into both studies from baseline. Moreover, because the same instruments are being used in both trials on comparable populations, we have the opportunity to not only assess differences in outcomes between study arms within each trial, but also to merge the data sets and test for differences across trials. Discussion Initiating XR-NTX for OUD prior to release from incarceration may improve patient health and well-being, while also producing downstream cost-offsets. This study offers the unique opportunity to assess the effectiveness and cost-effectiveness of multiple strategies, according to different stakeholder perspectives.

Purpose – The purpose of this paper is to compare the effects of two types of community-based, residential treatment programs among justice involved persons with dual diagnoses. Design/methodology/approach – A randomized clinical trial examined treatment conditions among justice involved persons with substance use disorders who reported high baseline levels of psychiatric severity indicative of diagnosable psychiatric comorbidity. Participants (n=39) were randomly assigned to one of three treatment conditions upon discharge from inpatient treatment for substance use disorders: a professionally staffed, integrated residential treatment setting (therapeutic community), a self-run residential setting (Oxford House), or a treatment-specific aftercare referral (usual care). Levels of psychiatric severity, a global estimate of current psychopathological problem severity, were measured at two years as the outcome. Findings – Participants randomly assigned to residential conditions reported significant reductions in psychiatric severity whereas those assigned to the usual care condition reported significant increases. There were no significant differences in psychiatric severity levels between residential conditions. Research limitations/implications – Findings suggest that cost-effective, self-run residential settings such as Oxford Houses provide benefits comparable to professionally run residential integrated treatments for justice involved persons who have dual diagnoses. Social implications – Results support the utilization of low-cost, community-based treatments for a highly marginalized population. Originality/value – Little is known about residential treatments that reduce psychiatric severity for this population. Results extend the body of knowledge regarding the effects of community-based, residential integrated treatment and the Oxford House model.

This systematic literature review aims to examine how digital exclusion during incarceration contributes to the social exclusion of both juvenile and adult incarcerated persons and to analyse how digital inclusion initiatives facilitate successful re-entry into a technology-driven society. The review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Articles were searched from Elsevier and Google Scholar. A total of 472 articles were retrieved. After applying inclusion and exclusion criteria, 46 studies were included for review. Our findings show that many correctional jurisdictions rely on offline means of incarcerated persons rehabilitation, and access to basic online services and modern technologies that are available to the public outside of prison is restricted. Most correctional institutions have little or no communication with the outside world. We also found that technology offers the opportunity to normalise the prison environment more closely to that of the outside world. Access to digitally enabled incarcerated persons programming reduces the effects of disproportionate deprivation. Our review concludes that correctional institutions do not exist in isolation; they are influenced by what is happening in the society in which they exist. Hence, the digital transformation of prisons is inevitable.

Justice-involved HIV-positive women have poor health outcomes that constitute health inequities. Researchers have yet to embrace the range of qualitative methods to elucidate how psychosocial histories are connected to pathways of vulnerability to HIV and incarceration for this key population. We used life course narratives and intersubjectivity—predicated on interview dialogue—to investigate how familial and social settings established their social patterning of HIV, incarceration risk, and poor health. Working with two Alabama community-based organizations, we recruited and interviewed 24 HIV-positive cisgender women with cyclical incarceration. We analyzed the data by charting women’s life histories and conducting iterative content analyses. Participants described chaotic home environments, marked by exposure to trauma in childhood. The majority experienced repeated sexual and physical abuse that went undiagnosed and untreated until adulthood. Adolescence and young adulthood were characterized by onset of substance use, violent intimate partnerships, and subsequent behavioral and mental health problems. In adulthood, risk behaviors persisted for decades and women lacked mental health treatment and social support. Life course narratives and intersubjectivity contributed to knowledge by affording agency to marginalized participants to reflect on and narrate their life stories; instilling needed trust for researchers to investigate the complex risk pathways and psychosocial histories with this population; illuminating the nature, timing, sequence, and frequency of events underlying women’s vulnerability and exposure to HIV and incarceration; and clarifying that early shaping events in childhood are connected to later risk environments and behaviors in adolescence and adulthood, suggesting the need for earlier interventions than are typically proposed.

According to a Washington Post database, in the USA, police-involved shootings have killed over 5680 people since January 1, 2015, with 1359 (23%) of those deaths involving a person with a mental illness. It has been asserted by Fuller et al. that people with an untreated mental illness are approximately 16 times more likely to be killed in a police-involved shooting than other community members. In response to this issue, several practices have been implemented to help prevent negative outcomes in police and person with mental illness interactions and promote safety for all involved parties. Three practices have developed into models for police departments which include the following: Community Oriented Policing, Crisis Intervention Team (CIT) programs and training, and co-responder mental health teams. In addition to the foregoing three practices, other individual-level approaches and techniques can be implemented that are evidence-informed, such as increased utilization of stress-reduction training techniques and implicit bias training. Based on an additional examination of the existing literature, this problem can be addressed at the macro level, through amending policies and procedures (e.g., use-of-force guidelines, use of community-review board) as well as increased access to non-lethal weapons, presence of civilians on the police staff roster, and utilization of special consideration response registries. This review aims to incorporate existing literature in an effort to synthesize best practice responses for law enforcement in improving outcomes related to interactions with persons with mental illness.

Persons living with diagnosed HIV (PLWDH) are overrepresented in correctional settings, as are Latinx including those of Puerto Rican (PR) origin. Little is known about this population’s HIV care engagement after incarceration. Semi-structured interviews were conducted with 23 PLWDH of PR origin incarcerated in NYC jails using the Behavioral Model for Vulnerable Populations as the theoretical basis. Most participants described a fragile connection to HIV care and inconsistent antiretroviral therapy adherence due to issues including substance use, poverty (e.g. homelessness), and other factors. Most were satisfied with their current communitybased providers and reported that their PR ethnicity and transnational ties to PR did not impact their HIV care, although some preferred Spanish-speaking providers. Greater access to stable housing and HIV care that is convenient to substance use treatment and other services appear to be the greatest needs of PLWDH of PR origin leaving jail.

BackgroundAlthough the link between substance use and criminal behavior is well-established, associations between the use of specific substances and specific criminal charges remains unclear. That is, there are mixed findings in the literature, and the majority of extant literature focuses only on associations between alcohol and marijuana use and a limited range of charges.ObjectiveThe current study examined 30-day frequency of use of various substances (i.e., traditional tobacco, alcohol, marijuana, e-cigarettes, and prescription drugs) prior to detainment, percentages of youth charged with various offenses, and whether certain offenses were associated with more frequent use of particular substances prior to detainment among detained youth. Additionally, differences in substance-charge associations among Black and White youth were evaluated.MethodDetained youth (N = 235; 71.9% male; M age = 15.59 years) from two facilities self-reported on their substance use and the facilities provided charge data.ResultsMarijuana was the most frequent substance used and violent-related offenses were the most common charge received. Interestingly, several charges (i.e., sex-, weapon-, and violent-related offenses) were associated with less frequent use of tobacco and/or marijuana use, but youth who were detained for non-criminal reasons (i.e., children in need of care) reported more frequent use of various substances than youth detained for criminal charges. Findings were more similar than different for Black and White youth, with very few differences evident.ConclusionsChildren in need of care appear more at risk for certain substances than those detained for criminal offenses, with associations similar for detained Black and White youth.

Black men who have sex with men (BMSM) and Black transgender women (BTW) are impacted by dual epidemics of HIV and incarceration. We advanced understanding of the relationship between criminal justice involvement, HIV, and other key HIV-related characteristics among these key populations in the US. We conducted a systematic review up to 2018 and 47 articles met the inclusion criteria of scientific publications involving quantitative findings of US-based HIV-related studies focused on criminal justice–involved (CJI) BMSM and BTW. Overall, there was a dearth of studies focused specifically on BTW. Criminal justice involvement was relatively high among BMSM and BTW and more pronounced among BTW. The current evidence favors no association between incarceration and HIV acquisition among BMSM with limited information about BTW. Criminal justice involvement was associated with a greater likelihood of STIs among BMSM with mixed results for sexual risk behaviors. Criminal justice settings served as an important venue for HIV testing/diagnosis for both BMSM and BTW. However, these settings were not conducive for subsequent stages of the HIV care continuum. Studies pointed to an independent association between criminal justice involvement, substance use, housing instability, and greater odds of incarceration among BMSM who were unemployed and had limited education. Future incarceration was associated with high levels of perceived racism among BMSM. Among young BMSM, high network criminal justice prevalence was also associated with sexual risk behaviors, poorer mental health outcomes, drug use, and housing instability. CJI BMSM and BTW represent a critical subpopulation to end the HIV epidemic in the US.