COMMUNITY DISRUPTION AND HIV/AIDS IN THE DISTRICT OF COLUMBIA
September 13-14, 2012
American University
Incarceration Presentations Todd Clear, PhD: Dean, School of Criminal Justice, Rutgers University “Coercive Mobility-­‐
-­‐Theory and Evidence” • Clear's presentation explored how coercive mobility, the movement back and forth between criminal justice system and the community, has unintended consequences and disrupts communities and may contribute to higher crimes rates. This process could contribute to increased health risks, particularly in urban, minority and low-­‐income communities experiencing high levels of incarceration. Christopher Wildeman, PhD: Assistant Professor, Department of Sociology, Yale University “Incarceration and Population Health in Wealthy Democracies” • Wildeman's research looked at how high rates of incarceration may contribute to U.S. health problems and racial health inequalities, and might help to explain worse health outcomes in the U.S. compared to other high-­‐income countries. James C. Thomas, MPH, PhD: Associate Professor of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill “Community Health Effects of Incarceration” • Thomas's presentation discussed the negative health impacts of incarceration on communities in North Carolina and the association between high-­‐rates of incarceration and STDs. Incarceration may have direct effects on prisoners by changing sexual partnerships, finances and substance abuse as well as indirect effects on communities by reducing social capital and collective efficacy. Maria Khan, PhD: Assistant Professor, Department of Epidemiology, University of Florida at Gainesville “Incarceration-­‐related Social Network Disruption, and How HIV Thrives on it” • Khans' research explored how criminal justice involvement represents an underlying determinant of HIV risk that operates through intermediate and proximate mechanisms. She found increased risk of HIV associated with personal incarceration and incarceration of a sexual partner, which is likely due to the association between incarceration and high-­‐risk partnerships and disruption of committed relationships. Key themes: 1 Community Disruption and HIV/AIDS In the District Of Columbia, Sept 13-14, 2012 American University •
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The impacts of mass incarceration on family structure and stability, economic opportunity and social ties that lead to increased crime are also associated with HIV risk and vulnerability. Involvement with the criminal justice system can also disrupt HIV care upon entry and exit and elevated viral loads can increase the likelihood of transmission. Mass incarceration is concentrated in black neighborhoods and there are large racial, gender and class disparities, which in turn exacerbate and contribute to inequalities in health, particularly HIV/AIDS infection and treatment. Incarceration affects individuals who are in the criminal justice system as well as their families, partners, social networks and communities, but also has spillover affects on the population at large. Prisons and jails also provide a possible site for health treatment, interventions and HIV testing that could link people to care in and then outside of the correctional system. However, this requires resources and more holistic approaches, particularly assistance with re-­‐entry and ensuring continuity of healthcare. DC is an important and useful site to study the disruptions and health inequalities related to incarceration because of large racial disparities in both HIV/AIDS and incarceration. Incarceration Working Group Research gaps: • Impact of incarceration on HIV rates, communities, partnerships and relationships and broader implications of incarceration on the spread of disease. • Lack data on the frequency and length of pre-­‐trial detention and subsequent health impacts, despite the potential for public health approach to pretrial detention. • No research in DC on how mass incarceration and criminal justice system involvement disrupts partnerships, sexual risk taking and other social ties. • Less research and information on the different impacts of pre-­‐trial detention, prison, jail, probation and parole. • Difficult to have a control group—is the appropriate comparison between drug users with and without an incarceration history? Is it a random sample of the population comparing those with and without such a history? A random sample of populations in poor vs non-­‐poor neighborhoods? • More research needed on social networks and communities and how disruption from coercive mobility affects communities in different and similar ways to other forms of instability and disruption (e.g. military service, deportation). Research questions: • To what extent are impacts associated with incarceration unique to incarceration and to what extent are they related to drug use, poverty, etc.? How does Community Disruption and HIV/AIDS In the District Of Columbia, Sept 13-14, 2012 American University 2 coercive mobility increase social dislocation and possibly have unintended health consequences? • What are the impacts of criminal justice involvement on children, families and partners, who may not themselves be CJ involved? What are the implications for economic burdens such as loss of Social Security benefits and medical coverage? • How do we truly measure different types of relationships/partnerships to understand how they are impacted by criminal justice involvement (i.e. qualitative data reveal that people have complex understandings of relationships, sex partners, commitment, etc)? • How can we conceptualize, measure and analyze community level impacts of the criminal justice system in ways that capture more than aggregations of individual characteristics? How do communities adapt and respond to mass incarceration? • How do communities perceive incarceration and people in the CJ system and how does this contribute to stigma? How can public health programs and care providers reduce stigma and labeling? • What types of interventions can be effective in addressing the impacts of CJ involvement (structural and policy interventions that keep people out of the CJ system as well as interventions to reduce the impacts of CJ involvement)? • How can we be most effective in promoting change in CJ policy? What advocacy groups should researchers work with and how can research empower them? • In what ways are the instabilities and disruptions created by incarceration/re-­‐
entry similar to and different from disruptions associated with military service? Deportation? • Are there characteristics of CJ involvement and subsequent impacts that are unique to DC (e.g. because it is not a state, prisoners frequently serve prison time far away, more vulnerable to federal penalties, etc.)? • How does CJ involvement impact different groups and sexualities, ie. MSM, MSMW? Are the risk factors of CJ involvement the same for MSM, MSMW and MSW? • How does incarceration and reentry impact the continuity of care for people who are HIV positive? Does the criminalization of HIV impact people's willingness to get tested and seek services? • What are the public health implications of cost-­‐cutting policies and changes in criminal justice, prison and health care policies? • How relevant is HIV for people involved in CJ given their complex lives and economic, housing, substance abuse and mental health challenges? Potential research projects: • Replicate existing research projects in DC, particularly projects that look at the impact of coercive mobility and CJ involvement on HIV risk factors and sexual partnerships. • Comparisons with other institutions such as military or college where risky sexual behavior might increase HIV risks. Community Disruption and HIV/AIDS In the District Of Columbia, Sept 13-14, 2012 American University 3 •
Research interventions in the CJ system such as case management for incarcerated individuals and other incentive and technology based interventions to promote continuity of HIV care. Sources of data and methodologies: • Existing data that have been collected for other purposes that may ask about incarceration experience (e.g. WIHS data, Fragile Families, ADD Health)? • Longitudinal data drawn from vulnerable populations, such that drug use, criminal justice involvement, and HIV status are variable. o General population sample (neighborhood based, clinic based, grocery store based, convenience sample) of high risk communities, particularly in DC where HIV and incarceration are geographically concentrated, then follow participants over time. • Policy analysis/collation of policy characteristics. • Community level data – need aggregate data but also qualitative/ ethnographic/archival, particularly to understand people's relationships and sex • Mixed-­‐method research projects. • Data on pretrial detention, potentially from Bureau of Justice Statistics. • Need geographic data, such as zip code. • Challenge of isolating the effect of incarceration which requires having a good control group that will help make linkages to other disciplines, publications in journalists and get attention of policy makers. Community Disruption and HIV/AIDS In the District Of Columbia, Sept 13-14, 2012 American University 4