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As people are living longer and healthier lives with HIV, the risk of HIV transmission through unprotected sexual intercourse or sharing injection equipment continues to grow. While the general consensus is that most people who know they are HIV+ are careful to avoid transmitting the virus, it is estimated that one third of HIV+ gay/bisexual men continue to engage in unprotected sex. There is now a growing call to develop targeted and effective prevention strategies addressing the specific needs of people living with HIV.

The Implicit Theory project was designed to capture how HIV prevention providers delivering services think behavior change in their clients happens, what we refer to as providers’ implicit theories. This is important for many reasons. To begin with, the providers work directly with clients and were often peers of these clients. They are directly interacting with their clients and may be able to even witness when change has occurred. The providers’ position as peer or former peer, as the practice of hiring from the community that one wants to serve is very popular among HIV prevention organizations, is also key. This position provides insight and familiarity about the context and complexities of clients’ lives that is unique to providers. But the most compelling reason to capture this is that this is what providers are actually doing. Regardless of what researchers are studying or what funders are funding, we found that the providers we interviewed are out in the field acting on what they believe helps change behavior. Providers’ implicit theories drive their services, and therefore, it’s important to understand these implicit theories.

There are more than two million adults incarcerated in the US and four million more on probation or parole. Rates of HIV are 8 to 10 times higher for incarcerated persons than for the general US population, hepatitis C rates are 9 to 10 times higher, and sexually transmitted disease (STD) rates among men entering jails are as high as 35%. Because many prisoners are serving short sentences for parole violation, and return to prison is common, at-risk individuals move frequently between prisons and their home communities. (National Commission on Correctional Health Care, 2002) There is an urgent need to develop effective, accessible HIV prevention programs and population-specific HIV education materials for prisoners and their partners. Despite this, institutional barriers have impeded development and evaluation of such programs. Prisoners in the US have virtually no access to condoms, bleach, clean syringes, comprehensive HIV prevention education or support for transitioning out of prison. Rules protecting the security of the institution also limit access by community-based organizations (CBOs) and researchers. Staff at Centerforce, a CBO, have provided comprehensive HIV prevention education at San Quentin State Prison since 1986. Since 1992 they have been evaluating many of these programs in collaboration with the Center for AIDS Prevention Studies (CAPS), UCSF.

En los EE.UU. existen más de 2 millones de personas adultas encarceladas y 4 millones más en libertad condicional. Las tasas de VIH son de 8 a 10 veces más altas para los encarcelados que para la población en general; las tasas de hepatitis C son de 9 a 10 veces más altas y las de enfermedades de transmisión sexual (ETS) entre hombres que recién ingresan a la cárcel alcanzan hasta un 35%. Muchos internos tienen sentencias cortas por infringir su libertad condicional y el regreso a la prisión es común, por lo que dichas personas transitan frecuentemente entre la prisión y su comunidad aumentando su condición de riesgo y la de sus familias. (National Commission on Correctional Health Care, 2002) Existe la necesidad urgente de desarrollar programas de prevención del VIH eficientes y accesibles así como materiales educativos específicos para las personas en prisión y sus parejas. Sin embargo, las barreras institucionales han impedido el desarrollo y la evaluación de dichos programas. En EE.UU. los internos prácticamente no tienen acceso a condones, cloro, jeringas limpias, información sobre las formas de transmisión y prevención del VIH o apoyo para la transición al salir de prisión. Las reglas de seguridad de las instituciones limitan el acceso de las organizaciones de servicio comunitarias (OSC) e investigadores. Desde 1986, Centerforce, una OSC, ha proporcionado educación preventiva del VIH en la prisión estatal de San Quintín y desde 1992, ha evaluado varios de sus programas en colaboración con el Centro de Estudios de Prevención del SIDA (CAPS sus siglas en inglés) de UCSF.

By the end of 2002, over 2 million adults were incarcerated in the US, and 93% of those were men. African Americans and Latinos were incarcerated at greater rates than Whites in the US, 7.6 times greater for African Americans and 2.6 times greater for Latinos. Nearly 40% of incarcerated men were under the age of 30. Young men of color are at high risk of incarceration and the health problems related to incarceration. These young men also are our neighbors, frequently passing in and out of jail and prison and returning back to the community. Men who are incarcerated have disproportionate rates of HIV, sexually transmitted diseases (STDs) and hepatitis. Rates of HIV are 8-10 times higher for incarcerated persons than for the general US population; hepatitis C rates are 9-10 times higher, and STD rates among men entering jails are as high as 35%. Men leaving prison face numerous challenges that may impede their ability to protect themselves against these diseases. Men often must re-establish relationships, find employment and housing and deal with addictions and mental health issues. Prisons present a unique opportunity for HIV/STD education and skills building to help men avoid risk after their release from prison.