May 18, 2011
US incarceration rates have increased 239 percent during the past two decades; currently, 2 million people are held in US jails or prisons. The authors noted that while earlier research has found an association between previously imprisoned homeless individuals and increased health risks, limited data are available "on the relationship between incarceration, substance abuse, and resource access among homeless persons with and without histories of incarceration."
The team sought to examine differences in drug and alcohol use and sexual risk behavior, mental and physical health, and access to public assistance in three mutually exclusive groups: homeless persons recently discharged from prison (less than one year ago); homeless persons discharged from prison at least one year ago; and never-incarcerated homeless persons. Data for this project came from a larger prospective study evaluating the effectiveness of three different interventions on completion of hepatitis A and B vaccination series among sheltered homeless adults in the Skid Row section of Los Angeles.
Among the 664 homeless individuals, 38 percent reported prison time, and 16 percent were recently discharged from prison. Almost half of those discharged at least one year ago reported daily use of drugs and alcohol in the preceding six months, compared to one in five persons recently released.
"Individuals with a dual history of incarceration and homelessness are at greater risk of engaging in behaviors, e.g. substance abuse, that increase their chance for HIV infection," the authors wrote. "These individuals also have sporadic and inconsistent access to substance abuse treatment and public assistance. Both drug and alcohol treatment and increased stability via financial support can reduce risk for HIV infection and, thereby, improve health outcomes in this population, one of society's most vulnerable and marginalized.
"Therefore, research and policy should direct attention to further integration of resources during and after incarceration," the authors concluded. "Social services, public assistance, and substance abuse treatment should be available to these individuals over longer term and accessible regardless of parole or probation status."