Abstract

Preventing HIV among juvenile offenders: evidence from randomized and quasi-randomized controlled trials

Presented by Kristen Ann Underhill (United States).

K.A. Underhill, D. Operario

Brown University, Department of Community Health, Providence, United States

Background: Juveniles with criminal justice involvement are at disproportionately high risk for HIV infection. Drug and alcohol use, mental health issues, poverty, abuse, neighborhood effects, risky sexual behaviors, peer networks, and inadequate or unstable housing contribute to HIV risk in this group. This systematic review aimed to identify, appraise, and summarize the evidence for the effectiveness of HIV prevention programming among juvenile offenders.
Methods: Cochrane systematic review methods were used. Two reviewers examined 9153 records from PubMed, PsycINFO, EMBASE, CENTRAL, and cross-referencing. Included studies met the following criteria: randomized or quasi-randomized controlled trial; all participants had criminal justice involvement (arrest, conviction, imprisonment); participants were juveniles not known to be HIV-positive; interventions aimed to prevent HIV; results included an HIV-related behavioral or biological outcome. We provide a narrative synthesis of results; meta-analysis was impossible due to data limitations.
Results: Seven studies met inclusion criteria, along with two ongoing studies for which outcome data were unavailable. Included studies enrolled n=2559 participants, and all but one study took place in the US. Studies enrolled all men (2 studies), or a mixed group (5). All interventions were psychosocial, including group intervention, family therapy, case management, and motivational interviewing. Three studies (n=1029) found a protective intervention effect one or more HIV-related behaviors, compared to control groups that received usual care services or basic information about HIV. No study observed an iatrogenic effect. Across studies, limitations included relatively short follow-up periods and underutilization of biological outcomes.
Conclusions: Juvenile offenders in detention and community settings can benefit from HIV prevention interventions, although additional trials are necessary to identify the most effective prevention strategies. Interventions do not appear to cause harm in this population. We found no trials examining interventions tailored for female juvenile offenders, which is a critical gap in HIV prevention knowledge.