Incidence of sexually transmitted infections among hazardously drinking women after incarceration

Role of the Intersections of Gender, Race and Sexual Orientation in the Association between Substance Use Behaviors and Sexually Transmitted Infections in a National Sample of Adults with Recent Criminal Legal Involvement

Limited research has focused on how substance use and sexual risk behaviors differ among individuals impacted by the criminal legal system based on social identities. Using the National Survey on Drug Use and Health, we estimated relative risk for reporting a sexually transmitted infection (STI) among intersectional social groups with criminal legal involvement using a modified Poisson regression. We then utilized multivariate logistic regression and marginal effects to measure associations between substance use behaviors and STIs and to estimate whether these varied among the intersectional social groups with elevated STI rates. Three groups had elevated risk of reporting an STI compared to white, heterosexual men: white, heterosexual women (1.53, 95% CI: 1.05-2.20); Black, heterosexual women (2.03, 95% CI: 1.18-3.49); and white, gay or bisexual men (5.65, 95% CI: 2.61-12.20). Considering the intersections of gender, race, and sexual orientation, elevated risks for STIs among white and Black heterosexual women were mitigated after adjusting for substance use alongside other confounders. Only those who identified as white, gay or bisexual, and male had increased STI risk after controlling for substance use. Interventions targeting Black and white heterosexual women's sexual health following incarceration should focus on substance use and interventions targeting white, gay or bisexual men should focus on healthy sexual behaviors, HIV/STI screening, and care continuum efforts.

Risk Profiles of Women Experiencing Initial and Repeat Incarcerations: Implications for Prevention Programs

Incarcerated women experience myriad individual, interpersonal, and structural factors leading to arrest and rearrest. This study examined risk profiles of women experiencing initial and repeat incarcerations. The sample included 521 women recruited from two prisons in North Carolina and enrolled in a HIV/STD risk-reduction intervention trial. Variables included socio-demographics, structural/economic factors, sexual and substance use behaviors, STDs, victimization history, and depressive symptoms. Bivariate and multivariable analyses identified risk differences. Compared to women incarcerated for the first time, women with repeat incarcerations reported significantly greater economic instability, substance use and sexual risk behaviors, laboratory-confirmed STDs, and victimization during childhood and adulthood. Multivariable logistic regression found women with repeat incarcerations experienced greater unstable housing, injection drug use, crack cocaine use, concurrent sex partners, and childhood sexual victimization. Findings can inform the development of prevention programs by addressing economic instability, sexual risk, and substance use among women prisoners.

Epidemiology of Sexually Transmitted Infections Among Offenders Following Arrest or Incarceration

OBJECTIVES

We sought to estimate rates of sexually transmitted infections (STIs) among criminal offenders in the 1 year after arrest or release from incarceration.

METHODS

We performed a retrospective cohort study of risk of having a positive STI (chlamydia, gonorrhea, or syphilis) or incident-positive HIV test in the 1 year following arrest or incarceration in Marion County (Indianapolis), Indiana. Participants were 247,211 individuals with arrest or incarceration in jail, prison, or juvenile detention between 2003 and 2008.

RESULTS

Test positivity rates (per 100,000 and per year) were highest for chlamydia (2968) and gonorrhea (2305), and lower for syphilis (278) and HIV (61). Rates of positive STI and HIV were between 1.5 and 2.8 times higher in female than male participants and between 2.7 and 6.9 times higher for Blacks than Whites. Compared with nonoffenders, offenders had a relative risk of 3.9 for chlamydia, 6.6 for gonorrhea, 3.6 for syphilis, and 4.6 for HIV.

CONCLUSIONS

The 1-year period following arrest or release from incarceration represents a high-impact opportunity to reduce STI and HIV infection rates at a population level.

Test positivity for chlamydia, gonorrhea, and syphilis infection among a cohort of individuals released from jail in Marion County, Indiana

BACKGROUND

Individuals entering jails have high rates of sexually transmitted infections (STI), but there are few data on STI in the postincarceration period. This study aimed to describe rates of chlamydia, gonorrhea, and syphilis infection among individuals released from Marion County (Indianapolis), Indiana jails.

METHODS

We conducted a retrospective cohort study of individuals incarcerated in Marion County, Indiana jails from 2003 to 2008 (n = 118,670). We linked county jail and public health data to identify individuals with positive STI test results in the 1 year after release from jail. Rates per 100,000 individuals and Cox proportional hazard analyses were performed for each STI, stratified by demographic, STI, and jail characteristics.

RESULTS

We found significantly higher rates of STI in this cohort than in the general population, with rates in the 1 year after release being 2 to 7 times higher for chlamydia, 5 to 24 times higher for gonorrhea, and 19 to 32 times higher for syphilis compared with rates in the general population. Characteristics most associated with increased risk of a positive STI test result among this cohort were younger age for chlamydia and gonorrhea, older age for syphilis, black race for men, being jailed for prostitution for women, history of STI, and history of prior incarceration.

CONCLUSIONS

This study found high rates of STIs among a cohort of individuals recently released from jail and identified a number of risk factors. Further study is needed to improve targeted STI testing and treatment among this high-risk population.

Context of risk for HIV and sexually transmitted infections among incarcerated women in the south: individual, interpersonal, and societal factors

Incarcerated women are disproportionately affected by HIV and sexually transmitted infections (STIs) due to risk factors before, during, and after imprisonment. This study assessed the behavioral, social, and contextual conditions that contribute to continuing sexual risk behaviors among incarcerated women to inform the adaptation of an evidenced-based behavioral intervention for this population. Individual, in-depth interviews were conducted with 25 current and 28 former women prisoners to assess HIV/STI knowledge, perceptions of risk, intimate relationships, and life circumstances. Interviews were independently coded using an iterative process and analyzed using established qualitative analytic methods. Major themes identified in the interviews involved three focal points: individual risk (substance abuse, emotional need, self-worth, perceptions of risk, and safer sex practices); interpersonal risk (partner pressure, betrayal, and violence); and risk environment (economic self-sufficiency and preparation for reentry). These findings highlight the critical components of HIV/STI prevention interventions for incarcerated women.

HIV prevention for adults with criminal justice involvement: a systematic review of HIV risk-reduction interventions in incarceration and community settings

We summarized and appraised evidence regarding HIV prevention interventions for adults with criminal justice involvement. We included randomized and quasi-randomized controlled trials that evaluated an HIV prevention intervention, enrolled participants with histories of criminal justice involvement, and reported biological or behavioral outcomes. We used Cochrane methods to screen 32,271 citations from 16 databases and gray literature. We included 37 trials enrolling n = 12,629 participants. Interventions were 27 psychosocial, 7 opioid substitution therapy, and 3 HIV-testing programs. Eleven programs significantly reduced sexual risk taking, 4 reduced injection drug risks, and 4 increased testing. Numerous interventions may reduce HIV-related risks among adults with criminal justice involvement. Future research should consider process evaluations, programs involving partners or families, and interventions integrating biomedical, psychosocial, and structural approaches.

At a crossroads: reentry challenges and healthcare needs among homeless female ex-offenders

The exponential increase in the number of women parolees and probationers in the last decade has made women the most rapidly growing group of offenders in the United States. The purpose of this descriptive, qualitative study is to understand the unique gendered experiences of homeless female ex-offenders, in the context of healthcare needs, types of health services sought, and gaps in order to help them achieve a smooth transition post prison release. Focus group qualitative methodology was utilized to engage 14 female ex-offenders enrolled in a residential drug treatment program in Southern California. The findings suggested that for homeless female ex-offenders, there are a myriad of healthcare challenges, knowledge deficits, and barriers to moving forward in life, which necessitates strategies to prevent relapse. These findings support the development of gender-sensitive programs for preventing or reducing drug and alcohol use, recidivism, and sexually transmitted infections among this hard-to-reach population.