The United States has the highest number of people incarcerated in the world. Criminal-legal involved populations, including people who are incarcerated in jails and prisons and people who are under community carceral control through probation or parole are at an increased risk for human immunodeficiency virus (HIV). Increasing access to HIV testing, treatment and prevention is necessary to curb the HIV epidemic. This chapter outlines the history of HIV testing in jails and prisons and suggests a Status Neutral HIV Care Framework for improving access to HIV prevention services.

As Forensic Psychology continues to expand as an independent field, professionals regularly resort to psychological assessment tools to assess people involved within the justice system. The Personality Assessment Inventory (PAI) is a 344-item, self-report inventory that aims to provide meaningful information for diagnosis and clinical decision-making, specifically relating to psychopathology, personality, and psychosocial environment. Its applicability in forensic settings has been increasingly recognized on account of its benefits in comparison to other self-report inventories (e.g., MMPI-2, MCMI-III), since it includes scales that are relevant to forensic settings (e.g., violence risk levels, psychopathy, substance abuse), and the existence of profile distortion indicators is useful when dealing with highly defensive and/or malingering populations. The goal of this paper is to conduct a thorough review of the PAI\'s utility in forensic settings, by focusing on the relevant forensic constructs assessed by the PAI (e.g., personality disorders, psychosis, substance abuse, aggression, recidivism risk, and response distortion), as well as its application to offender and inmate populations, intimate partner violence contexts, family law cases, and forensic professionals. Overall, the PAI continues to gather international recognition and its relevance and usefulness in forensic settings is generally accepted and acknowledged.

Planning and implementing prison-based substance use disorder (SUD) interventions are challenging. We wanted to understand why and how people in correctional settings (CS) use drugs and to explore what policies, environmental, and interpersonal factors influence substance use among incarcerated people. Using the Behavior Change Wheel (BCW) framework, we proposed a thematic map with intervention functions to reduce substance use in CS.
We used the Framework Method of qualitative analysis. We did snowball sampling for the incarcerated people with drug use (PWD) and convenience sampling for the staff. The in-depth interview sample comprised 17 adult PWD, three prison administrative, and two healthcare staff. We determined the sample size by thematic data saturation. We followed a mixed coding approach for generating categories, i.e., deductive (based on the BCW framework) and inductive. The study constructed the final theoretical framework by determining the properties of the categories and relationships among the categories.
We identified eleven categories aligned with the BCW framework. The themes were prison routine, interpersonal dynamics of the incarcerated population, exposure to substance use, attitude of staff towards PWD, experience with prison healthcare, willingness (to reduce drug use) and coping, compassion, drug use harms, conflict between staff and residents, stigma, and family/peer support. The BCW framework aided the identification of potential intervention functions and their interactions with the organizational policies that could influence PWD\'s capability-opportunity-motivation (COM) and drug use behavior (B).
There is a need to raise awareness of SUD prevention and intervention among decision-makers and revisit the prison policies.

Psychopathy is associated with higher levels of violence as well as general and violent recidivism after release from prison. A disorder with a long and rich clinical and research history, psychopathy has gained an undeserved reputation as a syndrome that is unresponsive to treatment. This article presents information that undermines long-standing problematic assumptions regarding the treatability of individuals with psychopathic traits and posits that implementing treatment programs in correctional settings is critical to decrease recidivism and violence. We discuss several treatment programs that have evidenced some success in the treatment of individuals with psychopathy and have the potential to be widely implemented in correctional settings, as well as general tenets of successful treatment programs and specific targets.

Breastfeeding and pumping to express human milk are restricted practices for incarcerated women, and their infants are at high risk for not receiving human milk. Clinical practice guidelines are not applied to perinatal women who are incarcerated, and the rates of breastfeeding and the potential to do so in correctional facilities are extrapolated from small studies. The purpose of this analysis is to summarize current national trends in breastfeeding and lactation policy and the extent to which lactation in correctional facilities is addressed, identify ongoing lactation support programs and strategies in correctional facilities as potential areas for further study, and offer a context-specific, adaptable, and evidence-based approach to breastfeeding and lactation support using the Spatz 10-step model. This analysis calls for strategic updates to research and policy and offers recommendations in collaboration with existing programs to increase access to breastfeeding and lactation services for incarcerated women.

Over 10 million individuals pass through U.S. detention centers on an annual basis, with nearly two-thirds meeting criteria for drug dependence/abuse. Despite proven efficacy, treatment with medications for opioid use disorder (MOUD) is underutilized in jail settings-a gap that could be addressed using telemedicine. Here we describe a new program of telemedicine-based clinical provision of new/continuing buprenorphine treatment for individuals detained in a rural jail. Implementation objectives were completed between January and August 2020, and patient encounters were conducted between August 2020 and February 2021. We established (i) telemedicine hardware/software capability; (ii) a screening process; (iii) buprenorphine administration methods; (iv) necessary medical release procedures; (v) telemedicine encounter coordination and medication prescription procedures; and (vi) a research platform. Seven incarcerated patients have been treated, two of whom were referred from community treatment. Patients were mostly male (71%), non-Hispanic White (86%), and averaged 33 years old. All patients tested positive for an opioid upon intake and began/continued buprenorphine treatment in the jail. Average time to first MOUD appointment was 9 days and patients were maintained in treatment an average 21 days. Referrals for continuing community treatment were offered to all patients prior to discharge. We report successful implementation of telemedicine MOUD in a rural detention center, with treatment engagement and initiation occurring prior to the high-risk period of discharge. The fact that this program was launched during the height of the pandemic highlights the flexibility of telemedicine-based buprenorphine treatment. Challenges and obstacles to implementation of buprenorphine treatment in a correctional system are discussed.

To assess post-release outcomes associated with continuation of methadone treatment in correctional centers.
This case-control study of the post-incarceration impact of pilot methadone programs operating in jails in New Haven and Bridgeport, Connecticut, USA was conducted in 2014-18. The study compared non-fatal overdose, fatal overdose, reincarceration, and resumption of methadone in the community experienced by 1564 eligible men, 660 (42.2 %) of whom continued treatment while incarcerated.
Continuation of methadone was associated with a significant decrease in non-fatal overdose (OR:0.55; 95 % CI: 0.36, 0.85) and a greater likelihood of resuming methadone treatment in the community post-release (OR:2.56; 95 % CI: 2.07, 3.16). Time to resumption of methadone was shortened by treatment while time to non-fatal overdose was increased. Treatment while incarcerated resulted in a modest but not significant decrease in fatal overdoses and no difference in reincarceration between those who did and did not receive methadone. However, resumption of methadone after release did significantly reduce fatal overdoses (OR = 0.26, 95 % CI: 0.11, 0.62, p = 0.002).
Improvements in post-release outcomes of non-fatal overdose and treatment reengagement emphasize the benefits of continuing medication-based treatment for opioid use disorder within the criminal justice system for those receiving it prior to being incarcerated.

It has been estimated that approximately 15% of people who are incarcerated in the US have histories of opioid use disorder. Relapse to opioid use after release from prison poses a serious risk of HIV infection. Prison-initiated buprenorphine may help to reduce HIV infection given the association between opioid use and HIV-risk behaviors.
The present study is a secondary analysis of longitudinal data gathered from a randomized controlled trial of buprenorphine-naloxone for people who were incarcerated (N = 211) between 2008 and 2012. It compares the impact of assignment to initiate buprenorphine in prison (N = 106 randomized, N = 104 analyzed) versus in the community (N = 107 randomized, N = 107 analyzed) and whether or not participants entered community treatment on the frequency of HIV-risk behaviors in the 12 months following release from prison. Data were analyzed hierarchically and for each outcome variable, a multilevel, over-dispersed Poisson model was fit to the data. Outcome variables were the number of times the following behaviors occurred in the last 30 days: (1) having sex without a condom (2) injecting drugs (3) using unsterilized needles, and (4) sharing injection paraphernalia.
Participants assigned to begin buprenorphine in the community experienced a greater decrease in injection drug use over time compared to participants assigned to begin buprenorphine in prison. There were no significant associations between treatment assignment or community treatment entry and instances of having sex without a condom, sharing injection paraphernalia, or using unsterilized needles.
Overall, the present study did not find support for the initiation of buprenorphine in prison (as opposed to the community) as a means to reduce incidences of HIV-risk behaviors. Avenues for future research in the nexus of HIV-risk reduction, criminal justice, and pharmacotherapy are discussed. Trial registration This study was supported by the National Institute on Drug Abuse (NIDA), Buprenorphine for Prisoners (PI: Kinlock; R01DA021579). ClinicalTrials.gov identifier: NCT00574067.

With over half of individuals incarcerated having serious mental health concerns, correctional settings offer excellent opportunities for epidemiological, prevention, and intervention research. However, due to unique ethical and structural challenges, these settings create risks and vulnerabilities for participants not typically encountered in research populations. We surveyed 1,224 researchers, IRB members, and IRB prisoner representatives to assess their perceptions of risks associated with mental health research conducted in correctional settings. Highest-ranked risks were related to privacy, stigma, and confidentiality; lowest-ranked risks were related to prisoners\' loss of privileges or becoming targets of violence due to having participated in research. Cognitive impairment, mental illness, lack of autonomy, and limited access to services emerged as the greatest sources of vulnerability; being male, being female, being over age of 60, being a minority, and being pregnant were the lowest-ranked sources of vulnerability. Researchers with corrections experience perceived lower risks and vulnerabilities than all other groups, raising the question whether these researchers accurately appraise risk and vulnerability based on experience, or if their lower risk and vulnerability perceptions reflect potential bias due to their vested interests. By identifying areas of particular risk and vulnerability, this study provides important information for researchers and research reviewers alike.

Conducting or overseeing research in correctional settings requires knowledge of specific federal rules and regulations designed to protect the rights of individuals in incarceration. To investigate the extent to which relevant groups possess this knowledge, using a 10-item questionnaire, we surveyed 885 IRB prisoner representatives, IRB members and chairs with and without experience reviewing HIV/AIDS correctional protocols, and researchers with and without correctional HIV/AIDS research experience. Across all groups, respondents answered 4.5 of the items correctly. Individuals who have overseen or conducted correctional research had the highest scores; however, even these groups responded correctly only to slightly more than half of the items. These findings emphasize the need for ongoing training in federal guidelines governing correctional research, particularly for those individuals who are embarking on this type of research.