Jeremy A. Long

Former inmates are at high risk for death from drug overdose, especially in the immediate post-release period. The purpose of the study is to understand the drug use experiences, perceptions of overdose risk, and experiences with overdose among former prisoners.

Former prison inmates are at risk for HIV and hepatitis C (HCV) infection. This study was designed to understand how former inmates perceived their risk for HIV and HCV infection after release from prison, the behaviors and environmental factors that put patients at risk for new infection, and the barriers to accessing health care. This was a qualitative study using individual, face-to-face, semistructured interviews exploring participants' perceptions and behaviors putting them at risk for HIV and HCV infection and barriers to engaging in regular medical care after release. Interview transcripts were coded and analyzed using a team-based general inductive approach. Participants were racially and ethnically diverse and consisted of 20 men and 9 women with an age range of 22-57 years who were interviewed within the first 2 months after their release from prison to the Denver, Colorado community. Four major themes emerged: (1) risk factors including unprotected sex, transactional sex, and drug use were prevalent in the postrelease period; (2) engagement in risky behavior occurred disproportionately in the first few days after release; (3) former inmates had educational needs about HIV and HCV infection; and (4) former inmates faced major challenges in accessing health care and medications. Risk factors for HIV and HCV infection were prevalent among former inmates immediately after release. Prevention efforts should focus on education, promotion of safe sex and needle practices, substance abuse treatment, and drug-free transitional housing. Improved coordination between correctional staff, parole officers, and community health care providers may improve continuity of care.

Traditional medical training focuses on ameliorating disease states but not on the underlying socially determined causes. The LEADS (Leadership Education Advocacy Development Scholarship) program at the University of Colorado Denver School of Medicine was designed to train medical students to become effective advocates and to promote health at the community level. Participants in the LEADS Track complete courses in advocacy skills, perform a summer internship, and complete a mentored scholarly activity addressing population health. Students are paired with a faculty mentor and a community-based organization. Students report empowerment, improved self-efficacy, and increased likelihood of future engagement in leadership and health advocacy. Community sponsors also rate the experience as highly valuable. A curriculum in advocacy and leadership skills that includes an intensive, community-based service learning experience is effective at increasing student empowerment and disposition toward community service.