A latent class analysis of stigmatizing attitudes and knowledge of HIV risk among youth in South Africa

Background: The current study aims to investigate how the ability to accurately gauge risk factors associated with contracting HIV while taking into consideration various individual and community level socio-demographic characteristics (e.g., race and poverty) predicts the nature of stigmatizing attitudes toward persons with HIV. Methods: Data from a sample of 1,347 Cape Town area youth who participated in the Cape Area Panel Study (CAPS) Wave 2a were used. Latent Class Analysis was conducted to ascertain whether response patterns regarding knowledge of HIV contraction suggest the presence of subgroups within the sample. Results: Findings indicate that there are four latent classes representing unique response pattern profiles regarding knowledge of HIV contraction. Additionally, our results suggest that those in South Africa who are classified as "white," live in more affluent communities, and have more phobic perceptions of HIV risk are also more likely to have the most stigmatizing attitudes toward those who are HIV positive. Conclusion: Implications of these findings include extending HIV knowledge, education, and awareness programs to those who are not traditionally targeted in an attempt to increase levels of knowledge about HIV and, consequently, decrease stigma

Mass Incarceration as a Social-Structural Driver of Health Inequities: A Supplement to AJPH

Mass incarceration in the United States is a civil rights, human rights, and public health crisis that is the result of social, political, and economic forces, rooted in enduring legacies of slavery and oppression along lines of race and class. We conceptualized this issue because we believe that the theories, methods, and ethical tenets of public health have a distinct role to play in contributing to a growing movement to end mass incarceration and its multilayered harms on health

Solitary Confinement and Health

Individuals released from prison experience a higher risk of death compared to non-incarcerated individuals. The transition back into the community postrelease is characterized by instability related to social and economic factors that contribute to poor access to housing, employment, and health care

Incarceration, drug use, and infectious diseases: a syndemic still not addressed

Substantial progress has been made in reducing HIV and, to a lesser extent, hepatitis C virus (HCV) incidence among people who inject drugs (PWID) globally. However, specific populations of PWID, particularly those who are incarcerated, are often overlooked or left out of interventions designed to reduce HIV and HCV transmission

Invited Perspective: Uncovering Harmful Exposures in Carceral Environments

In a research letter in this issue, Rempel et al. compared community water systems that serve the Kern Valley State Prison (KVSP) and three comparable rural communities in California that rely solely on groundwater sources. They found that for each of the four systems, arsenic concentrations in drinking water periodically exceeded the legal limit in violation of Safe Drinking Water Act regulations. The communities neighboring the prison benefited from local and federal remediation efforts. Yet, for people who were incarcerated, interventions such as free bottled water were often restricted

MOUD Provision in Correctional Settings During Time of COVID-19 : Prevention and Solutions

Correctional settings can be vectors of infectious diseases due to overcrowding, unsanitary living conditions, and very little capacity to engage in social distancing. In the US, COVID-19 outbreaks were first identified in the New York City and Cook County jails, with infection rates far exceeding community rates. Each day new cases are being identified across the country in correctional facilities. People who are incarcerated are at increased risk of experiencing severe COVID-19 symptoms because of the increased prevalence of other underlying illnesses. Jails and prisons have begun initiating facility-level policies to help stop the spread of COVID-19. As a result, correctional agencies have reoriented staff to stem transmission in their facilities. This could translate into limited resources for other programming such as medications for opioid use disorder (MOUD) programs. In this commentary, we highlight risk mitigation practices for delivering MOUD in correctional settings during COVID-19 and note how to ensure quality of care while still preparing for the possibility of future pandemics

Ethical Considerations for COVID-19 Vaccine Trials in Correctional Facilities

The first phase 3 coronavirus disease 2019 (COVID-19) vaccine trials began in July 2020. China, Britain, and the US have experimental vaccines ready to move into large-scale human testing. In the US, the Vaccine and Treatment Evaluation Units, HIV Prevention Trials Network, AIDS Clinical Trials Group, and HIV Vaccine Trials Network have merged resources into Operation Warp Speed, as each phase 3 trial is anticipated to enroll 30 000 participants. Recruitment for the first US trial involving the Moderna vaccine is targeting participants “at high risk of SARS-CoV-2 infection.” However, even though 39 of the 50 largest US outbreaks have occurred in correctional facilities and the case rate of SARS-CoV-2 infection in prisons (3521 per 100 000) has been 5.5 times higher than the general population, one key setting in which US investigators will not be recruiting participants for trials of COVID-19 vaccines are prisons and jails. This omission is an example of unintended consequences of well-intentioned policies

Risk of COVID-19 infection among prison staff in the United States

Background: Multiple large outbreaks of COVID-19 have been documented in prisons and jails across regions of the world, with hazardous environmental conditions amplify the risks of exposure for both incarcerated people and correctional staff. The objectives of this study are to estimate the cumulative prevalence of COVID-19 cases among U.S. prison staff over time and compare it to the prison inmate population and the general U.S. population, overall, and to examine risk of COVID-19 infection among prison staff across jurisdictions. Methods: We use publicly available data (April 22, 2020 to January 15, 2021) to estimate COVID-19 crude case rates per 1000 with 95% confidence intervals over the study period for prison staff, incarcerated population, and general population. We also compare COVID-19 case rates between prison staff and the general population within jurisdictions. Results: Over the study period, prison staff have reported consistently higher rates of COVID-19 compared to the general population, with prison staff case rates more closely mirroring the incarcerated population case rates. The rolling 7-day average case rates for prison staff, prison population, and general population on January 15, 2021 were 196.04 per 1000 (95%CI 194.81, 197.26), 219.16 (95%CI 218.45, 219.86), and 69.80 (95%CI 69.78, 69.83), respectively. There was substantial heterogeneity across jurisdictions, yet in 87% of study jurisdictions, the risk of COVID-19 was significantly greater among prison staff than the general state population. Conclusions: Targeting staff for COVID-19 mitigation strategies is essential to protect the health of people who intersect with the correctional system and to flatten the curve in the surrounding communities

Incarceration and the health of detained children

Historically, the incarceration of children has been used limitedly. The two reasons used to justify depriving youth of their freedom have been specific and serious threats to either public safety or to the young person’s own wellbeing (such as suicidal ideations). Incarceration should only be a last resort, with the standard being to place children in the least restrictive environment, such as in the community, because of the high risks of physical and mental health harms associated with detention

Postrelease mortality among persons hospitalized during their incarceration

Purpose: Health and mortality of people released from incarceration have received increased attention, and yet little is known about the postrelease experiences of those hospitalized during incarceration. Methods: For persons incarcerated and released from the North Carolina (NC) state prison system between January 1, 2008, and June 30, 2015, we examined postrelease mortality from 2008 to 2016 by history of prison hospitalization. Results: Among 111,479 released persons, 0.9% (n = 1010) were hospitalized during their incarceration, and of those, 10.5% (n = 106) died during follow-up compared with 3.2% (3511/110,469) of other released persons. Those hospitalized in prison had a higher postrelease death rate (adjusted hazard ratio: 2.44), a lower 8-year conditional probability of survival (0.80 vs. 0.94), and were more likely to die from chronic causes (79.2% vs. 51.0%) than other released persons. The postrelease standardized mortality rate among men hospitalized in prison was 3.1 times higher than that of those not hospitalized and 7.1 times the rate of all NC men. Conclusions: People hospitalized during incarceration constitute a particularly vulnerable, yet relatively easily identifiable priority population to focus health interventions supporting continuity of care after prison release. Yet such efforts may be particularly challenging in NC and other Medicaid non-expansion states