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

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 six 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 (AOR): 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.

HIV-Related Sexual Risk among African American Men Preceding Incarceration: Associations with Support from Significant Others, Family, and Friends

“…Of those eligible, a total of 207 men (43.4% of 477) agreed to participate in the study [37]. However, the analytical sample was reduced to 189 participants due to data corruption and subsequent loss of baseline surveys.…”

“…We recruited DISRUPT participants from the North Carolina Department of Public Safety (NCDPS) from September 2011 to January 2014 and surveyed participants in prison just before release [37]. Eligible individuals were African American men, at least 18 years of age, anticipating release within 2 months, had been incarcerated less than 3 years, HIV-negative when incarcerated, and had a female intimate partner at the time of prison entry (participants with more than one committed partner were eligible if able to identify one partner that was most important).…”

“…Hence, to describe the social and economic context of those with low levels versus high levels of social support, we examined the associations between social support and age; indicators of poverty in the 6 months before incarceration including concern that the inmate or his family did not have enough money to pay housing/utility bills, homelessness, and concern about having enough food; and mental health and binge drinking, which was commonly reported in the sample [37]. We measured depression using a modified five-item version of the Center for Epidemiological Studies Depression Scale (CES-D) [41].…”

“…We examined binge drinking, defined as drinking ≥5 standard drinks on a typical day, a highly common form of substance use that we observed to be strongly linked to HIV-related sex risk [37]. According to the model, these mental health and substance use indicators are hypothesized to mediate the relationship between social support and reduced sex risk.…”

“…The study used data from Project DISRUPT (Disruption of Intimate Stable Relationships Unique to the Prison Term), a cohort study conducted to evaluate the degree to which support from a committed partner may buffer against the effects of stress, drug use, and HIV sex risk during re-entry [37]. Using baseline data collected during incarceration, we sought to describe the levels of pre-incarceration perceived support from three sources (significant others, family, and friends) and the relationship with socio-demographic background factors (e.g., age and poverty); describe the association between perceived support and mental disorder and substance use factors that may mediate the relationship between social support and sex risk; and compare associations between each source of support and HIV-related sexual risk behavior and sex with high-risk partners.…”