Sentinel surveillance for HIV infection and risk behavior among adolescents entering juvenile detention in San Francisco: 1990-1995

Developmental trajectory of sexual risk behaviors from adolescence to young adulthood

This study examined the trajectories of sexual risk behaviors among adolescents from ages 15 to 23, and factors associated with those trajectories. The sample was 5,419 adolescents from the 1997 National Longitudinal Survey of Youth. Using group-based trajectory modeling, five distinctive trajectory groups were identified. The High group had a high and increased risk trajectory over the observed ages. The Decreased group had a risk trajectory that accelerated before age 19, but decreased afterwards. The risk trajectories of the Increased-Early and Increased-Late groups were low at age 15, but increased significantly starting at ages 16 and 18 for the groups, respectively. Participants in the Low group remained at low risk over time. Sexual risk behaviors were also positively associated with alcohol use, marijuana use, and delinquency. Results highlight the need for intervention efforts to consider developmental timing of sexual risk behaviors and their associations with other problem behaviors.

Issues in gynecologic care for adolescent girls in the juvenile justice system

Incarcerated girls represent a captive audience, providing health care providers working in the juvenile justice system with a unique opportunity to intervene in this difficult to-reach population. Health care providers should promote and encourage healthy lifestyles with the aim of lowering their risk-taking behaviors, promote contraception and screen and treat sexually transmitted infections. For many delinquent girls this encounter represents their first contact with the medical care system as independent young women.It is important to encourage these girls to have a medical home and upon discharge from the facility, it is important to guarantee appropriate follow-up.

Health care for youth in the juvenile justice system

Youth in the juvenile correctional system are a high-risk population who, in many cases, have unmet physical, developmental, and mental health needs. Multiple studies have found that some of these health issues occur at higher rates than in the general adolescent population. Although some youth in the juvenile justice system have interfaced with health care providers in their community on a regular basis, others have had inconsistent or nonexistent care. The health needs of these youth are commonly identified when they are admitted to a juvenile custodial facility. Pediatricians and other health care providers play an important role in the care of these youth, and continuity between the community and the correctional facility is crucial. This policy statement provides an overview of the health needs of youth in the juvenile correctional system, including existing resources and standards for care, financing of health care within correctional facilities, and evidence-based interventions. Recommendations are provided for the provision of health care services to youth in the juvenile correctional system as well as specific areas for advocacy efforts.

Caring for incarcerated youth

PURPOSE OF REVIEW

Incarcerated youth are an unusually high-risk cohort with numerous unmet medical and psychiatric needs. Frequently seen medical conditions including sexually transmitted diseases, pregnancy, and psychiatric illness are reviewed along with recommended standards of care for this population.

RECENT FINDINGS

The recent realization that two-thirds of juvenile detainees have a psychiatric disorder has sparked renewed interest in screening and treating these high-risk adolescents. The push for increased identification and treatment has been prompted by the hypothesis that treating illness reduces recidivism and therefore improves individual and community public health. Although many facilities perform psychiatric and medical health screening within 24 hours of detention, there are many lacking areas. Examples include limited sexually transmitted disease, HIV and pregnancy testing; given the high rates of asymptomatic sexually transmitted disease infection, universal screening is essential. Also, interpretation of psychiatric screening tools by untrained individuals and utilization of results to incriminate juveniles are other problem areas.

SUMMARY

Incarcerated adolescents' time in detention represents a rare opportunity to provide care to this underserved population. Full implementation of recommended screening and assessment protocols could greatly enhance individual as well as community health.

Alcohol use severity and HIV sexual risk among juvenile offenders

Guided by the Information Motivation Behavioral Skills (IMB) model, we examine the alcohol severity/sexual risk relationship for juvenile offenders who are at extreme risk for HIV/AIDS due to situational vulnerabilities, substance abuse,1 and personality factors. Sexual risk behavior was analyzed by levels of alcohol use among 634 ethnically diverse adolescents in Miami between 1998 and 2002. Adolescents with the highest levels of alcohol use reported significantly higher levels of total and unprotected sexual activity and sex acts proximate to drinking. Alcohol use related problems require more attention by HIV interventionists. Alcohol severity may reduce the effectiveness of HIV interventions that do not address concurrent substance use.

Sexually transmitted infection and blood-borne virus screening in juvenile correctional facilities: A review of the literature and recommendations for Australian centres

BACKGROUND

Juveniles in custody are disproportionately affected by sexually transmitted infections (STI) and blood-borne viruses (BBV) due to high rates of risk behaviours.

METHODS

A literature review was undertaken with the aim of providing evidence-based recommendations on STI/BBV screening in Australian juvenile correctional facilities. Relevant research was identified using Premedline and Medline databases, followed by a manual search of reference lists in relevant articles identified in the database search. A total of 36 relevant publications were identified and reviewed.

RESULTS

STI/BBV knowledge in incarcerated youth is poor and accompanied by high rates of sexual and blood-borne risk behaviours. The prevalence of these infections is considerable. High rates of asymptomatic gonococcal and chlamydial infections exist, which can be easily diagnosed on self-collected specimens using new nucleic acid amplification technology. HIV infections are rare although continued vigilance is needed in view of substantial risk factors for infection. Hepatitis C prevalence is high, although much lower than that of adult prisoners, signifying a possible window of opportunity for Hepatitis C prevention. Many remain at risk of Hepatitis B, and it is important to assess the need for vaccination in this group.

CONCLUSION

Screening for STI/BBV in incarcerated juveniles is of major public health importance and all individuals should be offered screening in conjunction with risk-reduction education during their admission to juvenile detention centres.

Psychiatric functioning and substance use: factors associated with HIV risk among incarcerated adolescents

This study examined several types of psychiatric functioning (neuropsychiatric, emotional, and cognitive functioning) and substance use in relation to HIV risk behavior among 894 incarcerated girls and boys. Youth remanded to juvenile correctional facilities in a southern US state completed a structured interview regarding abuse history, emotional and behavioral difficulties, and demographics. Adolescents who experienced sullen affect were significantly more likely to engage in behaviors that put them at risk for HIV infection. Moreover, higher levels of alcohol use predicted HIV risk behavior. HIV prevention efforts need to address emotional distress as well as substance use among delinquent adolescents to reduce HIV risk behavior. Implications for treatment and future research are discussed.

Impulsivity and HIV risk among adjudicated alcohol- and other drug-abusing adolescent offenders

Although impulsivity is likely to be related to HIV risk--particularly in incarcerated substance-abusing youth--this area of research has been understudied. To investigate the relationship between impulsivity and various HIV/AIDS risk behaviors and attitudes, a sample of court-referred and incarcerated culturally diverse inner-city adolescents (males: N = 266; females: N = 111) were divided into high and low impulsive groups based on the Millon Adolescent Clinical Inventory Impulsivity Scale. Findings showed that compared to the less impulsive group, the highly impulsive adolescents reported more frequent marijuana and alcohol use in the last 3 months as well as a significantly higher proportion of unprotected sex when high on alcohol and marijuana, higher perceived susceptibility to HIV, more AIDS-related anxiety, greater HIV knowledge, less sexual self-efficacy, and less favorable sexual attitudes. Implications for interventions among incarcerated youth are discussed.

Differential characteristics of HIV-infected penitentiary patients and HIV-infected community patients

PURPOSE

To identify particular characteristics of HIV+ patients from correctional facilities (CF) compared with an HIV+ population from the community to better detect variables for intervention.

METHOD

In our hospital, HIV+ patients are admitted to an infectious diseases ward (IDW) when they come from the community or to a penitentiary unit (PU) when they are transferred from CF. We retrospectively reviewed admissions of those patients in both areas during 1999.

RESULTS

Admissions of HIV+ patients to IDW and PU generate 2.3% and 53.4% of hospital and PU stays, respectively. Both populations were equivalent in terms of mean age, CD4 count, viral load, prophylaxis for opportunistic infections, average stay, and death during stay. Male sex (91% vs. 74%), previous or current intravenous drug use (88% vs. 77%), and hepatitis C virus (HCV) seropositivity (97% vs. 82.6%) were more frequent in the PU than in the IDW. Multivariate analysis identified three factors as being independently related to admission from prison: longer time of known HIV infection (average 3.3 years; 95% CI 1.9-4.6), no previous antiretroviral treatment (odds ratio [OR] 2.95; 95% CI 1.46-6.0), and admission due to tuberculosis (OR 2.5; 95% CI 1.03-6.0).

CONCLUSION

HIV infection is still a serious medical problem in CF. Although imprisonment can provide access to health programs, HIV-infected prison patients suffer more frequently from tuberculosis and take less antiretroviral treatment.