AIDS and Behavior

, Volume 19, Issue 6, pp 1061–1069 | Cite as

Positive Transitions (POST): Evaluation of an HIV Prevention Intervention for HIV-Positive Persons Releasing from Correctional Facilities

  • Robin J. MacGowanEmail author
  • Julie Lifshay
  • Yuko Mizuno
  • Wayne D. Johnson
  • Lyle McCormick
  • Barry Zack
Original Paper


People with HIV who are released from custody frequently do not maintain the viral suppression and other health benefits achieved while incarcerated. This study was conducted to provide preliminary evidence of efficacy of an intervention to reduce HIV risk behaviors and increase use of HIV medical services following release from custody. People with HIV were recruited from San Francisco County jails, San Quentin State Prison and the California Medical Facility (Vacaville, CA), and randomly assigned to the “standard of care” or POST intervention. POST consisted of 4 sessions pre-release and 2 sessions post-release, focusing on HIV prevention and access to care. Behavioral data were obtained for the 3 months before incarceration and 3 months after release. Although POST participants reported a statistically significant increase in receiving health care at HIV clinics (62.5–84.4 %), there were no significant differences between the POST and control participants with respect to any primary outcomes.


HIV prevention Prison Jail Reentry 


Con frecuencia las personas infectadas con el VIH que son liberadas después de un periodo de encarcelamiento, no logran mantener la supresión viral y otros beneficios de salud logrados durante el encarcelamiento. Este estudio se realizó para proporcionar evidencia preliminar sobre la eficacia de una intervención cuyo objetivo es reducir las conductas de riesgo de transmisión del VIH y aumentar usar los servicios médicos para tratar la infección del VIH después de ser liberados del encarcelamiento. Participantes infectados con el VIH fueron reclutados de las cárceles del condado de San Francisco, la Prisión Estatal de San Quintín y el Servicio Médico de California (Vacaville, CA), y aleatoriamente asignados a la intervención POST o al cuidado estándar. POST consistió en 4 sesiones antes de ser liberados y 2 sesiones después de la liberación, centrándose en la prevención de la transmission del VIH y el acceso a servicios médicos. Datos sobre conductas de riesgo fueron obtenidos para los 3 meses antes de la encarcelación y 3 meses después de la liberación. Aunque los participantes POST reportaron un aumento estadísticamente significativo en recibir atención médica en las clínicas de VIH (62.5–84.4 %), no hubo diferencias significativas entre los participantes POST y los participantes control con respecto a cualquier resultado primario.



We acknowledge the contributions of Joseph Bick M.D., Chief Medical Executive, California Medical Facility, Vacaville, California, Joe Goldenson, MD, Director/Medical Director Jail Health Services, San Francisco Department of Public Health, Kate Monico Klein, Director, FAP, San Francisco Department of Public Health, Kathleen Morrow, PhD, Associate Professor of Psychiatry & Human Behavior, The Miriam Hospital and Alpert Medical School of Brown University, Elena Tootell, MD, Chief Medical Executive, California State Prison, San Quentin, TCM program personnel and the study participants. This study was funded by Cooperative Agreement UR6/PS000364 awarded to Centerforce.


  1. 1.
    CDC. Monitoring selected national HIV prevention and care objectives by using HIV surveillance data—United States and 6 U.S. dependent areas—2010. HIV Surveillance Supplemental Report 2012. Vol 17(3). Accessed July 2013.
  2. 2.
    Gulick RM, Mellors JW, Havlir D, et al. Treatment with indinavir, zidovudine, and lamivudine in adults with human immunodeficiency virus infection and prior antiretroviral therapy. N Engl J Med. 1997;337(11):734–9.PubMedCrossRefGoogle Scholar
  3. 3.
    Palella FJ Jr, Delaney KM, Moorman AC, et al. Declining morbidity and mortality among patients with advanced human immunodeficiency virus infection. HIV Outpatient Study Investigators. N Engl J Med. 1998;338(13):853–60.PubMedCrossRefGoogle Scholar
  4. 4.
    Porter K, Babiker A, Bhaskaran K, et al. Determinants of survival following HIV-1 seroconversion after the introduction of HAART. Lancet. 2003;362(9392):1267–74.PubMedCrossRefGoogle Scholar
  5. 5.
    Hogg RS, Yip B, Kully C, et al. Improved survival among HIV-infected patients after initiation of triple-drug antiretroviral regimens. CMAJ. 1999;160(5):659–65.PubMedCentralPubMedGoogle Scholar
  6. 6.
    Ray M, Logan R, Sterne JA, et al. The effect of combined antiretroviral therapy on the overall mortality of HIV-infected individuals. AIDS. 2010;24(1):123–37.PubMedCrossRefGoogle Scholar
  7. 7.
    Cohen MS, Chen YQ, McCauley M, et al. Prevention of HIV-1 Infection with Early Antiretroviral Therapy. N Engl J Med. 2011;365(6):493–505.PubMedCentralPubMedCrossRefGoogle Scholar
  8. 8.
    Office of National AIDS Policy. National HIV/AIDS Strategy for the United States: The White House; July 2010.Google Scholar
  9. 9.
    Spaulding AC, Seals RM, Page MJ, Brzozowski AK, Rhodes W, Hammett TM. HIV/AIDS among inmates of and releasees from US correctional facilities, 2006: declining share of epidemic but persistent public health opportunity. PLoS One. 2009;4(11):e7558.PubMedCentralPubMedCrossRefGoogle Scholar
  10. 10.
    MacGowan R, Margolis A, Richardson-Moore A, et al. Voluntary rapid human immunodeficiency virus (HIV) testing in jails. Sex Transm Dis. 2009;36(2 Suppl):S9–13.PubMedCrossRefGoogle Scholar
  11. 11.
    CDC. HIV screening of male inmates during prison intake medical evaluation—Washington, 2006–2010. MMWR. 2011;60(24):811–3.Google Scholar
  12. 12.
    VanHandel M, Beltrami JF, MacGowan RJ, Borkowf CB, Margolis AD. Newly identified HIV infections in correctional facilities, United States, 2007. Am J Public Health. 2012;102(Suppl 2):S201–4.PubMedCentralPubMedCrossRefGoogle Scholar
  13. 13.
    Beckwith CG, Liu T, Bazerman LB, et al. HIV risk behavior before and after HIV counseling and testing in jail: a pilot study. J Acquir Immune Defic Syndr. 2010;53(4):485–90. doi: 10.1097/QAI.1090b1013e3181c1997b1091.PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    CDC. Routine Jail-Based HIV Testing—Rhode Island, 2000–2007. MMWR. 2010;25(24):742–5.Google Scholar
  15. 15.
    CDC. Routine HIV screening during intake medical evaluation at a county jail—fulton county, georgia, 2011–2012. MMWR. 2013;62(24):495–7.Google Scholar
  16. 16.
    Maruschak LM. HIV In Prisons, 2001–2010. Bureau of Justice Statistics Bulletin: U.S. Department of Justice; 2012.Google Scholar
  17. 17.
    Springer S, Friedland G, Doros G, Pesanti E, Altice F. Antiretroviral Treatment Regimen Outcomes Among HIV-Infected Prisoners. HIV Clin Trials. 2007;8(4):205–12.PubMedCentralPubMedCrossRefGoogle Scholar
  18. 18.
    Baillargeon JG, Giordano TP, Harzke AJ, Baillargeon G, Rich JD, Paar DP. Enrollment in outpatient care among newly released prison inmates with HIV infection. Public Health Rep. 2010;125(1):64–71.PubMedCentralPubMedGoogle Scholar
  19. 19.
    Stephenson BL, Wohl DA, Golin CE, Tien HC, Stewart P, Kaplan AH. Effect of release from prison and re-incarceration on the viral loads of HIV-infected individuals. Public Health Rep. 2005;120(1):84–8.PubMedCentralPubMedGoogle Scholar
  20. 20.
    Springer SA, Pesanti E, Hodges J, Macura T, Doros G, Altice FL. Effectiveness of antiretroviral therapy among HIV-infected prisoners: reincarceration and the lack of sustained benefit after release to the community. Clin Infect Dis. 2004;38(12):1754–60.PubMedCrossRefGoogle Scholar
  21. 21.
    Baillargeon J, Giordano TP, Rich JD, et al. Accessing antiretroviral therapy following release from prison. JAMA. 2009;301(8):848–57.PubMedCentralPubMedCrossRefGoogle Scholar
  22. 22.
    Pant Pai N, Estes M, Moodie EEM, Reingold AL, Tulsky JP. The impact of antiretroviral therapy in a cohort of HIV infected patients going in and out of the San Francisco County Jail. PLoS One. 2009;4(9):e7115.PubMedCentralCrossRefGoogle Scholar
  23. 23.
    National Commission on Correctional Health Care. Standards for Health Services in Prisons. Chicago: National Commission on Correctional Health Care; 2008.Google Scholar
  24. 24.
    National Commission on Correctional Health Care. Standards for Health Services in Jails. Chicago: National Commission on Correctional Health Care; 2008.Google Scholar
  25. 25.
    CDC. HIV Testing Implementation Guidance for Correctional Settings. 2009; Accessed 9/8/2009.
  26. 26.
    Fontana L, Beckerman A. Recently released with HIV/AIDS: primary care treatment needs and experiences. J Health Care Poor Underserved. 2007;18(3):699–714.PubMedCrossRefGoogle Scholar
  27. 27.
    Baillargeon J, Giordano TP, Harzke AJ, et al. Predictors of reincarceration and disease progression among released HIV-infected inmates. AIDS Patient Care STDS. 2010;24(6):389–94.PubMedCentralPubMedCrossRefGoogle Scholar
  28. 28.
    Adams J, Nowels C, Corsi K, Long J, Steiner JF, Binswanger IA. HIV risk after release from prison. A qualitative study of former inmates. J Acquir Immune Defic Syndr. 2011;57(5):429–34. doi: 10.1097/QAI.1090b1013e31821e31829f31841.PubMedCentralPubMedCrossRefGoogle Scholar
  29. 29.
    Grinstead O, Zack B, Faigeles B. Reducing postrelease risk behavior among HIV seropositive prison inmates: the health promotion program. AIDS Educ Prev. 2001;13(2):109–19.PubMedCrossRefGoogle Scholar
  30. 30.
    Reznick OG, McCartney K, Gregorich SE, Zack B, Feaster DJ. An ecosystem-based intervention to reduce HIV transmission risk and increase medication adherence among inmates being released to the community. J Correct Health Care. 2013;19(3):178–93.PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Fisher JD, Fisher WA. Changing AIDS-risk behavior. Psychol Bull. 1992;111(3):455–74.PubMedCrossRefGoogle Scholar
  32. 32.
    MacGowan R, Eldridge G, Sosman J, et al. HIV counseling and testing of young men in prison. J Correct Health Care. 2006;12(3):203–13.CrossRefGoogle Scholar
  33. 33.
    Wolitski RJ. Relative efficacy of a multisession sexual risk-reduction intervention for young men released from prisons in 4 states. Am J Public Health. 2006;96(10):1854–61.PubMedCentralPubMedCrossRefGoogle Scholar
  34. 34.
    Marks G, Crepaz N, Senterfitt JW, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected with HIV in the United States: implications for HIV prevention programs. J Acquir Immune Defic Syndr. 2005;39(4):446–53.PubMedCrossRefGoogle Scholar
  35. 35.
    Vallabhaneni S, McConnell JJ, Loeb L, et al. Changes in Seroadaptive Practices from before to after Diagnosis of Recent HIV Infection among Men Who Have Sex with Men. PLoS One. 2013;8(2):e55397.PubMedCentralPubMedCrossRefGoogle Scholar
  36. 36.
    Steward WT, Remien RH, Higgins JA, et al. Behavior change following diagnosis with acute/early HIV infection-a move to serosorting with other HIV-infected individuals. The NIMH Multisite Acute HIV Infection Study: III. AIDS Behav. 2009;13(6):1054–60.PubMedCentralPubMedCrossRefGoogle Scholar
  37. 37.
    Harzke AJ, Ross MW, Scott DP. Predictors of post-release primary care utilization among HIV-positive prison inmates: a pilot study. AIDS Care. 2006;18(4):290–301.PubMedCrossRefGoogle Scholar
  38. 38.
    Johnson A, Hall H, Hu X, Lansky A, Holtgrave DR, Mermin J. Trends in diagnoses of hiv infection in the united states, 2002–2011. JAMA. 2014;312(4):432–4.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York (outside the USA) 2014

Authors and Affiliations

  • Robin J. MacGowan
    • 1
    Email author
  • Julie Lifshay
    • 2
  • Yuko Mizuno
    • 1
  • Wayne D. Johnson
    • 1
  • Lyle McCormick
    • 3
  • Barry Zack
    • 4
  1. 1.Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB PreventionAtlantaUSA
  2. 2.CenterforceSan QuentinUSA
  3. 3.ICF InternationalAtlantaUSA
  4. 4.The Bridging GroupOaklandUSA

Personalised recommendations