Adverse childhood experiences, mental illness, HIV and offending among female inmates in Durban, South Africa.

Background: Childhood adversities and adult trauma are common among female inmates. Associations have been documented with childhood adversities and mental illness, personality disorders, human immunodeficiency virus (HIV) and violent offending. However, no such study had been conducted in South Africa (SA), despite the high prevalence of HIV and trauma in SA. Aim: To measure the prevalence of childhood adversities and adult trauma; and to determine if there is a relationship between childhood adversities, mental illness, personality disorders, HIV and violent offending among female inmates. Setting: The study was conducted at the largest correctional centre in Durban, KwaZulu-Natal, South Africa. Methods: This cross-sectional, descriptive study randomly recruited 126 female inmates. The World Health Organization's Adverse Childhood Experiences- International Questionnaire (WHO ACE-IQ) was used to measure childhood adversities; the Structured Clinical Interview for the Diagnostics and Statistical Manual-5 Research Version (SCID 5-RV) was used to diagnose mental illness; and a structured questionnaire was used to measure adult trauma. Human immunodeficiency virus data was confirmed from prison medical records. Results: Elevated rates of individual childhood adversities and adult trauma were found. Associations were found between cumulative childhood adversities and post-traumatic stress disorder (PTSD), alcohol use disorder, substance use disorder, borderline personality disorder, and HIV. Conclusion: Female inmates are a highly traumatised population. Prison mental health services should provide trauma-informed and trauma-focussed care to improve inmates' mental health outcomes and decrease recidivism. Contribution: This study contributes to the emerging literature on adverse childhood experiences (ACEs) and their associations among incarcerated female populations, in a low- and middle-income, South African setting.

Mental illness and HIV amongst female inmates in Durban, South Africa.

BACKGROUND: There is limited data regarding the prevalence of mental illness and human immunodeficiency virus (HIV) amongst female inmates in South Africa. Rehabilitation programmes can only be formulated once the needs of this population have been identified. AIM: This study aimed to measure the prevalence of mental illnesses, borderline and antisocial personality disorders and HIV amongst female inmates. SETTING: The study was based at a correctional centre in Durban, KwaZulu-Natal, South Africa. METHODS: This study forms part of a larger two-phased, mixed methods, sequential, explanatory design study. In phase one, 126 female inmates were interviewed using a clinical questionnaire and the Structured Clinical Interview for Diagnostics and Statistical Manual (DSM)-5 diagnoses - Research Version. RESULTS: The following lifetime prevalence rates were found: depressive disorder 70.6%, alcohol use disorder 48.4%, post-traumatic stress disorder (PTSD) 46.8%, borderline personality disorder 33.3%, substance use disorder 31.7%, antisocial personality disorder 15.1% and psychotic disorder 4.8%. The prevalence of current adult attention-deficit and hyperactivity disorder was 9.5%. A total of 39% of the participants admitted to past suicide attempts, whilst 64.3% reported past suicidal ideation and 36.5% had a current episode of a psychiatric disorder. A total of 64.3% of the participants were living with HIV. Although 90.4% had a lifetime psychiatric disorder, only 16.7% were previously diagnosed with a mental illness. The majority of inmates with lifetime disorders had psychiatric comorbidities. CONCLUSION: The high prevalence of mental illness and HIV amongst female inmates, and the fact that most with mental illness remain undiagnosed, is concerning. Improved screening, identification and treatment of mental illnesses in this population is needed to ensure optimal mental health outcomes and decreased recidivism.

Prisoners' access to HIV services in southern Malawi: a cross-sectional mixed methods study.

BACKGROUND: The prevalence of Human Immunodeficiency Virus (HIV) among prisoners remains high in many countries, especially in Africa, despite a global decrease in HIV incidence. Programs to reach incarcerated populations with HIV services have been implemented in Malawi, but the success of these initiatives is uncertain. We explored which challenges prisoners face in receiving essential HIV services and whether HIV risk behavior is prevalent in prisons. METHODS: We conducted a mixed-methods (qualitative and quantitative), cross-sectional study in 2018 in six prisons in Southern Malawi, two large central prisons with on-site, non-governmental organization (NGO) supported clinics and 4 smaller rural prisons. Four hundred twelve prisoners were randomly selected and completed a structured questionnaire. We conducted in-depth interviews with 39 prisoners living with HIV, which we recorded, transcribed and translated. We used descriptive statistics and logistic regression to analyze quantitative data and content analysis for qualitative data. RESULTS: The majority of prisoners (93.2%) were male, 61.4% were married and 63.1% were incarcerated for 1-5 years. Comprehensive services were reported to be available in the two large, urban prisons. Female prisoners reported having less access to general medical services than males. HIV risk behavior was reported infrequently and was associated with incarceration in urban prisons (adjusted odds ratio [aOR] 18.43; 95% confidence interval [95%-CI] 7.59-44.74; p = < 0.001) and not being married (aOR 17.71; 95%-CI 6.95-45.13; p = < 0.001). In-depth interviews revealed that prisoners living with HIV experienced delays in referrals for more severe illnesses. Prisoners emphasized the detrimental impact of poor living conditions on their personal health and their ability to adhere to antiretroviral therapy (ART). CONCLUSIONS: Malawian prisoners reported adequate knowledge about HIV services albeit with gaps in specific areas. Prisoners from smaller, rural prisons had suboptimal access to comprehensive HIV services and female prisoners reported having less access to health care than males. Prisoners have great concern about their poor living conditions affecting general health and adherence to ART. These findings provide guidance for improvement of HIV services and general health care in Malawian institutionalized populations such as prisoners.

Self-esteem and aggression in women: differences between female prisoners and women without criminal records.

Contradictory findings have been reported regarding the association between self-esteem and aggression. Most studies have dealt with non-criminal populations. This study aimed to explore the relationship between self-esteem and aggression and investigate possible differences in self-esteem and aggression between female inmates and women without criminal records (non-criminals) in the prefecture of Attica, Greece. One hundred fifty-seven female inmates in the Attica's Korydallos Female Prison and 150 non-criminals from Attica's general population completed the Buss & Perry Aggression Questionnaire and Rosenberg's Self-esteem Scale between February 2012 and April 2014. Lower self-esteem was associated with higher aggression among women independent of criminality. Self-esteem was lower in inmates (Mean = 18.06, SD = 6.19) than in non-criminals (Mean = 21.65, SD = 4.90, p < .001). Female prisoners presented higher aggression than non-criminals (unadjusted Mean = 78.40, SD = 23.60 versus Mean = 68.82, SD = 14.95, p < .001). However, after adjusting for age, education and self-esteem, this difference was no longer statistically significant (p = .127). Further studies, especially in female offenders, should be conducted to broaden our understanding of female aggression with a view to developing and promoting focused therapeutic procedures.

Use of psychoactive substances in prison: Results of a study in the Lyon-Corbas prison, France.

BACKGROUND AND AIMS: In prison, in 2012, according to various sources, from 4 to 56% of the European inmate population used psychoactive substances (PAS). The aim of our study was to describe PAS consumption during incarceration in the prison of Lyon-Corbas, France. METHOD: A transversal descriptive study was conducted between September 23rd and September 27th 2013 among all inmates of this prison. We used an anonymous self-administered questionnaire, distributed at lunchtime and collected, the same day, at dinnertime, by the mental health service personnel. RESULTS: Among 785 inmates present at the time of the study in the prison of Lyon-Corbas, 710 were included and the response rate was 64.4% (95% CI [60.8-67.8]). Among 457 responding inmates, 16.4% (95% CI [13.2-20.0]) reported no PAS consumption. Among 382 consumers, 74.4% (95% CI [69.8-78.5]) used tobacco, 36.8% (95% CI [32.2-41.8]) cannabis, 30.4% (95% CI [25.9-35.1]) alcohol, 7.7% (95% CI [5.2-10.6]) heroin and 10.3% (95% CI [7.5-13.6]) cocaine. Furthermore, 15% of consumers had started PAS consumption during their incarceration. Among consumers of at least one PAS other than tobacco, cannabis and alcohol, the way of consumption was sniff for 60.0% (95% CI [48.5-70.2]) and injection for 31.0% (95% CI [21.6-42.1]). Use of several PAS at the same time and sharing sniffing and/or injection paraphernalia were other risky behaviors observed; 12% (95% CI [5.8-20.4]) of drug injectors declared using chlorine to sterilize their injection paraphernalia. CONCLUSION: Our study provides worrying data about PAS consumption in prison. The measures of prohibition do not prevent this consumption. There is even an initiation of consumption of PAS for 15% of the first-time incarcerated inmates. This finding should encourage public authorities to facilitate access of inmates to the care structures in prisons, to improve drug use prevention and care programs and to develop activities (sports, cultural, educational and vocational).

Reexploring Female Pathways to Incarceration: Assessing the Role of Mental Illness.

The pathways framework represents an emerging body of work that emphasizes gendered-based influences on crime and incarceration. To date, studies on female pathways often minimize or exclude the role of mental illness. The current study employs Life Course Theory and the use of Life History Calendar to examine the pathways of a sample of 15 female prison inmates diagnosed with serious and persistent mental health conditions. Findings indicate that mental illness carried criminogenic risk throughout the life course, with crucial transitions of risk leading these women toward long term incarceration. Self-reported pathways included repeated victimization, substance use, psychological trauma, delinquency, and/or crime. This study suggests that the pathway framework would benefit from the increased recognition of the role of mental illness on female criminality. Trauma-informed policy implications are provided and discussed.

Promoting Adaptation in Female Inmates to Reduce Risk of Opioid Overdose Post-Release Through HOPE.

The purpose of the project was to develop a sustainable pre-release education program to reduce the risk of opioid overdose post-release in female inmates in a rural county jail in Middle Tennessee. The project was supported and guided using Roy's adaptation model. Content analysis resulted in common themes (initiation, moral failure, ineffective strategies, supportive environment, new beginnings, and adaptive domains), identified within the pre- and post-implementation surveys. The implementation of a successful reentry program for the vulnerable female incarcerated population has the potential to reduce the risk of opioid overdose death and negative health outcomes post-release.

Adverse Childhood Experiences and Adulthood Negotiation in Intimate Partner Violence: The Sequentially Paradoxical Role of Interpersonal Sensitivity Among Female Inmates.

The present study examined interpersonal sensitivity and hostility as separate and sequential mediators in the association between adverse childhood experiences (ACE) and the conflict tactic of negotiation (e.g., a strategy utilized to resolve conflict with a romantic partner) among female inmates. Participants were 258 female inmates recruited from three Southern California jails. After statistically controlling for partner-negotiation, results from a sequential mediation model revealed that the association between ACE and negotiation was mediated through three separate pathways. The first single mediational pathway indicated that ACE was positively associated with interpersonal sensitivity, which in turn had a positive association with negotiation. The second single mediational pathway revealed that ACE was positively associated with hostility, which in turn had a negative association with negotiation. Finally, the sequential meditational path revealed that interpersonal sensitivity through hostility mediated the ACE and negotiation relationship. The present results suggest that ACE may result in increased interpersonal sensitivity, which may paradoxically result in both more and less negotiation with romantic partners. That is, ACE through interpersonal sensitivity alone may result in more negotiation, and ACE through interpersonal sensitivity and then hostility may result in less negotiation with romantic partners. We explicate how the psychopathological construct of interpersonal sensitivity may lead to increased and decreased rates of the positively construed conflict tacit of negotiation. In addition, the present findings are discussed in light of the high rates of both revictimization and perpetration of violence among female inmates.

An HIV Narrative of Female Inmates With a Lifetime History of Mental Illness in Durban, South Africa.

Introduction: South Africa (SA) has one of the highest prevalence rates of Human Immuno-deficiency Virus (HIV) globally, with women carrying a larger burden of the disease. Furthermore, female inmates have higher rates of HIV compared to their male counterparts, with an over-representation of mental illnesses among female inmates as well. Additionally, mental illnesses are highly prevalent in people living with HIV, with HIV and mental illness sharing a complex bidirectional relationship. This study, which forms part of a larger two-phased, mixed-methods study, describes the experiences of contracting and living with/being affected by HIV, among female inmates with a lifetime history of mental illness, in a South African setting. Method: This study was conducted at a correctional centre in Durban, KwaZulu-Natal, SA. Fourteen adult (18 years and older) female inmates, were purposively selected to participate in individual, in-depth semi-structured interviews. Participants had a lifetime history of mental illness, trauma and were either living with HIV, or affected by HIV. Women from diverse cultural backgrounds, who were fluent in English, were selected. This manuscript focuses on the description of the HIV component of the qualitative interviews only. Thematic analysis was used to analyse the data. Results: Themes related to contracting HIV included intimate partner betrayal, gender differences regarding sexual behaviour, fear associated with HIV and the importance of pre- and post-test HIV counselling. Themes related to living with/being affected by HIV included the challenges women experienced in their home community, which contrasted with their experience of living with HIV in the prison community, and the importance of accepting an HIV positive life. Conclusion: HIV is prevalent in the female inmate population at this correctional centre in SA. This study emphasises that whilst incarcerated, attempts should be made to educate, train, support and manage HIV in this population, thereby helping to curb the epidemic. Further research should aim at exploring such strategies. The study also underscores the importance of the continued need for HIV education in order to eradicate associated stigma and discrimination which are still prevalent in SA.

Health implications of sex trading characteristics in Long Beach, California, USA.

This study examined the comparative health risk behaviors of women who (a) traded sex for money, (b) traded sex for drugs, (c) traded sex for both drugs and money, or (d) did not trade sex. Self-report data were collected from 2369 women who received services through HIV and sexually transmitted infection (STI) testing programs and a subset were tested for HIV, hepatitis B, hepatitis C, and syphilis. Results revealed those women who traded sex only for money used condoms, were tested for HIV, and received the HIV test results more often than the other women. Women who traded sex for both drugs and money reported a significantly higher prevalence of gonorrhea, hepatitis B, and syphilis; were more likely to test positive for hepatitis B, syphilis, and HIV; engaged more often in sex acts without condoms; and were incarcerated for significantly more days. Based on these findings, the targets with greatest potential for STI prevention interventions are female sex workers who trade sex for both drugs and money.

Narcissism but Not Criminality Is Associated With Aggression in Women: A Study Among Female Prisoners and Women Without a Criminal Record.

Aggression has drawn research attention during the past decades. It remains unclear how self-esteem, self-perception, narcissism and certain socio-demographic factors impact the course of aggression. Female aggression is considered to differ in its origins and is understudied. Only few studies have attempted to examine the aforementioned variables among females, while none of them included a comparison between delinquent and non-delinquent individuals. The present study examines the effect of self-esteem, self-perception, narcissism, and socio-demographic factors on aggression among female inmates and women without criminal record (non-delinquents). One hundred fifty-seven female inmates in the Attica's Korydallos Female Prison and 150 women with no criminal record were assessed with Buss & Perry Aggression Questionnaire, Rosenberg's Self-esteem Scale, Narcissistic Personality Inventory-40 and the Self-Perception Profile for Adults. When inmates were compared to non-delinquent women, it emerged that higher aggression could be independently predicted by higher levels of narcissistic personality traits and sociability, as well as lower age, lower education, lower self-esteem, and lower levels of self-perception items including nurturance, job competence and athletic abilities. Aggression was not predicted by the participants' group (inmates vs. non-delinquents). Within female inmates, independently of the type of their offense (convicted for violent vs. non-violent crimes), it was found that lower job competence, higher narcissistic personality traits and a history of childhood maltreatment could predict higher aggression. Our results support the notion that female aggression differs from male and highlight the significant parameters that may predict aggression either among women (inmates and non-delinquent women) or among female inmates (violent or non-violent crimes). It is the presence of narcissistic traits which predict aggression rather than criminality in general, including violent and non-violent crimes.

Effectiveness of a Prison-Based Healthy Pregnancy Curriculum Delivered to Pregnant Inmates: A Pilot Study.

Incarcerated women experience stress related to their prison sentence, and this can be aggravated by pregnancy-related changes, with pregnant women at higher risks of adverse maternal and fetal health outcomes related to mental health problems and infant low birth weight. In a Midwestern correctional facility, 25 pregnant women were enrolled in a 4-week health and mental health education workshop comprised of seven sessions that taught women about self and infant care. Each 90-minute session included education and guided discussions using handouts that each participant could take with them. Pre and post-test surveys to measure change in knowledge were completed after each session. Findings indicate that an educational intervention for incarcerated pregnant women can lead to change in knowledge about self and infant care.

Female Offenders, HIV Peer Programs, and Attachment: The Importance of Prison-Based Civilian Staff in Creating Opportunities to Cultivate Prosocial Behaviors.

As women commit to a conventional lifestyle, the bond of attachment becomes a fundamental component in sustaining the desistance process. If weak attachments in the community cannot be replaced or enhanced with the cultivation of strong conventional attachments while incarcerated, female offenders will leave prison without a supportive network. Strong social networks and a high level of social capital are essential for female offenders to reintegrate successfully; if social bonds are constructed before release, there is a greater chance of maintaining a crime-free lifestyle. One way to cultivate strong bonds of attachment during incarceration is through prison-based programming. This qualitative study, based on the narratives of 49 female offenders, examines the potential for inmates to form prosocial attachments with staff in two HIV prison-based peer programs in New York State. Strong attachments were formed between the inmates and civilian staff during incarceration, maintained upon release, and served to reinforce the establishment of bourgeoning conventional identities. The dedication and commitment of the civilian staff, and the support they provided to the inmates, was essential to achieving both rehabilitative and reintegrative goals.

Addressing Women's Unmet Health Care Needs in a Canadian Remand Center: Catalyst for Improved Health?

Incarcerated women have a disproportionate burden of infectious and chronic disease, substance disorders, and mental illness. This study explored incarcerated women's health and whether a Women's Health Clinic improved care within this vulnerable population. Retrospective chart reviews and focus groups were conducted. Poor access to care in the community due to competing social needs was described. Barriers to care during incarceration included lack of comprehensive gender-specific services, mistrust of providers, and fragmentation. Of 109 women, high rates of mental illness, partner violence, substance use, sexually transmitted infection (STI), and irregular Pap testing were observed. Pap (15% to 54%, p < .001) and STI (17% to 89%, p < .001) testing rates increased. Fragmentation of care remained at transition points, and further work is needed to improve continuity within corrections and the community.

Development of healthcare facility standards for Thai female inmates.

Purpose The purpose of this paper is to develop and evaluate the Standards of Healthcare Facility for Thai Female Inmates (SHF-TFI) through healthcare service improvement. Design/methodology/approach This research and quality improvement project was comprised of three phases. Surveying healthcare facilities and in-depth interviews with female inmates as well as prison nurses were employed in Phase I. Expert reviews and public hearing meetings were used for developing the SHF-TFI in Phase II. Satisfaction questionnaires, focus group interviews of the female inmates, and in-depth interviews with nurses and prison wardens were utilized to evaluate feasibility and effectiveness of SHF-TFI implementation in Phase III. Findings The SHF-TFI was elaborated in order to be more specific to the context of the correctional institutes and correspond with healthcare as to the needs of female inmates. It was divided into three main aspects: administrative standards, health service standards and outcome standards. After implementation, nurses reflected on the feasibility and benefits of the SHF-TFI on the organizations, inmates and nurses. The female inmates perceived remarkable improvement in the healthcare services including physical activity promotion and screening programs for non-communicable diseases, the physical environment and sufficiency of medical equipment. Moreover, the pregnant inmates and incarcerated mothers with children shared their views on better antenatal and child developmental care, as well as availability of baby supplies. Originality/value The findings support the feasibility and effectiveness of the SHF-TFI for quality care improvement and applicability of the Bangkok Rules in women's correctional institutes.

Prevalence of borderline personality disorder and its risk factors in female prison inmates in China.

High prevalence of borderline personality disorder (BPD) has been found in Western prisons but no such data exists in China. The objective of this study was to determine the lifetime prevalence of BPD in Chinese female prison inmates and its associated risk factors. This cross-sectional study was conducted in Hunan Provincial Female Prison. Data on consenting inmates' socio-demographic and clinical characteristics were collected and the diagnosis of lifetime BPD was established using the Structural Clinical Interview for DSM-IV. The prevalence of BPD was 10.6% in the cohort of 2709 participating inmates. Multiple logistic regression analysis revealed that younger age, unmarried marital status, higher education level, fewer major medical conditions, more frequent personal and family members' drug use, more frequent comorbid psychiatric disorders and family history of psychiatric disorders were positively and independently associated with BPD. BPD is common in Chinese female prison inmates. Considering its adverse social consequences and impact on physical and mental well-being, serious attempts should be made to diagnose BPD early and improve access to treatment in women prisons.

Best Practices for Nutrition Care of Pregnant Women in Prison.

Approximately 3% to 4% of women are pregnant upon their admission to prison. Pregnant inmates present unique challenges for correctional health providers, including meeting the nutritional needs for healthy pregnancy outcomes. The authors outline six recommendations for nutrition care for pregnant inmates, including (1) test for pregnancy; (2) prescribe prenatal vitamins; (3) follow nutrition recommendations outlined by the Academy of Nutrition and Dietetics; (4) provide additional food, monitor over time, and allow for modifications to meet pregnancy needs; (5) ensure regular access to water; and (6) provide inmates with resources and education on healthy diet. The degree to which correctional facilities address the nutritional needs of pregnant women may have short- and long-term consequences for the health of women and their offspring.

The Impact of Homelessness and Incarceration on Women's Health.

Female inmates have multiple challenges during incarceration and as they transition into the community including: barriers to accessing health care within correctional facilities, poor transitional preparation preceding release, and inadequate continuity of health care after release. This qualitative study explored the health-seeking experiences and the health and housing needs of female inmates. Four focus groups were conducted in a remand facility in Canada. Women described poor health at entry to the correctional system and viewed incarceration as a means to access health care services. Transition back into the community represented a crossroad that was dependent on the stability of housing status. These findings support gender-sensitive health and housing programs to reduce addictions, recidivism, and poor health among this vulnerable population.

Barred from each other: why normative husbands remain married to incarcerated wives--an exploratory study.

This study explores men's motivation and justification to remain married to their criminal, imprisoned wives. Using semistructured interviews and content-analysis, data were collected and analyzed from eight men who maintain stable marriage relationships with their incarcerated wives. Participants are normative men who describe incarceration as a challenge that enhances mutual responsibility and commitment. They exaggerate the extent to which their partners resemble archetypal romantic ideals. They use motivational accounts to explain the woman's criminal conduct, which is perceived as nonrelevant to her real identity. Physical separation and lack of physical intimacy are perceived as the major difficulties in maintaining their marriage relations. Length of imprisonment and marriage was found to be related to the decision whether to continue or terminate the relationships. Women-inmates' partners experience difficulties and use coping strategies very similar to those cited by other normative spouses facing lengthy separation.

The Prevalence of Overweight and Obesity Among Aging Female Inmates.

The purpose of this study was to examine the prevalence of overweight and obesity in a sample of older female inmates (N = 458). Results indicate that 34% of older female inmates were overweight and 36% were obese; similar percentages were noted for the general population. Race and age were found to be significantly associated with the body mass index categories of healthy weight and obese. White inmates were significantly more likely to be of a healthy weight and significantly less likely to be obese than Black inmates. Age was positively associated with healthy weight and negatively associated with obesity. These two variables remained significant even after they were introduced into logistic regression models predicting healthy weight and obesity. Findings indicate the need for programming to improve the health of this population.