Incarceration history relative to health, substance use, and violence in a sample of vulnerable South African women: implications for health services in criminal justice settings

Jennifer E Johnson¹, Tara Carney², Tracy Kline³, Felicia A Browne⁴, Wendee M Wechsberg<sup>4

1</sup>Department of Psychiatry and Human Behavior, Brown University, Providence, RI, USA; ²Alcohol and Drug Abuse Research Unit, Medical Research Council, Cape Town, South Africa; ³Statistics and Epidemiology, RTI International, Research Triangle Park, NC, USA; ⁴Substance Abuse Treatment Evaluations and Interventions, RTI International, Research Triangle Park, NC, USA

Abstract: International research has suggested that women in the criminal justice system carry a higher burden of many illnesses than women in the community, especially mental health disorders, substance use disorders, sexually transmitted infections, and a history of violent victimization. Knowledge of these health disparities is often used to advocate for relevant screening and treatment services for women passing through criminal justice custody within US and European settings. However, almost all criminal justice health research has taken place in high-income countries, with little or no research taking place in other countries, especially in South Africa. This baseline analysis compares the health, substance use, and violent victimization of women who have ever been incarcerated to those who have not, in a cross-sectional sample of 720 young, vulnerable, substance-using women in Cape Town, South Africa. Results of univariate tests indicated that women who had ever been incarcerated had worse health, mental health, and sexually transmitted infection indicators and were more likely to report use of substances and to have been victims of physical and sexual assault than women who had never been incarcerated. Passing through the criminal justice system appears to be a marker for a variety of current and/or future health service needs among vulnerable South African women, suggesting that screening, prevention, and treatment referral efforts at the time of intersection with the criminal justice system may reduce health burden for these women.

Keywords: criminal justice, women, South Africa, mental health, HIV, trauma