1. AIDS 2008 – Int’l Conf1 August 5, 2008 Research Objectives To examine the following among a sample of inmates in a designated jail unit (K6G): for MSM and male-to-female transgenders  Sexual activity during incarceration.  Condom program utilization during incarceration.  Attitudes regarding the in-custody condom distribution program.

2. AIDS 2008 – Int’l Conf2 August 5, 2008 Background – K6G Jail Unit  Instituted to protect gay and transgender male inmates from the general jail population.  These inmates are often targeted for abuse, violence, and harassment. Have protected status and are segregated in all jail activities.  Involves 3 dormitories each houses 100+ inmates.

3. AIDS 2008 – Int’l Conf3 August 5, 2008 Background – Condom Distribution Program (CDP)  Initiated in November 2001 by CHJ in collaboration with LASD.  Condoms distributed once per week by CHJ staff inside each dorm. Official limit: 1 condom/per inmate/per week  Proceeded by brief educational session  Current average weekly distribution: ~120 condoms

4. AIDS 2008 – Int’l Conf4 August 5, 2008 Background – HIV/STD Risk  High prevalence of HIV and STDs. Testing for both offered at entry into the unit.  High prevalence of factors contributing to risk (especially drug use).  Other programs offered: HIV prevention classes HIV treatment education Transitional case management Partner counseling and referral services

5. AIDS 2008 – Int’l Conf5 August 5, 2008 Study Population  Number days in the unit: Range: 7-297 days (median = 45 days)  Age Range: 18-79 years (median = 37)  Previous incarcerations (83%) Range: 0-80 times (median = 7.0) 54% had spent >1 year incarcerated as adults  STD/HIV diagnoses 93% ever tested for HIV  32% known HIV+ 24% reported an STD diagnosis during current their incarceration

6. AIDS 2008 – Int’l Conf6 August 5, 2008 Study Population - Sociodemographics Race/ethnicityEducation

7. AIDS 2008 – Int’l Conf7 August 5, 2008 Sex prior to/during current incarceration Any oral sex: 66% Any anal sex: 53%* No sex: 33% * Just 1 respondent reported anal but not oral sex.

8. AIDS 2008 – Int’l Conf8 August 5, 2008 Condom use/program utilization during current incarceration  93% were aware of the CDP 98% among those reporting anal sex  Condom receipt & use during incarceration 74% received at least one.  Median received directly from program 3 (prior 30 days)

9. AIDS 2008 – Int’l Conf9 August 5, 2008 Condom use for anal sex during current incarceration 75% of those reporting anal sex reported at least one episode of unprotected anal sex  No differences by HIV status (73% for HIV+, 76% for HIV-, p=0.813)  49% of all anal sex acts unprotected

10. AIDS 2008 – Int’l Conf10 August 5, 2008 Reasons for not using the condom program (n=17) Program Related Don't want staff to know I’m having sex n=0 The line was too long n=0 I was out during distribution n=2 They do not provide lube/lubricant n=0 I am afraid of being hassled by guards n=1 I am embarrassed to ask for them n=0 Other n=2 Non-Program related I am not having sex n=14 I don't like to use condoms n=1 They do not provide lube/lubricant n=0

11. AIDS 2008 – Int’l Conf11 August 5, 2008 Conclusions  Sexual activity is very common. Likelihood of sex differs little from the outside  Inmates generally favor CDP. Generally aware of and use the program Vast majority favor increased distribution Reasons for not obtaining condoms  Generally not condom program related  Reasons for not using condoms  Both program and non-program related