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Identifying Barriers to HIV and Substance Use Service Engagement for Young Adults Involved in the Criminal Legal System

Sweet, Sheridan H (2024) Identifying Barriers to HIV and Substance Use Service Engagement for Young Adults Involved in the Criminal Legal System. Master's Thesis, University of Pittsburgh. (Unpublished)

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Background: The prevalence of HIV and substance use (SU) disorder is significantly higher among individuals involved in the criminal legal system than in the US generally (HIV: 1.2% vs 0.013%) (SUD: 65% vs 16.1%). Young adults (YA) are disproportionately represented in rates of incarceration, HIV, and SU disorder. Despite the high need, there are few successful interventions that link criminal legal involved (CLI) individuals to SU and HIV services, and even fewer tailored to the needs of YA. Studies have shown that YA have lower engagement and retention rates in reentry programming, but causal factors have not been identified. The purpose of this study is to identify barriers to engaging CLI-YA in HIV and SU services.

Methods: Key informant interviews were conducted with systems partners (n=8) from the criminal legal (n=3) and public health sectors (n=5). Systems partners were asked about: 1) experiences linking CLI-YA to HIV and SU services; 2) perspectives on a navigator intervention for use with CLI-YA; 3) perspectives on how a navigator intervention could be adapted in the context of the study setting. Interviews were analyzed via Inductive Thematic Analysis. Analyses were facilitated via Dedoose.

Results: Four themes impacting HIV and SU service engagement for CLI-YA were identified: 1) the health and social services landscape; 2) life chaos; 3) relationships and social support; 4) readiness to change and engage in services. Structural factors were associated with the health and social service landscape (e.g., accessibility of services) and life chaos (e.g., competing needs), social factors with relationships and social support (e.g., provider relationships), and individual factors with readiness to change and engage in services (e.g. risk perception).

Conclusions: Improving rates of HIV and SU service engagement for CLI-YA would require an approach that addresses structural, social, and individual level factors. Instituting a collaborative jail discharge process that includes jail staff, service providers, and CLI-YA could help address structural barriers to SU and HIV service engagement. Developing HIV and SU programs that include peers, build non-judgmental provider-patient relationships, prioritize autonomy, and employ principles of harm reduction could address social and individual level barriers to program engagement for CLI-YA.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Sweet, Sheridan HSHS406@pitt.eduSHS4060009-0001-4782-0765
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairHa, Toantoan.ha@pitt.edutoan.ha
Committee MemberFrank, Lindafrankie@pitt.edufrankie
Committee MemberDauria, Emilyefd16@pitt.eduefd16
Date: 17 May 2024
Date Type: Publication
Defense Date: 5 April 2024
Approval Date: 17 May 2024
Submission Date: 25 April 2024
Access Restriction: No restriction; Release the ETD for access worldwide immediately.
Number of Pages: 82
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Infectious Diseases and Microbiology
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: HIV PrEP Substance Use Young Adults Criminal Legal Jail
Date Deposited: 17 May 2024 18:07
Last Modified: 17 May 2024 18:07


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