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Marziali ME, Prins SJ, Gutkind S, Martins SS. Partner incarceration, maternal substance use, and the mediating role of social support: A longitudinal analysis using the future of families and child wellbeing study. Soc Sci Med 2024; 349:116896. [PMID: 38653185 PMCID: PMC11097120 DOI: 10.1016/j.socscimed.2024.116896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION The United States is responsible for the highest incarceration rate globally. This study aimed to explore the impact of partner incarceration on maternal substance use and whether social support mediates the relationship between partner incarceration and maternal substance use. METHODS Using data from the Future of Families and Child Wellbeing Study, a longitudinal cohort following new parents and children, this analysis quantifies the relationship between paternal incarceration and maternal substance use (N = 2823). We analyzed maternal responses in years 3 (2001-2003), 5 (2003-2006), 9 (2007-2010), and 15 (2014-2017). We explored the role of financial support and emergency social support as potential mediators. Confirmatory factor analysis (CFA) was employed to construct support-related mediators. We modeled the impact of partner incarceration and maternal substance use using generalized estimating equations (GEE) to account for repeated measures, adjusting for appropriate confounders (age of mother at child's birth, race, education, employment, and history of intimate partner violence). RESULTS Nearly half (44.2%, N = 1247) of participants reported partner incarceration. Among mothers who experienced partner incarceration, the odds of reporting substance use were 110% greater than those who reported no partner incarceration (adjusted Odds Ratio [aOR]: 2.10; 95% Confidence Interval (CI):1.67-2.63). Financial support at year 5 accounted for 19.5% (95% CI: 6.03-33.06%) of the association between partner incarceration at year 3 and substance use at year 9; emergency social support at year 5 accounted for 6.4% (95% CI: 0.51-12.25%) of the association between partner incarceration and substance use at year 9. Neither financial nor emergency social support at year 9 were significant mediators between partner incarceration at year 3 and substance use at year 15. CONCLUSIONS These findings demonstrate that partner incarceration impacts maternal substance use. Financial and emergency support may partially mediate this relationship in the short term, which has important implications for families disrupted by mass incarceration.
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Affiliation(s)
- Megan E Marziali
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA.
| | - Seth J Prins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Sarah Gutkind
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
| | - Silvia S Martins
- Department of Epidemiology, Mailman School of Public Health, Columbia University, 722 W 168th St, New York, NY, 10032, USA
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Hull SJ, Duan X, Brant AR, Ye PP, Lotke PS, Huang JC, Coleman ME, Nalls P, Scott RK. Understanding Psychosocial Determinants of PrEP Uptake Among Cisgender Women Experiencing Heightened HIV Risk: Implications for Multi-Level Communication Intervention. HEALTH COMMUNICATION 2023; 38:3264-3275. [PMID: 36398676 PMCID: PMC10192462 DOI: 10.1080/10410236.2022.2145781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Pre-exposure prophylaxis (PrEP) is a highly effective daily pill that decreases the likelihood of HIV acquisition by up to 92% among individuals at risk for HIV. PrEP can be discretely used, autonomously controlled, and in place at the time of risk exposure, making it an especially promising method for HIV prevention for cisgender women (CGW). But, PrEP is underutilized by CGW relative to the demonstrable need. We apply the Integrative Model of Behavioral Prediction to identify the critical psychosocial factors that shape CGW's intentions to use PrEP and their relevant underlying beliefs. We surveyed (N = 294) community- and clinic-recruited PrEP eligible CGW to understand the relative importance of attitudes, norms, and efficacy in shaping PrEP intentions. We utilized structural equation modeling to identify the relevant paths. We inspected the summary statistics in relation to three message three selection criteria. We identified beliefs that demonstrated (1) an association with intention, (2) substantial room to move the population, (3) practicality as a target for change through communication intervention. Results show that PrEP awareness was low. When women learned about PrEP, they voiced positive intentions to use it. There were significant and positive direct effects of SE (0.316***), attitudes (0.201**), and subjective norms (0.249***) on intention to initiate PrEP. We illustrate the strategic identification of beliefs within the relevant paths using the 3 belief selection criteria. We also discuss implications for social and structural communication interventions to support women's HIV prevention.
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Affiliation(s)
| | - Xuejing Duan
- Department of Biostatistics and Bioinformatics, The George Washington University
| | | | - Peggy Peng Ye
- Women’s and Infants’ Services Department, MedStar Washington Hospital Center
- Obstetrics & Gynecology, Georgetown University School of Medicine
| | - Pamela S. Lotke
- Women’s and Infants’ Services Department, MedStar Washington Hospital Center
- Obstetrics & Gynecology, Georgetown University School of Medicine
| | - Jim C. Huang
- Department of Business Management, National Sun Yat-sen University
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3
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Delaney DJ, Stein LAR, Bassett SS, Clarke JG. Motivational interviewing for family planning and reducing risky sexual behavior among incarcerated men nearing release: A randomized controlled pilot study. Psychol Serv 2023; 20:538-552. [PMID: 34735198 PMCID: PMC10354667 DOI: 10.1037/ser0000552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Incarcerated men are at high risk for sexually transmitted infections (STIs) and unintended partner pregnancy postrelease. Limited research has been invested in developing and testing treatments targeting risky sexual behavior and unwanted pregnancy for this at-risk population. Motivational interviewing (MI) is a promising behavioral intervention for decreasing risky sexual behaviors. This study assessed the feasibility and acceptability of MI for family planning and risky sexual behaviors with incarcerated men nearing release. Preliminary efficacy of the MI intervention was also compared to an educational control group. Thirty-two men were assessed at baseline and randomized to one 90-min session. Assessment occurred 2 months after release. MI was feasibly administered, and participants were highly satisfied with both treatments. In addition, those who received MI reported higher rates of condom use with casual partners, higher rates of partner use of hormonal contraceptives, and slightly higher rates of sex that was protected against pregnancy. Increases are readiness to discuss family planning with sexual partners, as well as reported frequency of these discussions, and increases in family planning knowledge were also found in those randomized to MI. The findings from this study indicate the need to further assess MI with this population with a full-scale clinical trial. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Affiliation(s)
- Daniel J Delaney
- Department of Psychology, Chafee Social Science Center, University of Rhode Island
| | - L A R Stein
- Department of Psychology, Chafee Social Science Center, University of Rhode Island
| | - Shayna S Bassett
- Department of Psychology, Chafee Social Science Center, University of Rhode Island
| | - Jennifer G Clarke
- Center for Primary Care and Prevention, Memorial Hospital, Brown University
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Scheidell JD, Kapadia F, Turpin RE, Mazumdar M, Dyer TV, Feelemyer J, Cleland CM, Brewer R, Parker SD, Irvine NM, Remch M, Mayer KH, Khan MR. Incarceration, Social Support Networks, and Health among Black Sexual Minority Men and Transgender Women: Evidence from the HPTN 061 Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12064. [PMID: 36231367 PMCID: PMC9564690 DOI: 10.3390/ijerph191912064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/21/2022] [Accepted: 09/22/2022] [Indexed: 06/16/2023]
Abstract
Support from social networks buffers against negative effects of stress but is disrupted by incarceration. Few studies examine incarceration, social support networks, and health among Black sexual minority men (BSMM) and Black transgender women (BTW). We conducted a secondary analysis using HIV Prevention Trials Network 061 (HPTN 061), a sample of BSMM/BTW recruited from six US cities. We measured associations between recent incarceration reported at six months follow-up and social support networks at twelve months follow-up, and cross-sectional associations between support networks and twelve-month health outcomes (e.g., sexual partnerships, substance use, healthcare access and depressive symptoms). Among the analytic sample (N = 1169), recent incarceration was associated with small medical support networks (adjusted risk ratio [aRR] 1.16, 95% CI 1.01, 1.34) and small financial support networks (aRR 1.18, 95% CI 1.04, 1.35). Support networks were associated with multiple partnerships (adjusted prevalence ratio [aPR] 0.77, 95% CI 0.65, 0.90), unhealthy alcohol use (aPR 1.20, 95% CI 0.96, 1.51), and depressive symptoms (aPR 1.16, 95% CI 0.99, 1.36). Incarceration adversely impacts social support networks of BSMM/BTW, and support networks were associated with a range of important health outcomes.
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Affiliation(s)
- Joy D. Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Farzana Kapadia
- School of Global Public Health, New York University, New York, NY 10012, USA
| | - Rodman E. Turpin
- School of Public Health, Epidemiology and Biostatistics, University of Maryland at College Park, College Park, MD 20742, USA or
- Department of Global and Community Health, College of Health and Human Services, George Mason University, Fairfax, VA 22030, USA
| | - Medha Mazumdar
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Typhanye V. Dyer
- School of Public Health, Epidemiology and Biostatistics, University of Maryland at College Park, College Park, MD 20742, USA or
| | - Jonathan Feelemyer
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Charles M. Cleland
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL 60637, USA
| | - Sharon D. Parker
- Department of Social Work, North Carolina Agricultural and Technical State University, Greensboro, NC 27411, USA
| | - Natalia M. Irvine
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
| | - Molly Remch
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Kenneth H. Mayer
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA 02115, USA
- The Fenway Institute, Fenway Health, Boston, MA 02215, USA
| | - Maria R. Khan
- Department of Population Health, New York University Grossman School of Medicine, New York, NY 10016, USA
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Scheidell JD, Dyer TV, Knittel AK, Caniglia EC, Thorpe LE, Troxel AB, Lejuez CW, Khan MR. Incarceration and Subsequent Pregnancy Loss: Exploration of Sexually Transmitted Infections as Mediating Pathways. J Womens Health (Larchmt) 2022; 31:242-251. [PMID: 34061656 PMCID: PMC8864438 DOI: 10.1089/jwh.2020.8980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background: Incarceration is linked to risk of sexually transmitted infection (STI) postrelease among women. There has been little examination of incarceration's association with related sexual and reproductive outcomes such as pelvic inflammatory disease (PID) and pregnancy loss, or the role of STI in this relationship and whether these relationships differ between Black and White women. Methods: Using data from the National Longitudinal Study of Adolescent to Adult Health, we examined cross-sectional associations between incarceration (Wave IV; 2007-2008; ages 24-34) and history of STI and PID (n = 5,968), and longitudinal associations between incarceration and later pregnancy loss in mid-adulthood (Wave V; 2016-2018; ages 34-43) among women who had ever been pregnant (n = 2,353); we estimated racial differences. Using causal mediation, we explored whether STI mediated associations with pregnancy loss. Results: Incarceration was associated with a history of STI (White adjusted prevalence ratio [APR]: 1.54, 95% confidence interval [CI] 1.14-2.06; Black APR: 1.26, 95% CI 1.02-1.56); the association between incarceration and PID was null among White women (APR: 0.99, 95% CI 0.47-2.09) and elevated among Black women (APR: 2.82, 95% CI 1.36-5.83). Prior incarceration did not appear associated with pregnancy loss among White women (APR: 1.01, 95% CI 0.70-1.45), but was associated among Black women (APR: 1.38, 95% CI: 0.97-1.97), with STI appearing to partially mediate. Conclusions: Pregnancy loss may be elevated among Black women who have been incarcerated, and incarceration-related increases in STI may account for some of this association.
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Affiliation(s)
- Joy D. Scheidell
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Address correspondence to: Joy D. Scheidell, PhD, MPH, Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, 227 East 30th Street, Office 624, New York, NY 6402, USA
| | - Typhanye V. Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, Maryland, USA
| | - Andrea K. Knittel
- Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Ellen C. Caniglia
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Lorna E. Thorpe
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Andrea B. Troxel
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Carl W. Lejuez
- Department of Psychological Sciences, University of Connecticut, Storrs, Connecticut, USA
| | - Maria R. Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA.,Division of Epidemiology, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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6
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Scheidell JD, Dyer TV, Hucks-Ortiz C, Abrams J, Mazumdar M, Cleland C, Irvine N, Turpin RE, Severe M, Mayer K, Khan M. Characterisation of social support following incarceration among black sexual minority men and transgender women in the HPTN 061 cohort study. BMJ Open 2021; 11:e053334. [PMID: 34588263 PMCID: PMC8483031 DOI: 10.1136/bmjopen-2021-053334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To examine longitudinal associations between recent incarceration and subsequent social support among black sexual minority men and transgender women, and whether associations differed between those who did and did not have support prior to incarceration. DESIGN A secondary analysis in 2020 of data from the HIV Prevention Trials Network 061, a cohort study of black sexual minority men and transgender women recruited in 2009-2010 and followed for 12 months. SETTING Six US cities (Atlanta, Boston, Los Angeles, New York City, San Francisco and Washington DC). PARTICIPANTS Individuals ≥18 years of age who identified as black, reported being male or assigned male at birth, reported ≥1 unprotected anal intercourse event with a male partner in the past 6 months, and reported on incarceration at the 6-month follow-up visit. EXPOSURE Having spent ≥1 night in jail/prison in the past 6 months reported at the 6-month follow-up visit. OUTCOME Social support measured using a six-item scale assessing frequency of emotional/informational, affectionate and tangible support (range 6-30); and dichotomous indicators of low support for each item (ie, receiving that form of support none/little of the time). RESULTS Among participants who returned for the 6-month visit (N=1169), 14% had experienced incarceration in the past 6 months. Mean support score was 20.9; 18.9 among those with recent incarceration versus 21.2 among those without. Recent incarceration predicted lower support (adjusted β -2.40, 95% CI -3.94 to -0.85). Those recently incarcerated had increased risk of lacking emotional/informational (eg, no one to talk to adjusted risk ratio (aRR) 1.55, 95% CI 1.13 to 2.13) and affectionate (aRR 1.51, 95% CI 1.11 to 2.04) but not tangible support. Effects appeared somewhat stronger among those who had support at baseline. CONCLUSIONS Incarceration may reduce support on re-entry among black sexual minority men and transgender women, populations unequally targeted for incarceration and at risk for low support.
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Affiliation(s)
- Joy D Scheidell
- Population Health, New York University School of Medicine, New York, New York, USA
| | - Typhanye V Dyer
- School of Public Health, Epidemiology and Biostatistics, University of Maryland at College Park, College Park, Maryland, USA
| | | | - Jasmyn Abrams
- Population Health, New York University School of Medicine, New York, New York, USA
| | - Medha Mazumdar
- Population Health, New York University School of Medicine, New York, New York, USA
| | - Charles Cleland
- Population Health, New York University School of Medicine, New York, New York, USA
| | - Natalia Irvine
- Population Health, New York University School of Medicine, New York, New York, USA
| | - Rodman E Turpin
- School of Public Health, Epidemiology and Biostatistics, University of Maryland at College Park, College Park, Maryland, USA
| | - MacRegga Severe
- Population Health, New York University School of Medicine, New York, New York, USA
| | - Kenneth Mayer
- Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Maria Khan
- Population Health, New York University School of Medicine, New York, New York, USA
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Linton SL, Jarlais DCD, Ornstein JT, Kasman M, Hammond R, Kianian B, Smith JC, Wolfe ME, Ross Z, German D, Flynn C, Raymond HF, Klevens RM, Spencer E, Schacht JM, Finlayson T, Paz-Bailey G, Wejnert C, Cooper HLF. An application of agent-based modeling to explore the impact of decreasing incarceration rates and increasing drug treatment access on sero-discordant partnerships among people who inject drugs. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103194. [PMID: 33812133 PMCID: PMC8608566 DOI: 10.1016/j.drugpo.2021.103194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 02/19/2021] [Accepted: 02/24/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND People who inject drugs (PWID) lag behind other key populations in HIV care continuum outcomes. The impacts of criminal justice reform and increasing drug treatment access on HIV have been underexplored. METHODS We developed agent-based models (ABM) of sexual partnerships among PWID and non-PWID, and injection equipment-sharing partnerships among PWID in five US cities (Baltimore, Boston, Miami, New York City, San Francisco) over 3 years. The first set of ABM projected changes in partnership discordance among PWID as a function of decreasing ZIP code-level incarceration rates. The second set projected discordance as a function of increasing ZIP code-level drug treatment access. ABM were parameterized and validated overall, and by city and PWID race/ethnicity (Black, Latino, White) using National HIV Behavioral Surveillance data, administrative ZIP code-level data, surveillance reports and prior literature. Informed by research on prisoner release and community-level HIV prevalence, reductions in incarceration rates were fixed at 5% and 30% and respectively projected to increase ZIP code-level HIV prevalence by 2% and 12%. Increases in drug treatment access were fixed at 30% and 58%. RESULTS In each city, a 30% reduction in ZIP code-level incarceration rates and 12% increase in ZIP code-level HIV prevalence significantly increased sero-discordance among at least one racial/ethnic group of PWID by 1-3 percentage points. A 5% reduction in incarceration rates, and 30% and 58% increases in drug treatment access, led to isolated significant changes in sero-discordance among Black and White PWID that were less than 1 percentage point. CONCLUSION Reductions in incarceration rates may lead to short-term increases in sero-discordant partnerships among some PWID by increasing community-level HIV prevalence. Efforts to increase HIV testing, engagement in care and community reintegration post release, should be strengthened in the wake of incarceration reform. Additional research should confirm these findings and explore the lack of widespread impacts of drug treatment in this study.
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Affiliation(s)
- Sabriya L Linton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Don C Des Jarlais
- College of Global Public Health, New York University, New York City, NY, USA
| | - Joseph T Ornstein
- School of Public and International Affairs, The University of Georgia, Athens, GA, USA
| | - Matt Kasman
- Brookings Institution, District of Columbia, USA
| | - Ross Hammond
- Brookings Institution, District of Columbia, USA
| | - Behzad Kianian
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Justin C Smith
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Mary E Wolfe
- Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY, USA
| | - Danielle German
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Colin Flynn
- Maryland Department of Health and Mental Hygiene, Baltimore, MD, USA
| | | | | | - Emma Spencer
- Florida Department of Health, Tallahassee, FL, USA
| | | | | | | | - Cyprian Wejnert
- Centers for Disease Control and Prevention, Atlanta, GA, USA
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Severe M, Scheidell JD, Dyer TV, Brewer RA, Negri A, Turpin RE, Young KE, Hucks-Ortiz C, Cleland CM, Mayer KH, Khan MR. Lifetime Burden of Incarceration and Violence, Internalized Homophobia, and HIV/STI Risk Among Black Men Who Have Sex with Men in the HPTN 061 Study. AIDS Behav 2021; 25:1507-1517. [PMID: 32797357 PMCID: PMC8022355 DOI: 10.1007/s10461-020-02989-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Black men who have sex with men (BMSM) have disproportionate HIV/STI acquisition risk. Incarceration may increase exposure to violence and exacerbate psychosocial vulnerabilities, including internalized homophobia, which are associated with HIV/STI acquisition risk. Using data from HIV Prevention Trials Network 061 (N = 1553), we estimated adjusted prevalence ratios (APR) and 95% confidence intervals (CIs) for associations between lifetime burden of incarceration and HIV/STI risk outcomes. We measured associations between incarceration and HIV/STI risk outcomes with hypothesized mediators of recent violence victimization and internalized homophobia. Compared to those never incarcerated, those with 3-9 or ≥ 10 incarcerations had approximately 10% higher prevalence of multiple partnerships. Incarceration burden was associated with selling sex (1-2 incarcerations: APR: 1.52, 95% CI 1.14-2.03; 3-9: APR: 1.77, 95% CI 1.35-2.33; ≥ 10: APR: 1.85, 95% CI 1.37-2.51) and buying sex (≥ 10 incarcerations APR: 1.80, 95% CI 1.18-2.75). Compared to never incarcerated, 1-2 incarcerations appeared to be associated with current chlamydia (APR: 1.47, 95% CI 0.98-2.20) and 3-9 incarcerations appeared to be associated with current syphilis (APR: 1.46, 95% CI 0.92-2.30). Incarceration was independently associated with violence, which in turn was a correlate of transactional sex. Longitudinal research is warranted to clarify the role of incarceration in violence and HIV/STI risk in this population.
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Affiliation(s)
- MacRegga Severe
- Department of Population Health, New York University Grossman School of Medicine, 227 East 30th St, #617J, New York, NY, 10016, USA
| | - Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, 227 East 30th St, #617J, New York, NY, 10016, USA.
| | - Typhanye V Dyer
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | | | - Alberta Negri
- Department of Population Health, New York University Grossman School of Medicine, 227 East 30th St, #617J, New York, NY, 10016, USA
| | - Rodman E Turpin
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Kailyn E Young
- Department of Population Health, New York University Grossman School of Medicine, 227 East 30th St, #617J, New York, NY, 10016, USA
| | | | - Charles M Cleland
- Department of Population Health, New York University Grossman School of Medicine, 227 East 30th St, #617J, New York, NY, 10016, USA
| | | | - Maria R Khan
- Department of Population Health, New York University Grossman School of Medicine, 227 East 30th St, #617J, New York, NY, 10016, USA
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9
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Turpin R, Khan M, Scheidell J, Feelemyer J, Hucks-Ortiz C, Abrams J, Cleland C, Mayer K, Dyer T. Estimating the Roles of Racism and Homophobia in HIV Testing Among Black Sexual Minority Men and Transgender Women With a History of Incarceration in the HPTN 061 Cohort. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:143-157. [PMID: 33821677 PMCID: PMC10576191 DOI: 10.1521/aeap.2021.33.2.143] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Black sexual minority men (BSMM) and Black transgender women (BTW) have disproportionately high HIV prevalence, making HIV testing critical for treatment and prevention. Racism and homophobia may be barriers to testing among BSMM/BTW, particularly in the context of previous incarceration. We analyzed a subsample (n = 655) of HIV-negative, previously incarcerated BSMM/BTW in the HIV Prevention Trials Network 061 study, generating prevalence ratios and interaction terms testing associations between experienced racism and homophobia with past-year HIV testing. Both racism (aPR = 0.83, 95% CI [0.70, 0.98]) and homophobia (aPR: 0.68, 95% CI [0.48, 0.98]) were associated with lower testing, although their interaction was associated with unexpectedly higher testing (Interaction aPR = 1.77, 95% CI [1.25, 2.49]). Among BSMM/BTW with a history of incarceration, racism and homophobia are barriers to HIV testing. Positive interactions between racism and homophobia could be explained by numerous factors (e.g., resilience, coping) and warrants further study.
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Affiliation(s)
- Rodman Turpin
- Rodman Turpin and Typhanye Dyer are affiliated with the University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, College Park, Maryland
| | - Maria Khan
- Rodman Turpin and Typhanye Dyer are affiliated with the University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, College Park, Maryland
| | - Joy Scheidell
- Rodman Turpin and Typhanye Dyer are affiliated with the University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, College Park, Maryland
| | - Jonathan Feelemyer
- Rodman Turpin and Typhanye Dyer are affiliated with the University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, College Park, Maryland
| | - Christopher Hucks-Ortiz
- Rodman Turpin and Typhanye Dyer are affiliated with the University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, College Park, Maryland
| | - Jasmyn Abrams
- Rodman Turpin and Typhanye Dyer are affiliated with the University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, College Park, Maryland
| | - Charles Cleland
- Rodman Turpin and Typhanye Dyer are affiliated with the University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, College Park, Maryland
| | - Kenneth Mayer
- Rodman Turpin and Typhanye Dyer are affiliated with the University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, College Park, Maryland
| | - Typhanye Dyer
- Rodman Turpin and Typhanye Dyer are affiliated with the University of Maryland, College Park, School of Public Health, Department of Epidemiology and Biostatistics, College Park, Maryland
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10
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Nowotny KM, Omori M, McKenna M, Kleinman J. Incarceration Rates and Incidence of Sexually Transmitted Infections in US Counties, 2011-2016. Am J Public Health 2020; 110:S130-S136. [PMID: 31967898 DOI: 10.2105/ajph.2019.305425] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Objectives. To examine rates of sexually transmitted infections as a function of jail and prison incarceration rates across US counties for the years 2011 to 2016.Methods. We used data from several national databases. The outcomes were county-level chlamydia and gonorrhea incidence as reported by the Centers for Disease Control and Prevention (2012-2016). The exposures were lagged specifications of county-level jail and prison incarceration rates as reported by the Vera Institute of Justice (2011-2015). We estimated mixed models to account for the 3 sources of response variable variation occurring across repeated measures collected from counties nested within states.Results. In the final model, jail and prison incarceration rates were associated with a rate increase of 10.13 per 100 000 and 8.22 per 100 000, respectively, of chlamydia incidence. The corresponding rate increases for gonorrhea incidence were 2.47 per 100 000 and 4.40 per 100 000.Conclusions. These findings provide some evidence that the documented differences in chlamydia and gonorrhea incidence between counties may be partially attributable to differences in jail and prison incarceration rates.
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Affiliation(s)
- Kathryn M Nowotny
- Kathryn M. Nowotny, Melanie McKenna, and Joshua Kleinman are with the Department of Sociology, University of Miami, Coral Gables, FL. Marisa Omori is with the Department of Criminology and Criminal Justice, University of Missouri-St. Louis
| | - Marisa Omori
- Kathryn M. Nowotny, Melanie McKenna, and Joshua Kleinman are with the Department of Sociology, University of Miami, Coral Gables, FL. Marisa Omori is with the Department of Criminology and Criminal Justice, University of Missouri-St. Louis
| | - Melanie McKenna
- Kathryn M. Nowotny, Melanie McKenna, and Joshua Kleinman are with the Department of Sociology, University of Miami, Coral Gables, FL. Marisa Omori is with the Department of Criminology and Criminal Justice, University of Missouri-St. Louis
| | - Joshua Kleinman
- Kathryn M. Nowotny, Melanie McKenna, and Joshua Kleinman are with the Department of Sociology, University of Miami, Coral Gables, FL. Marisa Omori is with the Department of Criminology and Criminal Justice, University of Missouri-St. Louis
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11
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Taggart T, Milburn NG, Nyhan K, Ritchwood TD. Utilizing a Life Course Approach to Examine HIV Risk for Black Adolescent Girls and Young Adult Women in the United States: A Systematic Review of Recent Literature. Ethn Dis 2020; 30:277-286. [PMID: 32346273 DOI: 10.18865/ed.30.2.277] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Objective Black female youth have been disproportionately burdened by the HIV epidemic. Emerging literature suggests that individual and social-structural factors may uniquely increase HIV risk within this population during key developmental periods, namely adolescence (ages 10-17 years) and emerging adulthood (ages 18-25 years). Few studies, however, have compared drivers of risk within and between these key developmental periods. Therefore, we conducted a systematic review of recent literature to characterize and identify important gaps in our understanding of the individual, psychosocial, and social-structural determinants of HIV risk among Black adolescent girls and emerging adult women. Design Using a replicable strategy, we searched electronic databases for articles and abstracts published between October 1, 2017 and September 30, 2019 in which the primary focus was on HIV prevention among Black adolescent girls and emerging adults in the United States. Results In total, 21 studies met the inclusion criteria. Most of the studies on Black adolescent girls assessed family functioning, parental monitoring, and parent-adolescent communication as determinants of HIV-related behaviors. However, equivalent studies were lacking for Black emerging adult women. Moreover, few studies assessed neighborhood characteristics, social networks, or other community-level factors as determinants of HIV-related behaviors, which are known drivers of HIV disparities. Conclusions Our findings highlighted several gaps in the literature, including failure to recognize the ethnic and cultural differences among Black women that may contribute to behavioral differences within this population and insufficient acknowledgment of the role of HIV protective factors (eg, resilience and community assets). Implications and future directions are discussed.
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Affiliation(s)
- Tamara Taggart
- Department of Prevention and Community Health, George Washington University, Washington, DC; Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
| | - Norweeta G Milburn
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles, CA
| | - Kate Nyhan
- Yale School of Public Health; Harvey Cushing/John Hay Whitney Medical Library, Department of Environmental Health Sciences, Yale University, New Haven, CT
| | - Tiarney D Ritchwood
- Department of Family Medicine and Community Health, Duke University School of Medicine, Durham, NC
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12
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Khan MR, McGinnis KA, Grov C, Scheidell JD, Hawks L, Edelman EJ, Fiellin DA, McInnes DK, Braithwaite RS, Justice AC, Wang EA. Past year and prior incarceration and HIV transmission risk among HIV-positive men who have sex with men in the US .. AIDS Care 2019; 31:349-356. [PMID: 30064277 PMCID: PMC6699634 DOI: 10.1080/09540121.2018.1499861] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 07/10/2018] [Indexed: 10/28/2022]
Abstract
Three quarters of new HIV infections in the US are among men who have sex with men (MSM). In other populations, incarceration is a social determinant of elevations in viral load and HIV-related substance use and sex risk behavior. There has been limited research on incarceration and these HIV transmission risk determinants in HIV-positive MSM. We used the Veterans Aging Cohort Study (VACS) 2011-2012 follow-up survey to measure associations between past year and prior (more than one year ago) incarceration and HIV viral load and substance use and sex risk behavior among HIV-positive MSM (N = 532). Approximately 40% had ever been incarcerated, including 9% in the past year. In analyses adjusting for sociodemographic factors, past year and prior incarceration were strongly associated with detectable viral load (HIV-1 RNA >500 copies/mL) (past year adjusted odds ratio (AOR): 3.50 95% confidence interval (CI): 1.59, 7.71; prior AOR: 2.48 95% CI: 1.44, 4.29) and past 12 month injection drug use (AORs > 6), multiple sex partnerships (AORs > 1.8), and condomless sex in the context of substance use (AORs > 3). Past year incarceration also was strongly associated with alcohol and non-injection drug use (AOR > 2.5). Less than one in five HIV-positive MSM recently released from incarceration took advantage of a jail/prison re-entry health care program available to veterans. We need to reach HIV-positive MSM leaving jails and prisons to improve linkage to care and clinical outcomes and reduce transmission risk upon release.
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Affiliation(s)
- Maria R Khan
- a Division of Comparative Effectiveness and Decision Science, Department of Population Health , New York University School of Medicine , New York , NY , USA
| | | | - Christian Grov
- c CUNY Graduate School of Public Health and Health Policy & The CUNY Institute for Implementation Science and Population Health , New York , NY , USA
| | - Joy D Scheidell
- a Division of Comparative Effectiveness and Decision Science, Department of Population Health , New York University School of Medicine , New York , NY , USA
| | - Laura Hawks
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
| | - E Jennifer Edelman
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
- e Center for Interdisciplinary Research on AIDS , Yale School of Public Health , New Haven , CT , USA
| | - David A Fiellin
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
- e Center for Interdisciplinary Research on AIDS , Yale School of Public Health , New Haven , CT , USA
| | - D Keith McInnes
- f Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center , Bedford , MA , USA
- g Department of Health Law, Policy, and Management , Boston University School of Public Health , Boston , MA , USA
| | - R Scott Braithwaite
- a Division of Comparative Effectiveness and Decision Science, Department of Population Health , New York University School of Medicine , New York , NY , USA
| | - Amy C Justice
- b VA Connecticut Healthcare System , West Haven , CT , USA
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
- e Center for Interdisciplinary Research on AIDS , Yale School of Public Health , New Haven , CT , USA
| | - Emily A Wang
- d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA
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13
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Adams JW, Lurie MN, King MRF, Brady KA, Galea S, Friedman SR, Khan MR, Marshall BDL. Potential drivers of HIV acquisition in African-American women related to mass incarceration: an agent-based modelling study. BMC Public Health 2018; 18:1387. [PMID: 30563496 PMCID: PMC6299641 DOI: 10.1186/s12889-018-6304-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/05/2018] [Indexed: 02/06/2023] Open
Abstract
Background The United States has the highest incarceration rate in the world. Incarceration can increase HIV risk behaviors for individuals involved with the criminal justice system and may be a driver of HIV acquisition within the community. Methods We used an agent-based model to simulate HIV transmission in a sexual-contact network representing heterosexual African American men and women in Philadelphia to identify factors influencing the impact of male mass incarceration on HIV acquisition in women. The model was calibrated using surveillance data and assumed incarceration increased the number of sexual contacts and decreased HIV care engagement for men post-release. Incarceration of a partner increased the number of sexual contacts for women. We compared a counterfactual scenario with no incarceration to scenarios varying key parameters to determine what factors drove HIV acquisition in women. Results Setting the duration of male high-risk sexual behavior to two years post-release increased the number of HIV transmissions to women by more than 20%. Decreasing post-release HIV care engagement and increasing HIV acquisition risk attributable to sexually transmitted infections (STIs) also increased the number of HIV transmissions to women. Changing the duration of risk behavior for women, the proportion of women engaging in higher risk behavior, and the relative risk of incarceration for HIV-infected men had minimal impact. Conclusion The mass incarceration of African American men can increase HIV acquisition in African American women on a population-level through factors including post-release high-risk behaviors, disruption of HIV care engagement among formerly incarcerated men, and increased STI prevalence. These findings suggest that the most influential points of intervention may be programs seeking to reduce male risk behaviors and promote HIV care engagement post-release, as well as STI testing and treatment programs for recently incarcerated men, as well as women with incarcerated partners. Electronic supplementary material The online version of this article (10.1186/s12889-018-6304-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Joëlla W Adams
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Mark N Lurie
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Maximilian R F King
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA
| | - Kathleen A Brady
- Philadelphia Department of Public Health, AIDS Activities Coordinating Office, Philadelphia, PA, USA
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA, USA
| | - Samuel R Friedman
- National Development and Research Institutes, New York City, NY, USA
| | - Maria R Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University, New York City, NY, USA
| | - Brandon D L Marshall
- Brown University School of Public Health, 121 South Main Street, Providence, RI, 02912, USA.
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14
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Rowell-Cunsolo TL, Long Y, Szeto B, Mkuu R, El-Bassel N. Examining factors associated with unprotected sexual behavior among Black Americans postrelease from incarceration in New York City. JOURNAL OF OFFENDER REHABILITATION 2018; 57:330-342. [PMID: 31649474 PMCID: PMC6812487 DOI: 10.1080/10509674.2018.1487899] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2017] [Revised: 07/05/2017] [Accepted: 12/27/2017] [Indexed: 06/10/2023]
Abstract
Black Americans are overrepresented among incarcerated individuals and those infected with sexually transmitted infections. We assessed unprotected sexual behavior among 165 formerly incarcerated Black Americans in New York City, New York. Most participants (63%) reported engaging in unprotected sexual behavior post-incarceration. According to our regression results, less time spent in jail and reporting multiple sexual partnerships were associated with a greater likelihood of engaging in unprotected sexual behavior. High rates of unprotected sexual behavior may place formerly incarcerated Black Americans at risk for sexually transmitted infections. Discharge planning programs that include STI/HIV prevention information and education may be useful for this population.
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Affiliation(s)
| | - Yue Long
- Columbia University, Quantitative Methods in the Social Sciences,
New York, NY
| | - Betsy Szeto
- Columbia University, College of Physicians & Surgeons, New
York, NY
| | - Rahma Mkuu
- Texas A & M University, College Station, TX
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15
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Khan MR, Scheidell JD, Golin CE, Friedman SR, Adimora AA, Lejuez CW, Hu H, Quinn K, Wohl DA. Dissolution of Committed Partnerships during Incarceration and STI/HIV-Related Sexual Risk Behavior after Prison Release among African American Men. J Urban Health 2018; 95:479-487. [PMID: 30073599 PMCID: PMC6095753 DOI: 10.1007/s11524-018-0274-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Incarceration is strongly associated with post-release STI/HIV risk. One pathway linking incarceration and STI/HIV risk may be incarceration-related dissolution of protective network ties. Among African American men released from prison who were in committed partnerships with women at the time of incarceration (N = 207), we measured the association between committed partnership dissolution during incarceration and STI/HIV risk in the 4 weeks after release. Over one-quarter (28%) experienced incarceration-related partnership dissolution. In adjusted analyses, incarceration-related partnership dissolution was strongly associated with post-release binge drinking (adjusted odds ratio (AOR) 4.2, 95% confidence interval (CI); 1.4-15.5). Those who experienced incarceration-related partnership dissolution were much more likely to engage in multiple/concurrent partnerships or sex trade defined as buying or selling sex (64%) than those who returned to the partner (12%; AOR 20.1, 95% CI 3.4-175.6). Policies that promote maintenance of relationships during incarceration may be important for protecting health.
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Affiliation(s)
- Maria R Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU School of Medicine, New York, NY, USA.
| | - Joy D Scheidell
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - Carol E Golin
- Division of General Internal Medicine and Epidemiology, Department of Medicine, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Samuel R Friedman
- National Development and Research Institutes, Inc., New York, NY, USA
| | - Adaora A Adimora
- Division of Infectious Disease, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carl W Lejuez
- Cofrin Logan Center for Addiction Research and Treatment, Department of Psychology, College of Liberal Arts & Sciences, University of Kansas, Lawrence, KS, USA
| | - Hui Hu
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA
| | - Kelly Quinn
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, NYU School of Medicine, New York, NY, USA
| | - David A Wohl
- Division of Infectious Disease, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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17
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Fields JC, King KM, Alexander KA, Smith KC, Sherman SG, Knowlton A. Recently released Black men's perceptions of the impact of incarceration on sexual partnering. CULTURE, HEALTH & SEXUALITY 2018; 20:55-68. [PMID: 28532296 DOI: 10.1080/13691058.2017.1325009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Evidence suggests that men with recent histories of incarceration are more likely to engage in high-risk sexual activity, however there is limited research exploring how having been recently released from prison might impact men's sexual risk behaviours or sexual partnering. This qualitative study explores the ways in which exposure to incarceration impacts the dynamics of sexual partnering among recently released Black men in Baltimore, USA. In-depth interviews were conducted with 19 recently released Black men between 21-45 years of age living in the city. Data were analysed using a combination of inductive and deductive approaches. Participants reported that women living in the neighbourhoods to which they returned found recently released men to be highly desirable sexual partners because they offered increased potential for sexual gratification, were perceived as healthier than other sexual partners in their communities and represented opportunities for attaining financial stability and the potential for establishing romantic partnerships. As a result, men reported they had more opportunities for sex and more power to negotiate sex with women. Recently released Black men's perceptions of their own sexual desirability among women raise important implications regarding power in the sexual relationships of recently released men that may increase HIV- and sexually transmitted infection-related risk for recently released men and their sexual partners.
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Affiliation(s)
- Julie C Fields
- a Department of Health, Behaviour and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
| | - Kelly M King
- b Department of Epidemiology , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
| | - Kamila A Alexander
- c School of Nursing , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
| | - Katherine C Smith
- a Department of Health, Behaviour and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
| | - Susan G Sherman
- a Department of Health, Behaviour and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
| | - Amy Knowlton
- a Department of Health, Behaviour and Society , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
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18
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Khan MR, El-Bassel N, Golin CE, Scheidell JD, Adimora AA, Coatsworth AM, Hu H, Judon-Monk S, Medina KP, Wohl DA. The Committed Intimate Partnerships of Incarcerated African-American Men: Implications for Sexual HIV Transmission Risk and Prevention Opportunities. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:2173-2185. [PMID: 28332036 PMCID: PMC5911944 DOI: 10.1007/s10508-016-0916-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Revised: 11/10/2016] [Accepted: 12/03/2016] [Indexed: 06/06/2023]
Abstract
Incarceration is thought to influence HIV transmission by disrupting partnerships that provide support and protect against sex risk-taking. Current correctional facility-based family-strengthening programs focus on marital partnerships, a minority of inmates' partnerships. Research on the sex partnerships of incarcerated African-American men and the types of partnerships most likely to protect against HIV-related sex risk is limited. Improved understanding can inform expansion of correctional facility-based family-strengthening programs to a greater proportion of protective partnerships and HIV risk reduction programs to partnerships vulnerable to sex risk. Project DISRUPT is a cohort study of African-American men being released from prison in North Carolina who were in committed heterosexual partnerships at prison entry. Using baseline survey data (N = 189), we conducted latent class analysis (LCA) to identify subgroups of participants with distinct relationship profiles and measured associations between relationship characteristics and multiple partnerships of inmates and their partners in the six months before incarceration. LCA indicated a two-class solution, with relationships distinguished by satisfaction/stability (satisfied/stable class: 58.0%; dissatisfied/unstable class: 42.0%); each class had comparable relationship length and levels of marriage and cohabitation. Dissatisfied/unstable relationships were associated with multiple partnerships among participants (AOR 2.93, 95% CI 1.50, 5.72) and partners (AOR 4.95, 95% CI 1.68, 14.58). Satisfaction indicators-versus length, marriage, or cohabitation-were the strongest independent correlates of inmates' and partners' multiple partnerships. Pre-incarceration economic deprivation, mental disorder symptoms, substance use, and violence in relationships were associated with dissatisfaction/instability. Prison-based programs designed to maintain healthy partnerships, strengthen relationship skills, and reduce HIV risk-taking and violence in relationships are warranted and should be targeted to both marital and nonmarital partnerships. Programming also should address the poverty, mental illness, and substance use factors that threaten relationship satisfaction/stability and increase HIV risk.
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Affiliation(s)
- Maria R Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA.
| | - Nabila El-Bassel
- Social Intervention Group, Columbia University, New York, NY, USA
| | - Carol E Golin
- Division of General Internal Medicine and Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joy D Scheidell
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, 227 East 30th Street, New York, NY, 10016, USA
| | - Adaora A Adimora
- Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ashley M Coatsworth
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, College of Medicine, Gainesville, FL, USA
| | - Hui Hu
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, College of Medicine, Gainesville, FL, USA
| | - Selena Judon-Monk
- Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - Katie P Medina
- Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
| | - David A Wohl
- Division of Infectious Disease, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA
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Scheidell JD, Lejuez CW, Golin CE, Adimora AA, Wohl DA, Keen LD, Hammond M, Judon-Monk S, Khan MR. Patterns of Mood and Personality Factors and Associations With STI/HIV-Related Drug and Sex Risk Among African American Male Inmates. Subst Use Misuse 2017; 52:929-938. [PMID: 28426364 PMCID: PMC5908473 DOI: 10.1080/10826084.2016.1267221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Research on the association between antisocial personality disorder (ASPD) with comorbid mental disorders and sexually transmitted infection (STI)/HIV risk among inmates is scant despite the high prevalence of psychopathology and of STI/HIV in this population. METHODS We used baseline data from Project DISRUPT, a cohort study conducted among incarcerated African American men (n = 207), to measure associations between ASPD and STI/HIV risk. We also conducted latent class analyses (LCAs) to identify subgroups defined by ASPD with comorbid stress, depression, and borderline personality disorder symptoms and measured associations between latent class membership and STI/HIV risk. RESULTS Approximately 15% had ASPD and 39% reported depression. Controlling for sociodemographics, stress, and depression, ASPD was independently associated with illicit [AOR = 3.23, 95% confidence interval (CI): 1.18-8.87] and injection drug use (AOR: 5.49, 95% CI: 1.23-24.42) but not with sexual risk. LCAs suggested that those at high risk of ASPD were likely to experience co-morbid mental disorders. ASPD comorbid with these disorders was linked to drug and sex risk. CONCLUSIONS STI/HIV prevention for inmates should incorporate diagnosis and treatment of ASPD and comorbid disorders, and interventions to address ASPD-related factors (e.g., impulsivity) that drive STI/HIV risk.
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Affiliation(s)
- Joy D Scheidell
- a Department of Population Health , New York University School of Medicine , New York , New York , USA
| | - Carl W Lejuez
- b Center for Addictions, Personality, and Emotion Research, University of Maryland , College Park , Maryland , USA
| | - Carol E Golin
- c Division of General Internal Medicine and Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA.,d Department of Health Behavior , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - Adaora A Adimora
- e Division of Infectious Disease , University of North Carolina at Chapel Hill School of Medicine , Chapel Hill , North Carolina , USA.,f Department of Epidemiology , University of North Carolina at Chapel Hill , Chapel Hill , North Carolina , USA
| | - David A Wohl
- e Division of Infectious Disease , University of North Carolina at Chapel Hill School of Medicine , Chapel Hill , North Carolina , USA
| | - Larry D Keen
- g Department of Psychology , Virginia State University , Petersburg , Virginia , USA
| | - Michael Hammond
- e Division of Infectious Disease , University of North Carolina at Chapel Hill School of Medicine , Chapel Hill , North Carolina , USA
| | - Selena Judon-Monk
- e Division of Infectious Disease , University of North Carolina at Chapel Hill School of Medicine , Chapel Hill , North Carolina , USA
| | - Maria R Khan
- a Department of Population Health , New York University School of Medicine , New York , New York , USA
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20
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Linton SL, Cooper HLF, Luo R, Karnes C, Renneker K, Haley DF, Dauria EF, Hunter-Jones J, Ross Z, Wingood GM, Adimora AA, Bonney L, Rothenberg R. Changing Places and Partners: Associations of Neighborhood Conditions With Sexual Network Turnover Among African American Adults Relocated From Public Housing. ARCHIVES OF SEXUAL BEHAVIOR 2017; 46:925-936. [PMID: 26927277 PMCID: PMC5003751 DOI: 10.1007/s10508-015-0687-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/15/2015] [Accepted: 12/23/2015] [Indexed: 05/31/2023]
Abstract
Neighborhood conditions and sexual network turnover have been associated with the acquisition of HIV and other sexually transmitted infections (STIs). However, few studies investigate the influence of neighborhood conditions on sexual network turnover. This longitudinal study used data collected across 7 visits from a predominantly substance-misusing cohort of 172 African American adults relocated from public housing in Atlanta, Georgia, to determine whether post-relocation changes in exposure to neighborhood conditions influence sexual network stability, the number of new partners joining sexual networks, and the number of partners leaving sexual networks over time. At each visit, participant and sexual network characteristics were captured via survey, and administrative data were analyzed to describe the census tracts where participants lived. Multilevel models were used to longitudinally assess the relationships of tract-level characteristics to sexual network dynamics over time. On average, participants relocated to neighborhoods that were less economically deprived and violent, and had lower alcohol outlet densities. Post-relocation reductions in exposure to alcohol outlet density were associated with fewer new partners joining sexual networks. Reduced perceived community violence was associated with more sexual partners leaving sexual networks. These associations were marginally significant. No post-relocation changes in place characteristics were significantly associated with overall sexual network stability. Neighborhood social context may influence sexual network turnover. To increase understanding of the social-ecological determinants of HIV/STIs, a new line of research should investigate the combined influence of neighborhood conditions and sexual network dynamics on HIV/STI transmission over time.
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Affiliation(s)
- Sabriya L Linton
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA.
| | - Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Ruiyan Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, USA
| | - Conny Karnes
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Kristen Renneker
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Danielle F Haley
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Emily F Dauria
- Division of Infectious Disease, Alpert Medical School, Brown University, Providence, RI, USA
| | - Josalin Hunter-Jones
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, NY, USA
| | - Gina M Wingood
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, USA
- Department of Sociomedical Sciences, Columbia University's Mailman School of Public Health, New York, NY, USA
| | - Adaora A Adimora
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Loida Bonney
- Department of General Medicine, Emory University School of Medicine, Fayetteville, GA, USA
| | - Richard Rothenberg
- Department of Epidemiology and Biostatistics, School of Public Health, Georgia State University, Atlanta, GA, USA
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HIV-Related Sexual Risk among African American Men Preceding Incarceration: Associations with Support from Significant Others, Family, and Friends. J Urban Health 2017; 94:136-148. [PMID: 28116586 PMCID: PMC5359176 DOI: 10.1007/s11524-016-0120-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We evaluated the association between social support received from significant others, family, and friends and HIV-related sexual risk behaviors among African American men involved in the criminal justice system. Project DISRUPT is a cohort study among African American men released from prison in North Carolina (N = 189). During the baseline (in-prison) survey, we assessed the amount of support men perceived they had received from significant others, family, and friends. We measured associations between low support from each source (<median value) and participants' sex risk in the 6 months before incarceration. Low levels of social support from significant others, family, or friends were associated with poverty and homelessness, mental disorders, and substance use. Adjusting for age, poverty, and other sources of support, perceiving low support from significant others was strongly associated with multiple partnerships (fully adjusted odds ratio (OR) 2.64, 95% confidence interval (CI) 1.29-5.42). Low significant other support also was strongly associated with sex trade involvement when adjusting for age and poverty status (adjusted OR 3.51, 95% CI 1.25-9.85) but further adjustment for low family and friend support weakened the association (fully adjusted OR 2.81, 95% CI 0.92-8.55). Significant other support was not associated with other sex risk outcomes including concurrent partnerships, anal sex, or sex with an STI/HIV-infected partner. Low family support was associated with multiple partnerships in analyses adjusting for age and poverty (adjusted OR 1.98, 95% CI 1.05-3.76) but the association weakened and was no longer significant after adjusting for other sources of support (fully adjusted OR 1.40, 95% CI 0.65-3.00); family support was not correlated with other risk behaviors. Friend support was not significantly associated with sex risk outcomes. Indicators of overall support from any source were not associated with sex risk outcomes. Helping inmates maintain ties may improve economic security and well-being during community re-entry, while supporting and strengthening relationships with a significant other in particular may help reduce sex risk. Studies should evaluate the protective effects of distinct support sources to avoid masking effects of support and to best understand the influence of social support on health.
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Abram KM, Stokes ML, Welty LJ, Aaby DA, Teplin LA. Disparities in HIV/AIDS Risk Behaviors After Youth Leave Detention: A 14-Year Longitudinal Study. Pediatrics 2017; 139:e20160360. [PMID: 28115541 PMCID: PMC5260145 DOI: 10.1542/peds.2016-0360] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2016] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine changes in the prevalence of 15 HIV/AIDS sex and drug risk behaviors in delinquent youth during the 14 years after they leave detention, focusing on sex and racial/ethnic differences. METHODS The Northwestern Juvenile Project, a prospective longitudinal study of 1829 youth randomly sampled from detention in Chicago, Illinois, recruited between 1995 and 1998 and reinterviewed up to 11 times. Independent interviewers assessed HIV/AIDS risk behaviors using the National Institutes on Drug Abuse Risk Behavior Assessment. RESULTS Fourteen years after detention (median age, 30 years), one-quarter of males and one-tenth of females had >1 sexual partner in the past 3 months. One-tenth of participants reported recent unprotected vaginal sex with a high-risk partner. There were many sex and racial/ethnic differences. For example, African American males had 4.67 times the odds of having >1 partner than African American females (95% confidence interval [CI], 3.22-6.76). Over time, compared with non-Hispanic white males, African American males had 2.56 times the odds (95% CI, 1.97-3.33) and Hispanic males had 1.63 times the odds (95% CI, 1.24-2.12) of having multiple partners, even after adjusting for incarceration and age. Non-Hispanic white females were more likely to have multiple partners than racial/ethnic minority females. CONCLUSIONS Although rates decrease over time, prevalence of sex risk behaviors are much higher than the general population. Among males, racial/ethnic minorities were at particular risk. The challenge for pediatric health is to address how disproportionate confinement of racial/ethnic minority youth contributes to disparities in the HIV/AIDS epidemic.
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Affiliation(s)
- Karen M Abram
- Departments of Psychiatry and Behavioral Sciences, and
| | | | - Leah J Welty
- Departments of Psychiatry and Behavioral Sciences, and
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - David A Aaby
- Departments of Psychiatry and Behavioral Sciences, and
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Multiplex crack smoking and sexual networks: associations between network members' incarceration and HIV risks among high-risk MSM. J Behav Med 2016; 39:845-54. [PMID: 27417286 DOI: 10.1007/s10865-016-9754-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 05/26/2016] [Indexed: 10/21/2022]
Abstract
This study examined HIV risks in the multiplex crack-smoking and sexual networks of incarcerated drug-using men who have sex with men (MSM) and their associates. We estimated the associations between the network members' incarceration, self-reported HIV infection, and trading sex for money. Our analytic sample consisted of 508 crack-smoking or sexual partnerships of 273 high-risk MSM. Network members were specified by (1) crack smoking and sexual behavior or (2) crack smoking only. Longer incarceration of the crack-smoking and sexual network members was associated with self-reported HIV infection (AOR = 1.61, p < 0.05), which extended up to one's partners' partners' partners (AOR = 1.63, p < 0.05). Similar results were found for trading sex (AOR = 2.77, p < 0.05). The findings of the study call for the development of a system-level HIV intervention among former incarcerated MSM and their associates.
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Nijhawan AE. Infectious Diseases and the Criminal Justice System. Am J Med Sci 2016; 352:399-407. [PMID: 27776722 DOI: 10.1016/j.amjms.2016.05.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/15/2016] [Accepted: 05/11/2016] [Indexed: 01/06/2023]
Abstract
The United States leads the world in incarceration, which disproportionately affects disadvantaged individuals, including those who are mentally ill, poor, homeless and racial minorities. Incarceration is disruptive to families and communities and contributes to health disparities in sexually transmitted infections (STIs) and human immunodeficiency virus (HIV). The objective of this grand rounds is to review (1) the epidemiology of incarceration in the United States, (2) the social factors which contribute to high rates of STIs in incarcerated individuals and (3) the HIV care cascade in incarcerated and recently released individuals. Routine screening and treatment for STIs and HIV in the criminal justice system can identify many new infections and has the potential to both improve individual outcomes and reduce transmission to others. Increased collaboration between the department of health and department of corrections, as well as partnerships between academic institutions and the criminal justice system, have the potential to improve outcomes in this vulnerable population.
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Affiliation(s)
- Ank E Nijhawan
- Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Outcomes and Health Services Research, University of Texas Southwestern Medical Center, Dallas, Texas.
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Wiehe SE, Rosenman MB, Aalsma MC, Scanlon ML, Fortenberry JD. Epidemiology of Sexually Transmitted Infections Among Offenders Following Arrest or Incarceration. Am J Public Health 2015; 105:e26-32. [PMID: 26469659 DOI: 10.2105/ajph.2015.302852] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Sarah E Wiehe
- Sarah E. Wiehe, Marc B. Rosenman, and Michael L. Scanlon are with Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Sarah E. Wiehe and Marc B. Rosenman are also with Regenstrief Institute Inc, Indianapolis. Matthew C. Aalsma and J. Dennis Fortenberry are with Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine
| | - Marc B Rosenman
- Sarah E. Wiehe, Marc B. Rosenman, and Michael L. Scanlon are with Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Sarah E. Wiehe and Marc B. Rosenman are also with Regenstrief Institute Inc, Indianapolis. Matthew C. Aalsma and J. Dennis Fortenberry are with Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine
| | - Matthew C Aalsma
- Sarah E. Wiehe, Marc B. Rosenman, and Michael L. Scanlon are with Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Sarah E. Wiehe and Marc B. Rosenman are also with Regenstrief Institute Inc, Indianapolis. Matthew C. Aalsma and J. Dennis Fortenberry are with Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine
| | - Michael L Scanlon
- Sarah E. Wiehe, Marc B. Rosenman, and Michael L. Scanlon are with Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Sarah E. Wiehe and Marc B. Rosenman are also with Regenstrief Institute Inc, Indianapolis. Matthew C. Aalsma and J. Dennis Fortenberry are with Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine
| | - J Dennis Fortenberry
- Sarah E. Wiehe, Marc B. Rosenman, and Michael L. Scanlon are with Children's Health Services Research, Department of Pediatrics, Indiana University School of Medicine, Indianapolis. Sarah E. Wiehe and Marc B. Rosenman are also with Regenstrief Institute Inc, Indianapolis. Matthew C. Aalsma and J. Dennis Fortenberry are with Section of Adolescent Medicine, Department of Pediatrics, Indiana University School of Medicine
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STI/HIV Sexual Risk Behavior and Prevalent STI Among Incarcerated African American Men in Committed Partnerships: The Significance of Poverty, Mood Disorders, and Substance Use. AIDS Behav 2015; 19:1478-90. [PMID: 25863467 DOI: 10.1007/s10461-015-1062-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
African Americans face disproportionate sexually transmitted infection including HIV (STI/HIV), with those passing through a correctional facility at heightened risk. There is a need to identify modifiable STI/HIV risk factors among incarcerated African Americans. Project DISRUPT is a cohort study of incarcerated African American men recruited from September 2011 through January 2014 from prisons in North Carolina who were in committed partnerships with women at prison entry (N = 207). During the baseline (in-prison) study visit, participants responded to a risk behavior survey and provided a urine specimen, which was tested for STIs. Substantial proportions reported multiple partnerships (42 %), concurrent partnerships (33 %), and buying sex (11 %) in the 6 months before incarceration, and 9 % tested positive for an STI at baseline (chlamydia: 5.3 %, gonorrhea: 0.5 %, trichomoniasis: 4.9 %). Poverty and depression appeared to be strongly associated with sexual risk behaviors. Substance use was linked to prevalent STI, with binge drinking the strongest independent risk factor (adjusted odds ratio: 3.79, 95 % CI 1.19-12.04). There is a continued need for improved prison-based STI testing, treatment, and prevention education as well as mental health and substance use diagnosis.
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King KM, Latkin CA, Davey-Rothwell MA. Love on lockdown: how social network characteristics predict separational concurrency among low income African-American women. J Urban Health 2015; 92:460-71. [PMID: 25820220 PMCID: PMC4456476 DOI: 10.1007/s11524-015-9951-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
One out of nine African-American men between the ages of 20 and 34 is behind bars, resulting in many African-American women losing their primary romantic partners to incarceration. Research suggests that partner incarceration may contribute to increased risk of sexually transmitted infections (STIs)/human immunodeficiency virus (HIV); however, factors associated with women's decisions to begin new sexual partnerships following partner incarceration (i.e., separational concurrency) have not been well studied. This study examined the social context relevant to initiating separational concurrency, following incarceration of a primary male partner. Cross-sectional secondary data analysis of 6-month follow-up data from the CHAT Project, a social-network based HIV/sexually transmitted disease (STD) prevention study in Baltimore, MD, USA. Participants were N = 196 African-American women, who reported ever having had a partner who was incarcerated for at least 6 months during the relationship. The majority (81.5%) of women were unemployed with a mean age of 41.7 years. Over half of the sample (59.5%) reported having used crack or heroin at least once in the previous 12 months; 48.5% of the women had experienced physical abuse, with over half of the sample reporting a lifetime history of emotional abuse (54.6%). Separational concurrency, defined as answering yes to the item, "While [your] partner was incarcerated, did you have any other sexual partners?," was the primary outcome measure. After adjusting for age, drug use and unemployment the multiple logistic regression model found that women who reported a history of physical or emotional abuse were over two times as likely to report separational concurrency than women without an abuse history [adjusted odds ratio (AOR), 2.24; 95% CI, 1.24, 4.05; p = .007 and AOR, 2.44; 95% CI, 1.33, 4.46; p = .004, respectively]. Individuals who reported a higher number of drug-using sex partners (AOR, 2.49; 95% CI, 1.4, 4.5; p = .002), sex exchange partners (AOR, 4.0; 95% CI, 1.8 8.9; p = .001), and sexual partners who engaged in concurrency (AOR: 2.67; 95% CI: 1.5, 4.8; p = .001) were significantly more likely to report separational concurrency. Conversely, participants who reported more female kin in their social networks (AOR, .808; 95% CI, .67, .97; p = .025), having known network members a longer time (AOR, .997; 95% CI, .993, .999; p = .043), and higher levels of trust for network members (AOR, .761; 95% CI, .63, .92; p = .005) were significantly less likely to report separational concurrency. Results of this study demonstrate that social network characteristics may be crucial to understanding separational concurrency among African-American urban women who have lost a partner to incarceration. Social network and other resource-based interventions, which provide instrumental, social, and economic resources to women who have experienced the loss of a partner to incarceration, may be important tools in empowering women and helping to reduce the disproportionate burden of STIs/HIV among low income, African-American women.
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Affiliation(s)
- Kelly M King
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, 21231, USA,
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Iroh PA, Mayo H, Nijhawan AE. The HIV Care Cascade Before, During, and After Incarceration: A Systematic Review and Data Synthesis. Am J Public Health 2015; 105:e5-16. [PMID: 25973818 DOI: 10.2105/ajph.2015.302635] [Citation(s) in RCA: 172] [Impact Index Per Article: 19.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We conducted a systematic literature review of the data on HIV testing, engagement in care, and treatment in incarcerated persons, and estimated the care cascade in this group. We identified 2706 titles in MEDLINE, EBSCO, and Cochrane Library databases for studies indexed to January 13, 2015, and included 92 for analysis. We summarized HIV testing results by type (blinded, opt-out, voluntary); reviewed studies on HIV care engagement, treatment, and virological suppression; and synthesized these results into an HIV care cascade before, during, and after incarceration. The HIV care cascade following diagnosis increased during incarceration and declined substantially after release, often to levels lower than before incarceration. Incarceration provides an opportunity to address HIV care in hard-to-reach individuals, though new interventions are needed to improve postrelease care continuity.
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Affiliation(s)
- Princess A Iroh
- Princess A. Iroh and Ank E. Nijhawan are with Department of Internal Medicine, Division of Infectious Diseases, University of Texas Southwestern Medical Center, Dallas. Helen Mayo is with Health Sciences Digital Library and Learning Center, University of Texas Southwestern Medical Center
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Dyer TP, Regan R, Pacek LR, Acheampong A, Khan MR. Psychosocial vulnerability and HIV-related sexual risk among men who have sex with men and women in the United States. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:429-41. [PMID: 25183549 PMCID: PMC4324087 DOI: 10.1007/s10508-014-0346-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Revised: 01/31/2014] [Accepted: 01/31/2014] [Indexed: 05/12/2023]
Abstract
In the U.S., HIV is concentrated among men who have sex with men (MSM), some of whom have had female partners (MSMW). MSMW are disproportionately impacted by psychosocial vulnerabilities, like depression and substance use that increase sexually transmitted infection (STI) and HIV risk. Research on psychosocial vulnerability and HIV-related sexual risk among MSMW is warranted to reduce infection transmission among MSM and to prevent bridging to female partners. We analyzed data from Wave IV (2007-2008) of the National Longitudinal Study of Adolescent Health to assess psychosocial vulnerability and HIV risk-taking among MSMW. Using lifetime and past year sexual activity, we classified men as ever having sex with: women only (MSW), men only (MSMO) or MSMW, with further refined categorization of MSMW with male only partners in the past 12 months, only female partners in the past 12 months, and both male and female partners in the past 12 months (N = 6,945). We compared psychosocial vulnerability characteristics and HIV-related risk behaviors among the five categories of men. MSMW were more likely to report depression, suicidality, substance use, and incarceration than MSW and MSMO. Compared to MSW, MSMW with current female partners had greater odds of unprotected sex, exchange sex, and STI. MSMW with male partners in the past year had greater odds of multiple or concurrent partners in the past year. HIV risk and psychosocial vulnerability factors are elevated among MSMW, a priority population for HIV risk reduction. HIV risk reduction interventions should address this and heterogeneity of sexual partnerships among MSMW.
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Affiliation(s)
- Typhanye P Dyer
- Department of Epidemiology and Biostatistics, University of Maryland, 2234FF School of Public Health, College Park, MD, 20742, USA,
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Stoltey JE, Li Y, Bernstein KT, Philip SS. Ecological analysis examining the association between census tract-level incarceration and reported chlamydia incidence among female adolescents and young adults in San Francisco. Sex Transm Infect 2015; 91:370-4. [PMID: 25609259 DOI: 10.1136/sextrans-2014-051740] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2014] [Accepted: 12/28/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Incarceration has been linked to increased risk of sexually transmitted infections (STIs). We conducted a census tract-level ecological analysis to explore the relationship between neighbourhood incarceration rates and chlamydia incidence among adolescent girls and young women under age 25 in San Francisco in 2010 to focus public health efforts in neighbourhoods at risk. METHODS Female chlamydial cases under age 25 that were reported to the San Francisco Department of Public Health in 2010 were geocoded to census tract, and chlamydia incidence was calculated. Addresses of incarcerated individuals were geocoded, and census tract-specific incarceration was estimated. American Community Survey data from 2005 to 2009 provided tract-specific survey estimates of demographic and socioeconomic characteristics of communities to allow for evaluation of potential census tract-level confounders. A Poisson mixed model was used to assess the relationship of census tract-level incarceration rate with chlamydial case rate. RESULTS Accounting for spatial dependence in neighbouring regions, there was a positive association between incarceration rates and chlamydia incidence in young women under age 25 in San Francisco, and this association decreased as poverty increased, after controlling for other risk factors in the model. CONCLUSIONS This ecological analysis supports the neighbourhood role of incarceration in the risk of chlamydia among young women. These results have important implications for directing limited public health resources to local areas at risk in order to geographically focus prevention interventions and provide improved access to STI services in specific neighbourhoods with high incarceration rates.
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Affiliation(s)
- Juliet E Stoltey
- Division of Infectious Diseases, University of California, San Francisco, California, USA
| | - Ye Li
- Public Health Ontario, Toronto, Ontario, Canada Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Kyle T Bernstein
- STD Prevention and Control Services, San Francisco Department of Public Health, San Francisco, California, USA Division of Epidemiology, University of California, Berkeley, California, USA
| | - Susan S Philip
- Division of Infectious Diseases, University of California, San Francisco, California, USA STD Prevention and Control Services, San Francisco Department of Public Health, San Francisco, California, USA
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Nunn A, MacCarthy S, Barnett N, Rose J, Chan P, Yolken A, Cornwall A, Chamberlain N, Barnes A, Riggins R, Moore E, Simmons D, Parker S, Mena L. Prevalence and predictors of concurrent sexual partnerships in a predominantly African American population in Jackson, Mississippi. AIDS Behav 2014; 18:2457-68. [PMID: 24803130 PMCID: PMC4224631 DOI: 10.1007/s10461-014-0777-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Concurrent sexual partnerships, or sexual partnerships that overlap in time, have been associated with HIV and sexually transmitted infections (STI). How best to measure concurrency and the personal characteristics and predictors of concurrency are not yet well understood. We compared two frequently used concurrency definitions, including a self-reported measure based on participant response regarding overlapping sex with partners, and the UNAIDS measure based on overlapping dates of last sex and intention to have sex again. We performed multivariable logistic regression analyses to identify socio-demographic, behavioral, and structural predictors of concurrency among 1,542 patients at an urban STI clinic in Jackson, Mississippi. Nearly half (44 %) reported concurrency based on self-reported sex with other partners, and 26 % reported concurrency according to the UNAIDS concurrency measure. Using the self-reported concurrency measure, the strongest predictors of concurrency were perceived partner concurrency, drug use at last sex, having more than 10 lifetime partners, and being recently incarcerated. Strongest predictors of concurrency using the UNAIDS measure were lifetime number of partners and perceived partner concurrency. Concurrency is highly prevalent in this population in the Deep South and social, structural and behavioral factors were important predictors of concurrency for both measures. Future research should use time anchored data collection methods and biomarkers to assess whether both definitions of concurrency are associated with HIV outcomes.
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Affiliation(s)
- Amy Nunn
- Division of Infectious Diseases, The Miriam Hospital and The Warren Alpert School of Medicine at Brown University, 164 Summit Ave, RISE 109, Providence, RI, 02906, USA,
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Underhill K, Dumont D, Operario D. HIV prevention for adults with criminal justice involvement: a systematic review of HIV risk-reduction interventions in incarceration and community settings. Am J Public Health 2014; 104:e27-53. [PMID: 25211725 PMCID: PMC4202946 DOI: 10.2105/ajph.2014.302152] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2014] [Indexed: 11/04/2022]
Abstract
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.
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Affiliation(s)
- Kristen Underhill
- At the time of the study, Kristen Underhill was with Center for Alcohol and Addiction Studies, Department of Community Health, Brown University, Providence, RI, and Center for Interdisciplinary Research on AIDS and Yale Law School, Yale University, New Haven, CT. Dora Dumont was with The Center for Prisoner Health and Human Rights, Miriam Hospital, Providence, and Rhode Island Department of Health, Providence. Don Operario is with Center for Alcohol and Addiction Studies, School of Public Health, Brown University
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Peabody ME, Choung A, Rosen R, Kuo C, Wechsberg W, Fernandes K, Zlotnick C, Johnson J. Effects of incarceration on risky Sex: focus group data from Two New England states. HEALTH & JUSTICE 2014; 2:8. [PMCID: PMC5151510 DOI: 10.1186/2194-7899-2-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 03/04/2014] [Indexed: 05/30/2023]
Abstract
Background Human Immunodeficiency Virus (HIV) risk and interpersonal violence are interconnected public health problems facing incarcerated women. Prison may provide an opportune time to conduct HIV prevention activities with high-risk women. Methods This study used qualitative analysis to explore how incarceration affected women’s experiences of and thoughts about sex and sex risk. Twenty-one incarcerated women who had engaged in unprotected sex with a male in the 90 days prior to incarceration and experienced interpersonal violence in their lifetime participated in semi-structured focus groups at four women’s prison facilities in two New England States. Results Themes that emerged from these focus groups include: a) incarceration increased sexual desire for some women but decreased it for others, b) education and exposure to women with HIV during incarceration increased women’s intentions to use condoms after release, c) women recognized that partners were often unfaithful while women were incarcerated, d) women felt empowered by mental health/substance use treatment and sobriety in prison, and e) practical difficulties of re-entry challenged women’s resolve to practice safe sex after release. Conclusion Themes illuminate possible directions for public health interventions for this population at high risk for HIV. Electronic supplementary material The online version of this article (doi:10.1186/2194-7899-2-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Adam Choung
- Brown University, Box G-BH, Providence, RI 02912 USA
| | - Rochelle Rosen
- The Miriam Hospital, Centers for Behavioral and Preventive Medicine, Coro West, Suite 309164 Summit Ave, Providence, RI 02906 USA
| | - Caroline Kuo
- 121 S. Main St., 4th Floor, Rm 406, Providence, RI 02903 USA
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Magnus M, Phillips G, Kuo I, Peterson J, Rawls A, West-Ojo T, Jia Y, Opoku J, Greenberg AE. HIV among women in the District of Columbia: an evolving epidemic? AIDS Behav 2014; 18 Suppl 3:256-65. [PMID: 23702704 DOI: 10.1007/s10461-013-0514-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The epidemiology of HIV in urban centers of the United States such as the District of Columbia (DC) is dynamic with rates of new HIV and AIDS diagnoses as well as risk factors elevated. Correlates of HIV among heterosexual women extend beyond traditional, individual risk factors to structural factors. The purpose of this study was to compare proportions of HIV and correlates of HIV among women participating in National HIV behavioral surveillance (NHBS) system in 2006-7 (NHBS Cycle 1) and 2010 (NHBS Cycle 2). Analysis of 677 female participants at elevated risk for HIV revealed high prevalence of individual-level HIV-associated risk factors (e.g., sexual behavior) and socio-structural associated risk factors (e.g., homelessness, incarceration, lack of health insurance). While a greater proportion of women were HIV-infected in Cycle 2, after controlling for the distribution of demographic characteristics to adjust for a change in eligibility criteria, the pooled sample did not reveal a significantly increased proportion of HIV-infected women in Cycle 2. Homelessness and condom use were associated with greater relative odds of HIV after adjustment for confounders, and non-injection drug use was associated with reduced odds. Findings inform our understanding of the continuing HIV epidemic in DC and support development of effective interventions to slow the epidemic among women in DC and similar urban centers.
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Affiliation(s)
- Manya Magnus
- Department of Epidemiology and Biostatistics, The George Washington University School of Public Health and Health Services, 2100-W Pennsylvania Avenue, Suite 807, Washington, DC, 20037, USA,
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Comfort M, Reznick OG, Dilworth SE, Binson D, Darbes LA, Neilands TB. Sexual HIV Risk Among Male Parolees and Their Female Partners: The Relate Project. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2014; 7:26-53. [PMID: 25642396 PMCID: PMC4308977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND The massively disproportionate impact of America's prison boom on communities of color has raised questions about how incarceration may affect health disparities, including disparities in HIV. Primary partners are an important source of influence on sexual health. In this paper, we investigate sexual HIV risk among male-female couples following a man's release from prison. METHODS We draw upon data from the Relate Project, a novel cross-sectional survey of recently released men and their female partners in Oakland and San Francisco, California (N=344). Inferential analyses use the actor-partner model to explore actor and partner effects on sexual HIV risk outcomes. RESULTS Dyadic analyses of sexual HIV risk among male parolees and their female partners paint a complex portrait of couples affected by incarceration and of partners' influences on each other. Findings indicate that demographic factors such as education level and employment status, individual psycho-social factors such as perception of risk, and relationship factors such as commitment and power affect sexual HIV risk outcomes. CONCLUSION The Relate Project provides a novel dataset for the dyadic analysis of sexual risk among male parolees and their female partners, and results highlight the importance of focusing on the couple as a unit when assessing HIV risk and protective behaviors. Results also indicate potentially fruitful avenues for population-specific interventions that may help to reduce sexual health disparities among couples affected by incarceration.
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Affiliation(s)
- Megan Comfort
- RTI International and University of California, San Francisco
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Green TC, Johnson J, Harrington M, Pouget ER, Rhodes AG, Taxman FS, O'Connell DJ, Martin SS, Prendergast M, Friedmann PD. Parole officer-parolee relationships and HIV risk behaviors during community supervision. AIDS Behav 2013; 17:2667-75. [PMID: 22038082 DOI: 10.1007/s10461-011-0081-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
We tested if good parole officer (PO)-parolee relationships reduce HIV risk behaviors during parole, as they do for risk of rearrest. Analyses used data from 374 parolees enrolled in a randomized clinical trial. Past month HIV risk behaviors were assessed by interview at baseline, 3- and 9-months after parole initiation. The Working Alliance Inventory and the Dual-Role Relationships Inventory measured PO relationship. Gender-stratified multivariate regressions tested associations of PO-parolee relationship with sex with multiple partners, unprotected sex with risky partner(s), and drug injection. Women parolees (n = 65) who reported better PO relationship characteristics were less likely to report having multiple sex partners [adjusted odds ratio: 0.82 (0.69, 0.98) at 3-months, 0.89 (0.80, 0.99) at 9-months], and, among those reporting multiple sex partners, had fewer partners on average [adjusted relative risk 0.98 (0.96, 0.99)]. These effects were not found among men. PO-parolee relationship quality can influence sexual risk behaviors among women parolees.
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Leukefeld C, Havens J, Tindall MS, Oser CB, Mooney J, Hall MT, Knudsen HK. Risky relationships: targeting HIV prevention for women offenders. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:339-49. [PMID: 22827903 PMCID: PMC3490206 DOI: 10.1521/aeap.2012.24.4.339] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
HIV is a health issue for women offenders who are at particularly high risk. Women's prisons can be opportune settings for HIV prevention interventions. How women perceive partner relationships could be central to targeting HIV interventions. Consequently, this study examines changes in women offenders' risky relationships. Baseline and follow-up data are presented from 344 women offenders. Intent-to-treat analysis is used as well as analysis of covariance to control for baseline values. Findings indicate that women released to the community from prison who were randomized into the prevention intervention were significantly more likely to report changes in five of seven risky relationship thinking myths. Findings suggest that a relationship theory-based prevention intervention for reducing HIV risk could be promising for women offenders reentering the community after prison. Additional research is suggested.
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Affiliation(s)
- Carl Leukefeld
- Department of Behavioral Science, Medical Behavioral Science Building, University of Kentucky, Lexington, KY 40536-0086, USA.
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When they break up and get back together: length of adolescent romantic relationships and partner concurrency. Sex Transm Dis 2012; 39:281-5. [PMID: 22421694 DOI: 10.1097/olq.0b013e318244ac31] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Sex partner concurrency is an important risk factor for sexually transmitted infection transmission. Understanding how adolescents conceptualize the length of their relationships when they break up and get back together is essential to the assessment of concurrency. METHODS A prospective cohort of 392 late adolescents and emerging adults, aged 14 to 19 years at baseline, were recruited from 2 clinics in Baltimore, MD and interviewed semiannually for 3 years. At each interview, participants were asked to report on all of their sexual partners in the previous 6 months, the length of relationship, and whether they thought their partner had other sex partners. For relationships that had broken up and gotten back together, reports of length of the relationship were compared before and after the breakup. Random effects logistic regression was used to examine the association between length of relationship and both breakup and partner concurrency. RESULTS For relationships that ended and subsequently got back together, participants considered the length of relationship to include the period when they were broken up. Longer relationships were at increased odds of both having broken up and gotten back together (odds ratio [OR] = 1.04, 95% confidence interval [CI]: 1.02, 1.05) and of partner concurrency (OR = 1.03, 95% CI: 1.02, 1.04). The magnitude of the odds of concurrency was greater for relationships that had broken up and gotten back together (OR = 1.07, 95% CI: 1.02, 1.11). CONCLUSIONS Findings from this study emphasize the need for an improved understanding of the association between the temporal dynamics of late adolescent and emerging adult romantic relationships and concurrency.
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Nunn A, Dickman S, Cornwall A, Kwakwa H, Mayer KH, Rana A, Rosengard C. Concurrent sexual partnerships among African American women in Philadelphia: results from a qualitative study. Sex Health 2012; 9:288-96. [PMID: 22697147 PMCID: PMC4203371 DOI: 10.1071/sh11099] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2011] [Accepted: 09/30/2011] [Indexed: 11/23/2022]
Abstract
BACKGROUND African American women are disproportionately affected by HIV/AIDS. Concurrent sexual partnerships may contribute to racial disparities in HIV infection. Little is known about attitudes and practices related to concurrency among African American women, or the social, structural and behavioural factors influencing concurrency. METHODS We recruited 19 heterosexual African American women engaging in concurrent sexual partnerships from a public clinic in Philadelphia in 2009. We conducted interviews exploring social norms, attitudes and practices about concurrency, and the structural, social and behavioural factors influencing concurrent sexual partnerships, guided by grounded theory. RESULTS Seventeen women reported one main and one or more non-main partners; two reported no main partners. Many women used condoms more frequently with non-main than main partners, noting they trust main partners more than non-main partners. Social factors included social normalisation of concurrency, inability to negotiate partners' concurrent partnerships, being unmarried, and not trusting partners. Lack of trust was the most commonly cited reason that women engaged in concurrent partnerships. Structural factors included economic dependence on partners, partners' dependence on women for economic support and incarceration that interrupted partnerships. Behavioural factors included alcohol and cocaine use. CONCLUSIONS Social, structural and behavioural factors strongly influenced these African American women's concurrent sexual partnerships. Many HIV interventions disseminated by the CDC focus largely on behavioural factors and may fail to address the social and structural factors influencing African American women's sexual networks. Novel HIV prevention interventions that address the social determinants of African American women's HIV risks are urgently needed.
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Affiliation(s)
- Amy Nunn
- Alpert Medical School of Brown University, Division of Infectious Diseases, Providence, RI, USA.
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Green TC, Pouget ER, Harrington M, Taxman FS, Rhodes AG, OʼConnell D, Martin SS, Prendergast M, Friedmann PD. Limiting options: sex ratios, incarceration rates, and sexual risk behavior among people on probation and parole. Sex Transm Dis 2012; 39:424-30. [PMID: 22592827 PMCID: PMC3575024 DOI: 10.1097/olq.0b013e318254c81a] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND To investigate how incarceration may affect risk of acquiring HIV and other sexually transmitted infections, we tested associations of ex-offenders' sexual risk behavior with the male-female sex ratio and the male incarceration rate. METHODS Longitudinal data from 1287 drug-involved persons on probation and parole as part of the Criminal Justice Drug Abuse Treatment Studies were matched by county of residence with population factors, and stratified by race/ethnicity and gender. Generalized estimating equations assessed associations of having unprotected sex with a partner who had HIV risk factors, and having >1 sex partner in the past month. RESULTS Among non-Hispanic black men and women, low sex ratios were associated with greater risk of having unprotected sex with a risky partner (adjusted relative risk [ARR] = 1.76, 95% confidence interval [CI] = 1.29, 2.42; ARR = 2.48, 95% CI = 1.31, 4.73, respectively). Among non-Hispanic black and non-Hispanic white (NHW) women, low sex ratios were associated with having >1 sex partner (ARR = 2.00, 95% CI = 1.02, 3.94; ARR = 1.71, 95% CI = 1.06, 2.75, respectively). High incarceration rates were associated with greater risk of having a risky partner for all men (non-Hispanic black: ARR = 2.14, 95% CI = 1.39, 3.30; NHW: ARR = 1.39, 95% CI: 1.05, 1.85; Hispanic: ARR = 3.99, 95% CI = 1.55, 10.26) and having >1 partner among NHW men (ARR = 1.92, 95% CI = 1.40, 2.64). CONCLUSIONS Low sex ratios and high incarceration rates may influence the number and risk characteristics of sex partners of ex-offenders. HIV-prevention policies and programs for ex-offenders could be improved by addressing structural barriers to safer sexual behavior.
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Affiliation(s)
- Traci C Green
- Division of General Internal Medicine, Rhode Island Hospital/Brown Medical School, Providence, RI 02903, USA.
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Rogers SM, Khan MR, Tan S, Turner CF, Miller WC, Erbelding E. Incarceration, high-risk sexual partnerships and sexually transmitted infections in an urban population. Sex Transm Infect 2012; 88:63-8. [PMID: 22250181 DOI: 10.1136/sextrans-2011-050280] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The authors examined the associations between personal and partner incarceration, high-risk sexual partnerships and biologically confirmed sexually transmitted infection (STI) in a US urban population. METHODS Data from a probability survey of young adults 15-35 years of age in Baltimore, Maryland, USA, were analysed to assess the prevalence of personal and partner incarceration and its association with several measures of high-risk sexual partnerships including multiple partners, partner concurrency and current STI. RESULTS A history of incarceration was common (24.1% among men and 11.3% among women). Among women with an incarcerated partner in the past year (15.3%), the risk of current STI was significantly increased (adjusted prevalence ratio=2.3, 95% CI 1.5 to 3.5). Multiple partners (5+) in the past year and partner concurrency were disproportionately high among men and women who had been incarcerated or who had sexual partner(s) or who had recently been incarcerated. These associations remained robust independent of personal socio-demographic factors and illicit drug use. CONCLUSIONS Incarceration may contribute to STI risk by influencing engagement in high-risk behaviours and by influencing contact with partners who engage in risky behaviours and who hence have elevated risk of infection.
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Affiliation(s)
- Susan M Rogers
- Statistics and Epidemiology Division, Research Triangle Institute, 701 13th Street NW, Washington, DC 20009, USA.
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Abstract
The incarcerated population has increased to unprecedented levels following the 1970 US declaration of war on illicit drug use. A substantial proportion of people with or at risk for HIV infection, including those with substance use and mental health disorders, have become incarcerated. The overlapping epidemics of incarceration and HIV present a need for academic medical centers to collaborate with the criminal justice system to improve the health of incarcerated populations. With coordinated collaboration and new programmatic initiatives it is possible to reduce HIV-associated risk behaviors and the likelihood of acquisition and transmission of HIV. Centers for AIDS Research (CFAR), funded by the National Institutes of Health, have proactively responded to this need through Collaboration on HIV in Corrections (CHIC) to improve the diagnosis, treatment, linkage to care, and prevention of HIV. This collaboration serves as a model for aligning academic expertise with criminal justice to confront this challenge to individual and public health. This is especially relevant given recent evidence of the effectiveness of antiretroviral therapy in reducing HIV transmission.
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