Social Action Theory and HIV Risk Behavior: Early and Midlife Contextual Influences of Incarcerated Women in Washington State

Abstract

Objectives: To employ Social Action Theory (SAT) to better understand the sociocultural and psychosocial experiences of Washington State’s incarcerated women when they are outside of the criminal justice system and how these experiences impact HIV risk behavior. To identify known HIV risk behaviors that impact women involved in the criminal justice system (WICJS) in Washington State, and explore intrapersonal, interpersonal, and environmental factors that influence how WICJS negotiate engagement in HIV risk behaviors pre-/post-incarceration when they are in their community. To use the results of this study to create a set of recommendations for The IF Project (TIP)’s health and wellness program and the SHIELD program, two HIV- related health interventions currently being implemented in women’s correctional facilities in Washington State. Design: This study is a directed content analysis of twenty semi-structured one-on-one interviews with incarcerated women in Washington State, ten of which were conducted with women at a county jail and the other ten at a state prison. Codes were derived from previous research that identified contextual HIV risk factors and other variables that impact WICJS, as well as emerging variables that surfaced during the first phase of analysis. Analysis was completed using inductive and deductive approaches and codes were clustered into dominant themes based on their interrelated characteristics within the realm of SAT. Results: Early life contextual influences included unstable home environments, trauma and abuse, and substance use. Midlife contextual influences included having previously been incarcerated, unstable housing, poor mental health, substance and alcohol use (especially intravenous drug use [IDU]), trauma and abuse, having relationships with male partners who were previously incarcerated, having a male partner cheat on them, trading sex, having a history of STI diagnoses, barriers and facilitators to HIV/STI testing, and barriers and facilitators to condom use. Discussion: The findings of this study correspond with known HIV risk behaviors for WICJS and suggest that engagement in HIV risk behaviors for WICJS are dynamic, multifactorial, oftentimes occurring in concurrence, and span throughout the life course. The findings of this study indicate additional information and practices that can be included in TIP’s health and wellness program and the SHIELD program to better address the unique needs of this population, especially in regards to addressing HIV risk behaviors such as trauma and abuse, IDU education, condom negotiation, and HIV risk behaviors that occur throughout the life course. Conclusions: Incorporating the findings of this study into TIP’s health and wellness program and the SHIELD program has the potential to decrease HIV risk behaviors. Future HIV interventions targeting this population should aim to address how substance and alcohol use influences intrapersonal generative capabilities such as coping skills and self-esteem, as was seen with many of the participants who used substances to temporarily numb negative feelings and/or to ease stress. Furthermore, future interventions that occur earlier in the life course should be developed and aim to interrupt intergenerational trends in HIV risk behavior by targeting younger women populations at risk of becoming criminal justice-involved.