Augmenting substance use treatment in the drug court: A pilot randomized trial of peer recovery support.

INTRODUCTION: Peer recovery specialist (PRS) support has been used to varying degrees in community substance use and mental health treatment for a number of years. Although there has been some evidence of positive PRS impacts on client outcomes, previous research has shown inconsistent findings and methodological shortcomings. Given the high prevalence of substance use disorders among people involved in the criminal justice system, and limited available treatment opportunities, PRS support could provide a cost-effective opportunity to promote positive client outcomes. Drug courts, with their focus on treatment and rehabilitation rather than punishment, are an ideal laboratory to test the impacts of PRS on substance use recurrence and recidivism. METHODS: The present study is, to our knowledge, the first experimental test of the PRS model in a justice system setting. We implemented a pilot experiment in the Philadelphia Treatment Court, randomizing 76 drug court participants to be linked to a PRS or to services as usual, and analyzed client outcomes over a nine-month follow-up period. Most participants' drug of choice was marijuana. RESULTS: The results showed a reduction in rearrests and improvement in drug court engagement, but no impact on substance use recurrence or treatment engagement. CONCLUSIONS: The mixed findings suggest some promise for the PRS model in the drug court setting, but the need for further research with more diverse and higher-risk drug court populations.

Do Peer Recovery Specialists Improve Outcomes for Individuals with Substance Use Disorder in an Integrative Primary Care Setting? A Program Evaluation.

Peer recovery specialists (PRSs) combine their personal experiences with substance use and recovery with clinical skills to support patients in treatment for or recovery from substance use. This paper provides evaluation findings from a SAMHSA-funded program that integrated a PRS team into a primary care clinic to assess the efficacy of PRS support on patients' substance use, healthcare involvement, and criminal justice involvement. PRSs provided a range of services to patients with histories of incarceration and substance use, including facilitating support groups, providing one-on-one individualized support, and navigating services. Data were collected from PRS-supported patients at intake, discharge, and 6 months post-intake. Results revealed reductions in the percentage of patients using substances in the past 30 days, decreased number of days using alcohol, increased engagement in more medical services after program enrollment, increased school enrollment, and increased rates of employment for PRS-supported patients.

State policies in the United States impacting drug-related convictions and their consequences in 2015.

BACKGROUND: Criminal justice system involvement has been associated with health issues, including sexually transmitted disease. Both incarceration and sexually transmitted disease share associations with various social conditions, including poverty, stigma, and drug use. METHODS: United States state laws (including Washington, D.C.) regarding drug possession and consequences of drug-related criminal convictions were collected and coded. Drug possession policies focused on mandatory sentences for possession of marijuana, crack cocaine and methamphetamines. Consequences of drug-related convictions included ineligibility for public programmes, ineligibility for occupational licences and whether employers may ask prospective employees about criminal history. We analysed correlations between state sexually transmitted disease rates and percentage of a state's population convicted of a felony. RESULTS: First-time possession of marijuana results in mandatory incarceration in one state; first-time possession of crack cocaine or methamphetamines results in mandatory incarceration in 12 (23.5%) states. Many states provide enhanced punishment upon a third possession conviction. A felony drug conviction results in mandatory ineligibility for the Supplemental Nutrition Assistance Program and/or Temporary Assistance for Needy Families in 17 (33.3%) states. Nine (17.6%) states prohibit criminal history questions on job applications. Criminal convictions limit eligibility for various professional licences in all states. State chlamydia, gonorrhoea and syphilis rates were positively associated with the percentage of the state population convicted of a felony (p < 0.05). CONCLUSION: While associations between crime, poverty, stigma and health have been investigated, our findings could be used to investigate the relationship between the likelihood of criminal justice system interactions, their consequences and public health outcomes including sexually transmitted disease risk.

State and local policies related to sexual orientation in the United States.

Poorer health suffered by lesbian, gay, and bisexual (LGB) populations may be associated with public policies. We collected the laws that in 2013 prohibited discrimination based on sexual orientation from 50 United States (US) states, the District of Columbia (Washington, DC or DC), and the 30 most populous US metropolitan areas. To facilitate future research, we coded certain aspects of these laws to create a dataset. We generated descriptive statistics by jurisdiction type and tested for regional differences in state law using Chi-square tests. Sixteen (31.4 per cent) states prohibited discrimination by all employers based on sexual orientation, 25 states (49.0 per cent) in public employment, 18 states (35.3 per cent) in government contracting, and 21 states (41.2 per cent) in private employment. Twenty-one states prohibited discrimination (41.2 per cent) in housing practices (selling and renting), and 17 (33.3 per cent) in public accommodations. Local (county/city) laws prohibiting discrimination were less common. State laws differed significantly by US census region - West, Midwest, Northeast, and South. Future analyses of these data could examine the impact of these laws on various outcomes, including health among LGB populations.

Hypermasculinity and Sexual Risk Among Black and White Men Who Have Sex With Men and Women.

Men who have sex with men and women (MSMW), particularly Black MSMW, are at high risk for HIV. However, few studies have focused on factors that influence Black MSMW's specific HIV risk behaviors, and there are no evidence-based interventions specifically targeting this population. Some studies have suggested that masculine ideals are associated with high-risk sex practices and partners. Norms around masculinity in the social environments in which MSMW live may prohibit nonheterosexual identities and behaviors, may lead to internalized homophobia, and may promote high-risk strategies to seek male partners. Using data collected from 180 Black and 101 White MSMW recruited for a study to develop strategies for recruiting MSMW for research and services and to inform the content of HIV prevention messages, we examined the association between hypermasculinity ideals and sexual behaviors that may contribute to increased HIV risk among Black MSMW and a comparison group of White MSMW. Comparing Black and White MSMW, we explored how this association may differ by race. Multivariate models, controlling for sociodemographic and other covariates, indicate that hypermasculine ideals are associated with increased numbers of male and female partners among Black MSMW and an increased number of female partners among White MSMW. Hypermasculinity is important to address in programs that aim to reduce HIV risk among Black MSMW.

Preventing AIDS through live movement and sound: Efficacy of a theater-based HIV prevention intervention delivered to high-risk male adolescents in juvenile justice settings.

Male adolescents who cycle through the juvenile justice system are at high risk for HIV infection, yet there are few HIV prevention interventions for this high-risk population. This study evaluates the efficacy of Preventing AIDS through Live Movement and Sound (PALMS), an innovative, theory-based HIV risk reduction intervention that uses theatrical performances and role-play. The study used a nonrandomized concurrent comparison group design. A total of 289 predominantly African American males aged 12-18 from two juvenile justice facilities in Philadelphia, PA were enrolled. At 6-month follow-up, PALMS participants demonstrated greater increases in HIV and condom use knowledge and improved attitudes toward HIV testing and toward persons living with HIV/AIDS than did those in the comparison condition. PALMS participants were also significantly more likely to use a condom during their last sexual contact with a non-main female partner than comparison participants. This theater-based HIV prevention intervention is a potential resource for changing knowledge, attitudes, and behaviors of adolescents in juvenile justice settings.

Magic Johnson doesn't worry about how to pay for medicine: experiences of black men who have sex with men living with HIV.

Despite high and rapidly growing incidence of HIV, little is known about the everyday lived experiences of HIV-positive black men who have sex with men. Lack of empirical knowledge about members of this group is especially problematic as HIV-positive individuals continue to live in a world of hope, fear, waiting and wondering, which can heavily influence their everyday lives. In this exploratory study, we examine the everyday lives of HIV-positive black gay, bisexual and other men who have sex with men, particularly how being a racial minority may influence the ways that they manage living with the illness. Our goal was to provide a forum from which black men could share their personal experiences regarding the various aspects of living with HIV. In doing so, we identified five themes that may be unique to black men or experienced differently by black men due, in the USA, to their racial minority status.

Black men who have sex with men and the association of down-low identity with HIV risk behavior.

Black men "on the down low" have been considered prime agents of HIV transmission in the Black community despite little empirical evidence. We assessed the relationship between down-low identification and sexual risk outcomes among 1151 Black MSM. Down-low Identification was not associated with unprotected anal or vaginal sex with male or female partners. Future HIV prevention programs and research should target sexual risk behaviors of Black men, irrespective of identity, and not focus on the "down low."

Sexual risk behaviors of HIV-positive, HIV-negative, and serostatus-unknown Black men who have sex with men and women.

Black men who have sex with men and women (MSMW) are at high risk for HIV infection and transmission. This study compared the sexual risk behaviors of Black MSMW who self-reported being HIV-positive with those who reported being HIV-negative and those who did not know their HIV status. Respondent-driven sampling (RDS) was used to recruit 1,154 Black MSM in Philadelphia and New York who completed an audio computer-assisted self-interview (ACASI). Of these men, 212 had engaged in anal sex with male partners and vaginal or anal sex with female partners in the past 3 months. A quarter (23.6%; n = 50) of MSMW self-reported testing positive for HIV at their last test, 59.4% (n = 126) reported testing negative for HIV at their last test, and 17.0% (n = 36) reported never having an HIV test. Multivariate logistic regression analysis revealed that HIV-positive MSMW were much less likely than HIV-negative men and never-tested men to have engaged in unprotected intercourse with main male and main female partners perceived to be HIV-negative or of unknown serostatus. However, HIV-positive men were equally as likely as HIV-negative men to have unprotected intercourse with non-main male and non-main female partners perceived as HIV-negative or of unknown serostatus. Our findings indicate that some HIV-positive MSMW engage in unprotected sex that places female and male partners at risk for HIV infection. However, MSMW who have never taken an HIV test, or who have not been recently tested, may be a greater source of HIV transmission to their female and male partners.