1. PURPOSE BACKGROUND RESULTS STUDY DESIGN & METHODS HIV Risk Behaviors Among Male Prisoners Participating in a Randomized Clinical Trial of Methadone Maintenance Treatment: 12 Month Findings M.E. Wilson 1, T.W. Kinlock 1,2, M.S. Gordon 1, R.P. Schwartz 1, K.E. O’Grady 3 1 Friends Research Institute, 2 Division of Criminology, Criminal Justice and Forensic Studies, University of Baltimore, 3 Department of Psychology, University of MD, College Park FINDINGS Acknowledgement: Supported by NIDA R01DA016237-01 (PI: T. Kinlock, Ph.D.). The authors have no financial relationships related to the topic of this presentation. REFERENCES The Methadone Maintenance for Prisoners study examined the benefits of providing methadone maintenance to prison inmates nearing release. The present analysis examined differences in HIV-risk behaviors of these inmates over a 12-month time period. Total Sample: There were no significant Treatment Condition x Time interaction effects suggesting that participants in the three treatment conditions did not differentially change their drug use or sex risk behaviors over time. Of importance was the time main effect reduction in drug risk score ( p <.01), injection drug use ( p <.01), sex risk score ( p <.01) and having unprotected sex ( p <.01). Treatment Condition was not associated with participation in risky drug use behaviors and was only associated with the number of times had any kind of sex ( p =.02) and the number of times had unprotected vaginal sex ( p =.04), with the Counseling + Transfer condition reporting higher means. # times had any kind of sex: Counseling Only (M =10.6, SE =.92); Counseling + Transfer ( M =14.2, SE =.91) and Counseling + Methadone ( M =11.7, SE =.89). # times had unprotected vaginal sex: Counseling Only (M =7.2, SE =1.2); Counseling + Transfer ( M =11.4, SE =1.2) and Counseling + Methadone ( M =8.4, SE =1.1). Injector Sub-Sample There were no significant Treatment Condition X Time interaction effects (all p s >.39). There were no significant Treatment Condition main effects for risky drug use behaviors (all ps >.22). There were significant time main effects indicating reductions in participation in risky drug use behaviors (significant ps <.03). Unprotected Sex Sub-Sample There were no significant Treatment Condition X Time interaction effects (all ps >.40. There were no significant Treatment Condition main effects for risky sex behaviors (all ps >.14). There were significant time main effects, showing a decrease in participation in risky sexual behaviors (all ps <.03). Findings indicate that post-release participation in risky drug use and sex behaviors decreases over time, regardless of Treatment Condition, in a sample of adult males with histories of pre-incarceration heroin addiction. Categorical variables Counseling only ( n = 70) Counseling + transfer ( n = 70) Counseling + methadone ( n = 71) Race African American White Other 46 (65.7) 22 (31.4) 2 (2.9) 51 (72.9) 14 (20.0) 5 (7.1) 50 (70.4) 15 (21.1) 6 (8.5) Route of Heroin Administration Injector Non-Injector 48 (68.6) 22 (31.4) 40 (57.1) 30 (42.9) 43 (60.6) 28 (39.4) Continuous variables (M/SD) Age40.8 (7.6)39.6 (6.9)39.3 (7.0) Education10.9 (2.0)11.2 (1.6)10.9 (1.7) Age first heroin use18.8 (5.3)18.5 (4.8)18.0 (4.8) Age first crime13.6 (4.9)13.5 (4.9)13.5 (3.9) Lifetime substance abuse treatment (times)2.6 (4.4) 1.6 (1.7)1.9 (2.5) Lifetime incarceration (months)119.8 (96.1)100.0 (86.1)120.7 (93.4) Past 30 days heroin use*27.3 (7.5)27.8 (6.1)26.7 (8.9) Past 30 days cocaine use*19.9 (12.9)17.5 (13.0)17.2 (13.9) Table 1: Sample (N = 211) Characteristics at Baseline Study Design 211 male pre-release prisoners who were heroin-dependent during the year prior to their current incarceration were randomized to: Counseling Only: Counseling in prison, with passive referral to treatment upon release. Counseling + Transfer: counseling in prison with transfer to community-based methadone treatment program (MTP) upon release. Counseling + Methadone: Methadone treatment and counseling in prison, continued in a community-based MTP program upon release. Data were examined at study intake (Baseline, 30 days prior to most recent incarceration) and 1, 3, 6 and 12 months post-release. Follow-up data were available from 206 (97%) at 1 and 3 months; 203 (96%) at 6 months; and 194 participants (92%) at 12 months post-release. Analyses were conducted for the total sample and two overlapping subsamples. Total sample: All study participants (N = 211). Injector Subsample: Participants reporting injecting drugs at baseline (N = 131). Unprotected Sex Subsample: Participants reporting having unprotected sex at baseline (N = 144). Assessment Texas Christian University’s (TCU) HIV/AIDS Risk Assessment (ARA) was used to measure drug and sexual risk behaviors (Simpson et al., 1993). Addiction Severity Index (ASI) was used to measure drug use and criminal activity (McClellan, 1992). Statistical Analysis Linear mixed model analyses were used to determine differences on selected items from the ARA. Differences were examined by: Condition main effect Time main effect Condition x Time interaction effect Despite its effectiveness, methadone maintenance is rarely provided in American correctional facilities. The Methadone Maintenance for Prisoners study was the first randomized clinical trial in the US to examine the effectiveness of methadone maintenance treatment provided to prisoners (as opposed to jail inmates) with pre-incarceration histories of heroin addiction (Kinlock et al., 2007). Study findings indicated that there were significant differences in mean number of days of post-release drug abuse treatment over 12 months ( p >.01) favoring the group starting methadone in prison compared to the group starting post-release and the group that received a passive treatment referral. The group starting in prison was also significantly less likely as compared to the other two groups to have opioid or cocaine positive urine tests at 12 months post-release. These results support the effectiveness of prison-initiated methadone for males in the United States (Kinlock et al., 2009). The purpose of the present study was to determine the extent to which IV drug use and sexual practices are related to study Condition and participation in HIV risk behaviors over time. Kinlock, T.W., Gordon, M.S., Schwartz, R.P., Fitzgerald, T.T. & O'Grady, K E. ( 2009). A randomized clinical trial of methadone maintenance for prisoners: Results at 12 months post-release. Journal of Substance Abuse Treatment, 37, 277-285. Kinlock, T.W., Gordon, M.S., Schwartz, R.P., O’Grady, K.O., Fitzgerald, T.T. & Wilson, M. (2007). A randomized clinical trial of methadone maintenance for prisoners: Results at 1-month post-release. Drug and Alcohol Dependence, 91, 220-227. McLellan, A.T., Kushner, H., Metzger, D., Peters, R., Grissom, G., Pettinati, H. & Argeriou, M. (1992). The fifth edition of the addiction severity index: Historical critique and normative data. Journal of Substance Abuse Treatment, 9, 199- 213. Simpson, D.D., Knight, K. & Ray, S. (1993). Psychosocial and cognitive correlates of AIDS- risky behaviors. AIDS Education and Prevention, 5, 121-130. CONCLUSIONS Refers to 30 days in the community prior to current incarceration Table 2: Means ( M ) and Standard Errors ( SE ) of Past 30 Day Risky Drug- and Sex-related Behaviors for Time Main Effect QuestionBaseline 1 1 Month 2 3 Month 2 6 Month 2 12 Month 2 p Total Sample ( N = 211) ARA Drug Risk Scale Score195.8 (22.9)22.3 (5.0)31.8 (5.6)27.7 (5.6)22.4 (5.3)<.01 Times injected?110.4 (10.5)13.8 (2.7)24.2 (4.2)21.7 (4.5)16.0 (3.5)<.01 ARA Sex Risk Scale Score97.2 (10.8)38.7 (3.6)46.7 (6.4)31.3 (3.6)26.7 (3.8)<.01 Times had sex without using a latex condom?16.0 (1.8)7.1 (.88)8.7 (1.0)6.6 (.87)5.3 (.80)<.01 Injector Subsample ( N = 131) ARA Drug Risk Scale Score309.2 (32.1)34.5 (7.7)49.1 (8.6)39.7 (8.4)36.4 (8.4)<.01 Times injected?174.0 (13.7)21.4 (4.1)37.2 (6.4)30.6 (6.8)25.9 (5.5)<.01 Times used unsterilized needles?9.6 (5.2).13 (.07).23 (.21).22 (.18)*.294 Times used same cooker/cotton/rinse water someone else used?32.1 (8.7)4.1 (1.9)2.2 (1.2)1.0 (.65).02 (.02)<.01 Times injected drugs with others who were also injecting?89.1 (11.4)8.5 (2.9)8.7 (2.7)7.6 (2.6)10.5 (3.8)<.01 Number of PEOPLE shared the same works with?5.3 (2.8).31 (.15).71 (.39).26 (.17).02 (.02).020 Unprotected Sex Subsample ( N = 144) ARA Sex Risk Scale Score134.5 (14.9)48.7 (4.8)60.7 (9.2)41.6 (5.1)34.6 (5.1)<.01 Number of PEOPLE you had any kind of sex with?2.2 (.22)1.7 (.18)1.5 (.26)1.1 (.15)1.0 (.24)<.01 Times you have any kind of sex with someone?26.8 (2.5)14.1 (1.2)14.8 (1.3)12.3 (1.2)9.2 (1.1)<.01 Times had sex without using a latex condom?23.4 (2.4)9.7 (1.2)11.4 (1.4)9.0 (1.2)7.1 (1.1)<.01 When you had sex without a condom, how many times was it… …with someone who was not your spouse or primary partner?5.9 (1.4)1.5 (.35)2.8 (1.3)1.0 (.50)1.2 (.56).024 …with someone shoots drugs with needles?8.2 (2.1).79 (.27)1.8 (.94).20 (.10).06 (.05)<.01 …with someone who sometimes smokes crack/cocaine?4.6 (1.1).75 (.24).96 (.32).15 (.08).38 (.27)<.01 …while you or your partner was “high” on drugs or alcohol?20.1 (2.3)3.6 (.72)5.7 (1.1)3.9 (.77)2.8 (.70)<.01 …while trading (giving/getting) sex for drugs or alcohol?3.0 (1.1).35 (.15).83 (.78).13 (.12).37 (.23).080 Times you had vaginal without using a condom?21.7 (2.3)10.2 (1.2)13.6 (3.8)8.9 (1.2)7.0 (1.1)<.01 Times had oral sex without using a condom?16.3 (2.3)5.3 (.97)6.5 (1.2)4.6 (1.0)4.8 (.97)<.01 Times had anal sex in those 30 days without using a condom?2.7 (.66).73 (.22).63 (.49)**.018 1 Responses for 30 days prior to current incarceration 2 1, 3, 6, and 12-months are post-release *All responses for this item were “0” at 12 month follow-up ** Majority of responses for 6 and 12 month follow-up were “0” A limitation in the analysis is the difficulty in comparing baseline HIV risk behavior reports for a period of time prior to incarceration. Individuals may have had lengthy incarcerations and recall regarding specific HIV risk behaviors may be limited. LIMITATION Future research will include analyses of changes by Condition over time from 1 – 12 month follow-up, excluding the baseline pre-incarceration period. Further exploration of increases at 3 month follow-up should also be included in future analyses. FUTURE RESEARCH