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Gender Differences in HIV Risk Behaviors Among Persons Involved in the U.S. Criminal Justice System and Living with HIV or at Risk for HIV: A “Seek, Test, Treat, and Retain” Harmonization Consortium

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Abstract

The U.S. female criminal justice (CJ) population is rapidly growing, yet large-scale studies exploring gender-specific HIV risk behaviors in the CJ population are lacking. This analysis uses baseline data on adults with a CJ history from eight U.S. studies in an NIH-funded “Seek, Test, Treat, Retain” harmonization consortium. Data were collected using a standardized HIV risk behavior assessment tool and pooled across studies to describe participants’ characteristics and risk behaviors. Multilevel mixed-effects logistic regression models were used to test for gender-based behavior differences. Among 784 HIV-positive (21.4% female) and 5521 HIV-negative (8.5% female) participants, HIV-positive women had higher odds than HIV-positive men of engaging in condomless sexual intercourse (AOR 1.84 [1.16–2.95]) with potentially sero-discordant partners (AOR 2.40 [1.41–4.09]) and of sharing injection equipment (AOR 3.36 [1.31–8.63]). HIV risk reduction interventions targeting CJ-involved women with HIV are urgently needed as this population may represent an under-recognized potential source of HIV transmission.

Resumen

La población femenina del Sistema de justicia penal (JP) de EEUU está creciendo rápidamente, sin embargo, hacen falta estudios de gran escala que exploren conductas de alto riesgo de VIH, género específicas, en la población de JP. Este análisis usa datos de referencia de adultos con historia de JP, extraídos de ocho estudios de EEUU parte de un consorcio de armonización de “Buscar, Evaluar, Tratar, Retener”, financiado por el Instituto Nacional de Salud. Usando una herramienta estandarizada de evaluación de conductas de riesgo en VIH, los datos recopilados de los estudios fueron combinados para describir las características de los participantes y las conductas de riesgo. Se usaron modelos de regresión logística multinivel de efectos mixtos para evaluar diferencias en las conductas según el género. De 784 participantes VIH positivo (21.4% mujeres) y 5521 VIH negativo (8.5% mujeres), las mujeres VIH positivas tuvieron mayor probabilidad que los hombres VIH positivos de tener relaciones sexuales sin condón (AOR 1.84 [1.16–2.95]), con parejas potencialmente serodiscordantes (AOR 2.40 [1.41–4.09]) y de compartir equipos de inyección (AOR 3.36 [1.31–8.63]). Se necesitan urgentemente intervenciones dirigidas a mujeres VIH positivas del sistema de JP para la reducción del riesgo de VIH, ya que esta población puede representar una fuente potencial y poco conocida de VIH.

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Acknowledgements

Research presented in this paper is the result of secondary data analysis associated with the Seek, Test, Treat, and Retain (STTR) Data Collection and Harmonization Initiative, and was supported by U01DA037702 (University of Washington), F30DA041247 (Loeliger), and K02DA032322 (Springer) from the National Institute on Drug Abuse (NIDA) as well as the Yale University Medical Scientist Training Program under National Institute of General Medical Sciences Training Grant T32GM007205 (Loeliger) and P30AI042853 (Beckwith) from the Providence-Boston Center for AIDS Research. Primary data collection was conducted as part of the STTR consortium and was supported by Grants R01DA030768 (Altice, Springer), K24DA017072 (Altice), R01DA030771 (Gordon), R01DA030796 (Ouellet, Young), R01DA030770 (Seal), and R01DA030762 (Springer, Altice). The authors would like to thank the research teams associated with the STTR consortium whose collaboration made this project possible. The authors also thank the participants of the individual STTR studies for their valuable contributions. A full list of participating STTR investigators and institutions can be found at http://www.sttr-hiv.org.

Funding

This study was funded by the National Institute on Drug Abuse (Grant Numbers F30DA041247 [Loeliger], U01DA037702 [University of Washington], R01DA030770 [Seal], R01DA030771 [Gordon], R01DA030796 [Ouellet, Young], K24DA017072 [Altice], R01DA030768 [Altice, Springer], K02DA032322 [Springer], and R01DA030762 [Springer, Altice]), as well as the National Institute of General Medical Sciences (Grant Number T32GM007205 [Yale University Medical Scientist Training Program]) and the Providence-Boston Center for AIDS Research (Grant Number P30AI042853 [Beckwith]).

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Authors and Affiliations

  1. Yale University AIDS Program, Yale School of Medicine, New Haven, CT, USA

    Kelsey B. Loeliger, Frederick L. Altice & Sandra A. Springer

  2. Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA

    Kelsey B. Loeliger & Frederick L. Altice

  3. Department of Biostatistics, University of Washington, Seattle, WA, USA

    Mary L. Biggs & Rebekah Young

  4. Department of Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA

    David W. Seal

  5. Department of Medicine/Infectious Diseases, The Miriam Hospital/Alpert Medical School of Brown University, Providence, RI, USA

    Curt G. Beckwith

  6. Department of Epidemiology and Biostatistics, George Washington University Milken Institute School of Public Health, Washington, DC, USA

    Irene Kuo

  7. Friends Research Institute Inc., Baltimore, MD, USA

    Michael S. Gordon

  8. Centre of Excellence on Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia

    Frederick L. Altice

  9. Department of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, IL, USA

    Lawrence J. Ouellet

  10. Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    William E. Cunningham

  11. Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA

    William E. Cunningham

  12. Division of Infectious Diseases, Immunology and International Medicine, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Jeremy D. Young

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  1. Kelsey B. Loeliger
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Correspondence to Kelsey B. Loeliger.

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Loeliger, K.B., Biggs, M.L., Young, R. et al. Gender Differences in HIV Risk Behaviors Among Persons Involved in the U.S. Criminal Justice System and Living with HIV or at Risk for HIV: A “Seek, Test, Treat, and Retain” Harmonization Consortium. AIDS Behav 21, 2945–2957 (2017). https://doi.org/10.1007/s10461-017-1722-9

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