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Ayano G, Belete A, Duko B, Tsegay L, Dachew BA. Systematic review and meta-analysis of the prevalence of depressive symptoms, dysthymia and major depressive disorders among homeless people. BMJ Open 2021; 11:e040061. [PMID: 33622940 PMCID: PMC7907847 DOI: 10.1136/bmjopen-2020-040061] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess the global prevalence estimates of depressive symptoms, dysthymia and major depressive disorders (MDDs) among homeless people. DESIGN Systematic review and meta-analysis. DATA SOURCES Databases including PubMed, Scopus and Web of Science were systematically searched up to February 2020 to identify relevant studies that have reported data on the prevalence of depressive symptoms, dysthymia and MDDs among homeless people. ELIGIBILITY CRITERIA Original epidemiological studies written in English that addressed the prevalence of depressive problems among homeless people. DATA EXTRACTION AND SYNTHESIS A random-effect meta-analysis was performed to pool the prevalence estimated from individual studies. Subgroup and sensitivity analyses were employed to compare the prevalence across the groups as well as to identify the source of heterogeneities. The Joanna Briggs Institute's quality assessment checklist was used to measure the study quality. Cochran's Q and the I2 test were used to assess heterogeneity between the studies. RESULTS Forty publications, including 17 215 participants, were included in the final analysis. This meta-analysis demonstrated considerably higher prevalence rates of depressive symptoms 46.72% (95% CI 37.77% to 55.90%), dysthymia 8.25% (95% CI 4.79% to 11.86%), as well as MDDs 26.24% (95% CI 21.02% to 32.22%) among homeless people. Our subgroup analysis showed that the prevalence of depressive symptoms was high among younger homeless people (<25 years of age), whereas the prevalence of MDD was high among older homeless people (>50 years of age) when compared with adults (25-50 years). CONCLUSION This review showed that nearly half, one-fourth and one-tenth of homeless people are suffering from depressive symptoms, dysthymia and MDDs, respectively, which are notably higher than the reported prevalence rates in the general population. The findings suggest the need for appropriate mental health prevention and treatment strategies for this population group.
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Affiliation(s)
- Getinet Ayano
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
- Department of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Asmare Belete
- Department of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Duko
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Light Tsegay
- Department of Psychiatry, Aksum University, Aksum, Ethiopia
| | - Berihun Assefa Dachew
- Department of Public Health, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
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Ayano G, Shumet S, Tesfaw G, Tsegay L. A systematic review and meta-analysis of the prevalence of bipolar disorder among homeless people. BMC Public Health 2020; 20:731. [PMID: 32513264 PMCID: PMC7282102 DOI: 10.1186/s12889-020-08819-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 04/30/2020] [Indexed: 12/28/2022] Open
Abstract
Background Bipolar disorder (BD) is a common severe mental disorder among homeless people and is associated with an increased risk of disability and mortality from suicide, medical causes (including HIV/AIDS, hepatitis infection, hypertension, and tuberculosis), as well as substance use disorders. However, a systematic synthesis of the existing evidence on the subject is lacking. To fill this gap in the literature, this study aimed to carry out systematic review and meta-analysis to determine the consolidated prevalence of BD among homeless people. Methods In this systematic review and meta-analysis, we searched Embase, PubMed, and Scopus to identify pertinent studies that reported the prevalence of BD among homeless people in March 2019. Random effect meta-analysis was employed to pool data from the eligible studies. Subgroup and sensitivity analysis was conducted and Cochran’s Q- and the I2 test were utilized to quantify heterogeneity. Publication bias was assessed by using Egger’s test and visual inspection of the symmetry in funnel plots. Results Of 3236 studies identified, 10 studies with 4300 homeless individuals were included in the final analysis. Among the 10 studies, five studies used the Diagnostic Statistical Manual of Mental disorders (DSM), three studies used Mini-International Neuropsychiatric Interview (MINI), one study used Schedule for Clinical Assessment of Neuropsychiatry (SCAN), and one study used Composite International Neuropsychiatric Interview (CIDI) to assess BD among homeless individuals. Based on the results of the random effect model, the prevalence of BD among homeless people was 11.4% (95% CI; 7.5–16.9). The prevalence of BD was 10.0% (95% CI; 3.1–27.9) in Europe and it was 13.2% (95% CI; 8.9–19.3) in other countries. Moreover, the prevalence of BD was 11.5% (95% CI; 5.5–22.3) for studies that used DSM to assess BD and it was 11.0% (95% CI; 6.1–19.2) for studies that used other instruments (MINI, SCAN, and CIDI). Conclusion Our meta-analysis demonstrated that BD is highly prevalent among homeless individuals, underlying the importance of early screening and targeted interventions for BD among homeless individuals.
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Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia. .,School of Public Health, Curtin University, Perth, WA, Australia.
| | - Shegaye Shumet
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Getachew Tesfaw
- Department of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Light Tsegay
- Department of Psychiatric Nursing, College of Health Sciences, Axum University, Axum, Ethiopia
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Ayano G, Tesfaw G, Shumet S. The prevalence of schizophrenia and other psychotic disorders among homeless people: a systematic review and meta-analysis. BMC Psychiatry 2019; 19:370. [PMID: 31775786 PMCID: PMC6880407 DOI: 10.1186/s12888-019-2361-7] [Citation(s) in RCA: 69] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 11/15/2019] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Schizophrenia and other psychotic disorders constitute a huge global burden of disease and they are major contributors to disability as well as premature mortality among homeless people. This systematic review and meta-analysis aimed to estimate the pooled prevalence of schizophrenia and other psychotic disorders among homeless people. METHODS PubMed, Embase, and Scopus were searched to identify pertinent studies. We used a fixed- or random-effect meta-analysis to pool data from the included studies depending on the anticipated heterogeneity. A predesigned search strategy, as well as inclusion and exclusion criteria, were used. We also performed subgroup and sensitivity analysis and Cochran's Q- and the I2 test was employed to compute heterogeneity. Egger's test and visual inspection of the symmetry in funnel plots were used to assess publication bias. RESULTS Thirty-one studies involving 51,925 homeless people were included in the final analysis. The meta-analysis showed a remarkably higher prevalence of psychosis [21.21% (95% CI:13.73, 31.29), I2 = 99.43%], schizophrenia [10.29% (95%, CI: 6.44, 16.02), I2 = 98.76%], schizophreniform disorder [2.48% (95% CI: 6.16, 28.11), I2 = 88.84%] schizoaffective disorder [3.53% (95% CI: 1.33, 9.05), I2 = 31.63%,] as well as psychotic disorders not otherwise specified [9% (95% CI: 6.92, 11.62), I2 = 33.38%] among homeless people. The prevalence estimate of psychosis was higher in developing (29.16%) as compared to developed (18.80%) countries. Similarly, the prevalence of schizophrenia was highest in developing (22.15%) than developed (8.83%) countries. CONCLUSION This systematic review and meta-analysis revealed that schizophrenia and other psychotic disorders are highly prevalent among homeless people, indicating an urgent need for studies to help develop better mechanisms of prevention, detection as well as treatment of those disorders among homeless people.
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Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
| | - Getachew Tesfaw
- 0000 0000 8539 4635grid.59547.3aDepartment of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Shegaye Shumet
- 0000 0000 8539 4635grid.59547.3aDepartment of Psychiatry, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Horyniak D, Guy R, Prybylski D, Hellard M, Kaldor J. The utility of voluntary counselling and testing data as a source of information on HIV prevalence: a systematic review. Int J STD AIDS 2010; 21:305-11. [DOI: 10.1258/ijsa.2009.009427] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
We explored the utility of routine HIV testing data from clinical services for estimating HIV prevalence. A systematic review identified 28 eligible publications, covering concentrated epidemics (16 of 28) and generalized epidemics (12). Of the 16 papers from concentrated epidemics, five presented estimates by risk group and four by testing history with a median HIV prevalence of 1.8% in first-time testers compared with 3% in repeat testers. Two reports from generalized epidemics restricted estimates to asymptomatic clients and three included breakdowns by reason-for-test, with the median HIV prevalence higher in symptomatic clients (62%) than others (24%). Two papers from generalized epidemics showed prevalence estimates based on routine HIV testing data were slightly higher than estimates derived from other surveillance methods, but did not restrict estimates to asymptomatic patients. We conclude that routine HIV testing data may be a supplementary data source for HIV surveillance provided careful analyses are conducted.
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Affiliation(s)
- D Horyniak
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
| | - R Guy
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
- National Centre in HIV Epidemiology and Clinical Research (NCHECR), University of New South Wales, 45 Beach St, Coogee, NSW, Australia
| | - D Prybylski
- Family Health International, Asia-Pacific Regional Office, 130-132 Sindhorn Bldg, 19th Floor, Bangkok, Thailand
| | - M Hellard
- Centre for Population Health, Macfarlane Burnet Institute for Medical Research and Public Health, 85 Commercial Rd, Melbourne VIC 3004
| | - J Kaldor
- National Centre in HIV Epidemiology and Clinical Research (NCHECR), University of New South Wales, 45 Beach St, Coogee, NSW, Australia
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Kidder DP, Wolitski RJ, Royal S, Aidala A, Courtenay-Quirk C, Holtgrave DR, Harre D, Sumartojo E, Stall R. Access to housing as a structural intervention for homeless and unstably housed people living with HIV: rationale, methods, and implementation of the housing and health study. AIDS Behav 2007; 11:149-61. [PMID: 17546496 DOI: 10.1007/s10461-007-9249-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Accepted: 04/30/2007] [Indexed: 11/29/2022]
Abstract
Homelessness and unstable housing have been associated with HIV risk behavior and poorer health among persons living with HIV/AIDS (PLWHA), yet prior research has not tested causal associations. This paper describes the challenges, methods, and baseline sample of the Housing and Health Study, a longitudinal, multi-site, randomized controlled trial investigating the effects of providing immediate rental housing assistance to PLWHA who were homeless or at severe risk of homelessness. Primary outcomes included HIV disease progression, medical care access and utilization, treatment adherence, mental and physical health, and risks of transmitting HIV. Across three study sites, 630 participants completed baseline sessions and were randomized to receive either immediate rental housing assistance (treatment group) or assistance finding housing according to local standard practice (comparison group). Baseline sessions included a questionnaire, a two-session HIV risk-reduction counseling intervention, and blood sample collection to measure CD4 counts and viral load levels. Three follow-up visits occurred at 6, 12, and 18 months after baseline. Participants were mostly male, Black, unmarried, low-income, and nearly half were between 40 and 49 years old. At 18 months, 84% of the baseline sample was retained. The retention rates demonstrate the feasibility of conducting scientifically rigorous housing research, and the baseline results provide important information regarding characteristics of this understudied population that can inform future HIV prevention and treatment efforts.
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Affiliation(s)
- Daniel P Kidder
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Henny KD, Kidder DP, Stall R, Wolitski RJ. Physical and sexual abuse among homeless and unstably housed adults living with HIV: prevalence and associated risks. AIDS Behav 2007; 11:842-53. [PMID: 17577656 PMCID: PMC6592025 DOI: 10.1007/s10461-007-9251-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 04/30/2007] [Indexed: 10/23/2022]
Abstract
We examined the prevalence and risks associated with interpersonal (physical and sexual) abuse among HIV-seropositive homeless or unstably housed adults. Data were obtained from the Housing and Health Study of participants living in Baltimore, Chicago, and Los Angeles (n = 644). We used logistic regression to identify risks associated with abuse. About 77% of men and 86% of women reported ever experiencing abuse. Women were at greater risk than men for intimate partner physical abuse, childhood sexual abuse (CSA), and adulthood sexual abuse. Men and women experiencing intimate partner physical abuse reported increased risk of unprotected sex. Other risks associated with abuse include sex exchange; lifetime alcohol abuse; and depressive symptoms. Abuse prevalence among sample exceeds those found in other samples of general USA, HIV-seropositive, and homeless populations. Identifying persons at risk of abuse is needed to reduce risk among homeless or unstably housed persons living with HIV.
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Affiliation(s)
- Kirk D Henny
- National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, NE MS E-37, Atlanta, GA 30333, USA.
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Kidder DP, Wolitski RJ, Campsmith ML, Nakamura GV. Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. Am J Public Health 2007; 97:2238-45. [PMID: 17971562 DOI: 10.2105/ajph.2006.090209] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to compare health status, health care use, HIV anti-retroviral medication use, and HIV medication adherence among homeless and housed people with HIV/AIDS. METHODS Data were obtained from a cross-sectional, multisite behavioral survey of adults (N=7925) recently reported to be HIV positive. RESULTS At the time interviews were conducted, 304 respondents (4%) were homeless. Self-ratings of mental, physical, and overall health revealed that the health status of homeless respondents was poorer than that of housed respondents. Also, homeless respondents were more likely to be uninsured, to have visited an emergency department, and to have been admitted to a hospital. Homeless respondents had lower CD4 counts, were less likely to have taken HIV anti-retroviral medications, and were less adherent to their medication regimen. Homeless respondents needed more HIV social and medical services, but nearly all respondents in both groups had received needed services. Housing status remained a significant predictor of health and medication outcomes after we controlled for potential confounding variables. CONCLUSIONS Homeless people with HIV/AIDS are at increased risk of negative health outcomes, and housing is a potentially important mechanism for improving the health of this vulnerable group.
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Affiliation(s)
- Daniel P Kidder
- Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
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Gordon AJ, McGinnis KA, Conigliaro J, Rodriguez-Barradas MC, Rabeneck L, Justice AC. Associations between alcohol use and homelessness with healthcare utilization among human immunodeficiency virus-infected veterans. Med Care 2006; 44:S37-43. [PMID: 16849967 DOI: 10.1097/01.mlr.0000223705.00175.3d] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Alcohol use is a frequent root cause of homelessness, and both homelessness and alcohol use influence the quality and quantity of interactions with health care providers. OBJECTIVE The objectives of this study are to compare rates of homelessness and alcohol use in a cohort of human immunodeficiency virus (HIV)-infected persons and to evaluate the influence of homelessness and alcohol use on utilization of health services. RESEARCH DESIGN AND MEASURES: Data were obtained from the Veterans Aging Cohort 3-Site Study, a cohort study of 881 HIV-infected veterans at 3 VA hospitals. In a baseline survey, we assessed current and past history of homelessness and levels of alcohol consumption. Health care service utilization (ambulatory visits, emergency room visits, and hospital admissions) for the preceding 6 months was determined by self-report and VA administrative records. Logistic regression was used to assess whether homelessness and drinking variables were associated with health care visits in the past 6 months. RESULTS Among HIV-infected veterans with complete data (n = 839), 62 (7%) were currently homeless, and 212 (25.3%) had a past, but not current, history of homelessness. Among the currently homeless, 36% reported alcohol consumption, 34% were hazardous drinkers, 46% were binge drinkers, and 26% had a diagnosis of alcohol abuse. When adjusting for age, severity of HIV disease, and use of illicit drugs, hazardous drinking (adjusted odds ratio [AOR] 0.68, 95% confidence interval [CI] 0.49-0.93) and current homelessness (AOR 0.56, 95% CI 0.32-0.97) were associated with less than 2 outpatient clinic visits. HIV-infected veterans who were homeless in the past were more likely to be hospitalized in the prior 6 months than those never homeless (AOR 1.51, 95% CI 1.07-2.11). CONCLUSIONS Although homeless HIV-infected veterans tend to use inpatient services more than nonhomeless HIV infected veterans, they were less likely to achieve optimum outpatient care. Alcohol use complicates the effect of homelessness on adherence to outpatient care and is associated with increased inpatient utilization among HIV-infected veterans.
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Affiliation(s)
- Adam J Gordon
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15240, USA.
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Aidala A, Cross JE, Stall R, Harre D, Sumartojo E. Housing status and HIV risk behaviors: implications for prevention and policy. AIDS Behav 2005; 9:251-65. [PMID: 16088369 DOI: 10.1007/s10461-005-9000-7] [Citation(s) in RCA: 235] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
This paper examines housing as a contextual factor affecting drug and sexual risk behaviors among HIV positive people using pooled interview data from 2149 clients presenting for services at 16 medical and social service agencies participating in a multi-site evaluation study. The odds of recent drug use, needle use or sex exchange at the baseline interview was 2-4 times as high among the homeless and unstably housed compared to persons with stable housing. Follow-up data collected 6-9 months after baseline showed that change in housing status was associated with change in risk behaviors. Persons whose housing status improved between baseline and follow-up significantly reduced their risks of drug use, needle use, needle sharing and unprotected sex by half in comparison to individuals whose housing status did not change. In addition, for clients whose housing status worsened between baseline and follow-up, their odds of recently exchanging sex was over five times higher than for clients whose housing status did not change. The provision of housing is a promising structural intervention to reduce the spread of HIV.
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Affiliation(s)
- Angela Aidala
- Center for Applied Public Health, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
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Herndon B, Asch SM, Kilbourne AM, Wang M, Lee M, Wenzel SL, Andersen R, Gelberg L. Prevalence and predictors of HIV testing among a probability sample of homeless women in Los Angeles County. Public Health Rep 2003. [DOI: 10.1016/s0033-3549(04)50246-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Affiliation(s)
- John Song
- Center for Bioethics and Department of Medicine, University of Minnesota, N504 Boynton, 410 Church Street, Minneapolis, MN 55455, USA.
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McClelland GM, Teplin LA, Abram KM, Jacobs N. HIV and AIDS risk behaviors among female jail detainees: implications for public health policy. Am J Public Health 2002; 92:818-25. [PMID: 11988453 PMCID: PMC1447167 DOI: 10.2105/ajph.92.5.818] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the sexual and injection drug use HIV and AIDS risk behaviors of female jail detainees. METHODS The sample (n = 948) was stratified by charge type (felony vs misdemeanor) and race/ethnicity (African American, non-Hispanic White, Hispanic, other). RESULTS Non-Hispanic White women, women arrested for less serious charges, women who had prior arrests, women arrested on drug charges, and women with severe mental disorders were at especially high risk for sexual and injection drug transmission of HIV and AIDS. CONCLUSIONS Many women at risk for HIV and AIDS--women who use drugs, women who trade sex for money or drugs, homeless women, and women with mental disorders--eventually will cycle through jail. Because most jail detainees return to their communities within days, providing HIV and AIDS education in jail must become a public health priority.
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Affiliation(s)
- Gary Michael McClelland
- Psycho-Legal Studies Program, Northwestern University Medical School, Chicago, Ill 60611-3078, USA.
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