Learning Objective #1: Describe factors potentialy placing female prison inmates at greater risk for transmitting HIV

Learning Objective #2: Describe neurological associations with high-risk behaviors in female inmates

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Purpose: Neurological impairment has been reported in the rapidly growing female prison inmate population also known for high rates of Human Immunodeficiency Virus (HIV). Little information exists explaining the relationship between neurological impairment and HIV in high risk females. It is hypothesized that neurological impairment increases risk for HIV infection and transmission potentially contributing to more rapid neurological decline in HIV positive females. The purpose of this study was to describe factors potentially contributing to high-risk behaviors associated with HIV transmission in female inmates. Methods: Neurological histories and examinations were evaluated in 128 female inmates during private interviews with the first author in order to evaluate their correlations with high-risk behaviors potentially contributing to HIV transmission. Both quantitative and qualitative data were analyzed for relationships between histories of having been a victim of physical and sexual abuse, neurological history and physical examination abnormalities, high risk behaviors, and associated variables. Results: Neurological abnormalities were significantly associated with violent and HIV risk behaviors. Neurologically impaired females reported multiple sexual partners, as many as 1,000 lifetime partners as well as high-risk sexual partners. History of childhood abuse significantly correlated with neurological abnormalities, suicidal, violent, and HIV risk behaviors. Conclusions: Links between neurological impairment, violent, suicidal, and HIV risk behaviors suggest neurological risk factors as well as lack of regard for self and others, which could explain why education alone has not been effective in decreasing HIV risk behaviors in this population. Because female inmates often receive short sentences, returning to the community where their high-risk behaviors impact society, they should be targeted with HIV risk reduction appropriate for their impairment especially as HIV positive individuals are living longer to potentially transmit the virus to others. Preexisting neurological impairment should also be considered when studying the effects of HIV on the central nervous system.