Gender differences in baseline health, needs at release, and predictors of care engagement among HIV-positive clients leaving jail.

Women represent a significant and growing segment of jail detainees and persons living with HIV. This paper examines gender differences in health status, care and social service needs, and care engagement among jail releasees with HIV. Data are from 1,270 participants in the HRSA-funded Enhancing Linkages to HIV Primary Care and Social Services multisite demonstration project (EnhanceLink). Compared to men, more women reported homelessness, reduced adherence to prescribed ART, worse health, more severe substance use disorders, and more chronic health conditions. Men and women generally reported different needs post-release. As the number of expressed needs increased, women were more likely to drop out of care. Our findings suggest that effective and gender-specific strategies are required to identify needs, link services between jails and communities, and sustain retention of women with HIV in programs after release from criminal justice settings.

The impact of discontinuation of male STD screening services at a large urban county jail: Chicago, 2002-2004.

BACKGROUND: Before April 2003, all male detainees were offered chlamydia (CT) and gonorrhea (GC) screening tests, after which services were limited to symptom-based testing. In 2003, male screening was discontinued at a large urban county jail. OBJECTIVE: To evaluate the impact of discontinuing universal male sexually transmitted disease screening in a large county jail. METHODS: We compared the number of male CT/GC cases during the periods of universal screening (April 2002 to March 2003) with symptom-based testing (April 2003 to March 2004). RESULTS: The number of reported CT/GC cases among male detainees declined by -91.7% (3329-277) and -90.5% (1133-108), respectively after universal screening was discontinued. Citywide, CT/GC cases among males and females declined by -9.3% (24,885-22,563) and -12.9% (13,249-11,541), respectively. CONCLUSIONS: Discontinuation of universal male CT/GC screening services at a large county jail represents a missed opportunity to screen a high-risk population and was associated with substantial declines in reported morbidity.

Detection of chlamydial and gonococcal urethral infection during jail intake: development of a screening algorithm.

OBJECTIVES: To determine risk factors for chlamydial or gonococcal urethral infection among adult male detainees at Cook County Jail. To develop a screening algorithm with high sensitivity and specificity for detection of urethral infection. STUDY DESIGN: We interviewed adult male detainees and tested them for chlamydial or gonococcal urethral infection during jail intake from June 24 through July 29, 2004. We supplemented the cross-sectional survey with a nested case-control study. RESULTS: We screened 5,634 (93%) of 6,028 detainees; 348 (6.2%) had chlamydial or gonococcal urethral infection. Interviews were completed and collected for 35%. By multivariable analysis, infected detainees were more likely to be <31 years of age, have more than 6 sex partners in the previous 12 months, or have symptoms. Age less than 31 years or symptoms would have identified 73% of infected detainees while screening only 50%. CONCLUSIONS: A simple algorithm that included age and symptoms best identified detainees at increased risk for chlamydial or gonococcal urethral infection.