HIV Prevention in Rural Appalachian Jails: Implications for Re-entry Risk Reduction Among Women Who Use Drugs

Abstract

Rural women are at risk for health consequences (such as HIV) associated with substance misuse, but targeted interventions are limited for this population. Jails provide an underutilized opportunity for outreach to high-risk women in rural Appalachian communities. Rural women were randomized to either the NIDA Standard education intervention (n = 201) or the NIDA Standard plus motivational interviewing (MI-HIV; n = 199) while in jail. Outcomes focused on HIV risk behaviors 3 months post-release from jail. Decreases in HIV risk behaviors were observed at follow-up across conditions. Although participants in the MI-HIV group showed reductions in outcomes compared to the NIDA Standard group (OR = 0.82-0.93), these estimates did not reach significance (p values > .57). HIV education interventions can be associated with risk-reduction behaviors. These findings support the need for increased access to prevention education in criminal justice venues, particularly in rural communities.

Keywords: Drug use; HIV prevention; Incarceration; Intervention; Rural women.

Figure 1.

Study CONSORT Note. All participants in both intervention conditions completed the NIDA Standard. Of those in the Intervention group, 144 completed at least 3 of the 4 additional MI-HIV sessions (76%), 28 completed 1–2 MI-HIV sessions (15%), and 27 did not complete any of the sessions (14%).

Figure 2.

Reductions in drug and injection drug use at 3-month follow-up. Participants were randomized to a motivational interviewing plus NIDA standard intervention (black bars; MI + NIDA Standard; n = 199) or NIDA standard alone (white bars; NIDA Standard; n = 201). Plotted are the percentages of participants reporting drug use, injection drug use, or risky behaviors in the month prior to incarceration and during the 3-month follow-up period. Reductions at the 3-month period were significant in unadjusted and adjusted analyses for all measures.