prison research, privacy, confidentiality, coercion, consent, randomization, control groups, recruitment, safety, drug use, HIV, randomized trial, prisoners, people who use drugs
Globally, prevalence of HIV and associated infections is significantly higher among people who inject drugs and those who are in the criminal justice system compared to the general population.1,2 In one Asian country where illicit opioid use is widespread, crimes associated with drug use contribute substantially to imprisonment, and drug-related sentences typically include judicial corporal punishment (caning).2 Rapid HIV testing is mandatory upon incarceration, and those who test positive are segregated into a dedicated prison housing unit. Addiction treatment in the prison is primarily faith-based counseling, which is delivered weekly in the segregated cell block where prisoners with HIV are housed.
Decades of research support the use of methadone in community settings to treat opioid use disorder and reduce HIV risk and criminal behavior.3 A researcher with extensive experience working in prison settings designed a randomized study to test the use of prison-based methadone treatment in that country. The researcher recruited participants from a male prison and randomized them into intervention and control groups. The intervention group received methadone in prison and were linked to community-based methadone treatment after release. The control group received faith-based counseling in prison.
The researcher recruited study participants who were 18 years of age or older; HIV-positive; opioid-dependent in the 12 months prior to incarceration (determined by an abbreviated screening procedure); and citizens of that country (to assure availability of nationally subsidized methadone treatment). Prison officers provided to the research team a list of eligible inmates in the dedicated HIV housing block after removing names of those who were not citizens, sentenced to life in prison, or were awaiting execution. To help ensure safety of the research team and to protect the privacy of research participants, prison officers recommended the use of plexiglass windows in all rooms where in-prison research activities were conducted. While inmates were interviewed, prison security officers waited outside of the plexiglass windows.
Eligible individuals were invited by prison staff to attend voluntary, group-based information sessions about the study, and all interested individuals provided informed consent, which was repeated after release from prison to accompany the postrelease component of the study. Participants did not receive any financial incentives to participate in the study while in prison, but they did receive payment during the postrelease care-linkage program.
Questions
International ethics guidelines recommend that research in correctional settings carefully consider potential for coercion during the consent process. Does this case raise any such concerns? If so, what are they and how might the researcher address them?
Was the researcher justified in conducting a randomized controlled study design? Do you think it was justifiable to offer no addiction treatment to the control study participants? Would another study design be preferable? Why or why not?
Are there ethical concerns about the inclusion criteria or recruitment procedures?
Are there any concerns about the interview rooms, in which plexiglass windows were installed? Are there other strategies in a correctional setting to ensure the research team’s safety and, at the same time, protect participants’ privacy?
