HIV Prevention for Women with Incarcerated Male Partners: The HOME Project CAPS/UCSF: Olga Grinstead (PI), Megan Comfort (Project Director) Angela Allen, Philippe Bourgois, Barbara Garcia, Kelly Knight, Kathleen McCartney, Tor Neilands, Christine Soriano Centerforce: Yolanda Najera, Katie Kramer, Jolene Forman, Barry Zack Funded by National Institute of Nursing Research

Why work with women with incarcerated partners? June 2004: 726 inmates per 100,000 people, or 1 in every 138 U.S. residents behind bars 56% of those behind bars are people of color 2% of state prisoners in the U.S. were known to be infected with HIV in December 2002 Overall confirmed AIDS rate among U.S. prisoners in 2002 was more than 3 times the rate in the general population (0.48% vs. 0.14%)

Why work with women with incarcerated partners? Public-health study of low-income African-American women: – 22% had a current sexual partner who had been incarcerated at some point in his life – 5% had a current sexual partner who had been incarcerated for at least 12 months (Source: Battle et. al., (1995) “Accessing an Understudied Population in Behavioral HIV/AIDS Research: Low-Income African-American Women,” Journal of Health & Social Policy, 7(2), 1-17.)

Previous Research with Women with Incarcerated Partners Love Your Man, Love Yourself ( ) We learned: It is feasible to recruit and follow-up women who visit men in prison It is feasible to recruit and train peer educators

The HOME Project Health Options Mean Empowerment Began in October 2002 Phase 1: formative research Phase 2: intervention development Phase 3: intervention implementation and evaluation

HOME Research Questions Formative research: what are the HIV risks and needs that women with incarcerated male partners experience? Intervention Development: how can we address these risks and needs in a population- specific intervention? Evaluation: can the HOME intervention affect women’s knowledge, behavior, and/or attitudes regarding HIV risk?

Formative Data Collection  Qualitative interviews with women visiting an incarcerated male partner (N=20)  Qualitative interviews with correctional officers (N=13)  Quantitative survey with women visiting an incarcerated male partner (baseline N = 117, 30-day post-release follow-up N=99)

Consistent Findings from Previous and HOME Formative Research  Interventions designed for women with incarcerated male partners are feasible  Women do not feel at risk for HIV because they are monogamous  Lack of knowledge about prison policies diminishes women’s abilities to accurately assess their partners’ HIV risk, e.g., belief that all men are tested for HIV while incarcerated  Unprotected sexual intercourse has emotional and practical importance; partners are not using condoms

The HOME Intervention Intervention activities are: open to all (mothers, sisters, daughters, friends, as well as partners) Multi-component approaches: community fairs, small- group workshops, 1-on-1 outreach, warmline Holistic topics: women’s and children’s health, job skills, parenting, criminal-justice issues, community- building activities Peer Educators: trained, supervised, and paid to conduct 1-on-1 outreach at prison and in home communities, facilitate HOME activities

The HOME Evaluation Design Women visiting romantic partners who will be released within intervention period are recruited to be longitudinal study participants: baseline, post-release follow-up Two qualitative interviews will be conducted with each peer educator Attendance at HOME intervention activities will be encouraged and recorded for study participants A cross-sectional survey was conducted before (N=205) and will be conducted again after the year- long intervention to evaluate community-level impact

Acknowledgments Our study participants – past, present, and future Centerforce National Institute of Mental Health, Northern California Grantmakers, National Institute of Nursing Research