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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

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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.

Resumen

Los afroamericanos en general enfrentan tazas de infección de transmisión sexual (ITS) incluido VIH, desproporcionadamente altas, estando los que pasan por un centro penitenciario a más alto riesgo. Es necesario identificar los factores de riesgo modificables de ITS/VIH entre reclusos afroamericanos. El Proyecto DISRUPT es un estudio de cohorte con reclusos afroamericanos (n = 270), que se encontraban en una relación heterosexual seria cuando entraron a la prisión. Los participantes fueron reclutados en prisiones de Carolina del Norte entre Septiembre del 2011 y Enero del 2014. Durante la primera visita al principio del estudio (en prisión), los participantes respondieron a varias preguntas sobre conductas de riesgo y proporcionaron una muestra de orina para pruebas de ITS. Un porcentaje considerable reportó haber tenido múltiples parejas (42 %), relaciones concurrentes (33 %) y pagar por sexo (11 %) en los seis meses antes de entrar a la cárcel, y el 9 % dio positivo a la prueba de ITS al inicio del estudio (clamidia: 5,3 %, gonorrea: 0.5 %, tricomoniasis: 4,9 %). La pobreza y la depresión parecen estar fuertemente asociados con conductas sexuales de riesgo. El consumo de sustancias estaba vinculado a frecuentes infecciones de transmisión sexual, siendo el consumo excesivo de alcohol el factor de riesgo independiente más fuerte (odds ratio ajustado (AOR): CI 3,79, 95 %: 01.19 a 12.04). Es necesario continuar mejorando las pruebas de ITS en las cárceles, el tratamiento, la educación y la prevención, así como la salud mental y el diagnóstico de abuso de sustancias.

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Acknowledgments

This study was supported by NIDA R01DA028766 (PI: Khan) and the University of North Carolina Center for AIDS Research [AI050410]. Dr. Golin’s salary was partially supported by K24 HD06920. Dr. Friedman was supported by Theory Core of CDUHR P30 DA11041. Dr. Adimora was supported by 1K24HD059358. Laboratory testing for STIs was supported in part by the Southeastern Sexually Transmitted Infections Cooperative Research Center Grant U19-AI031496 from the National Institute of Allergy and Infectious Diseases.

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Authors and Affiliations

  1. Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, 227 East 30th Street 10016, New York, NY, USA

    M. R. Khan, J. D. Scheidell & K. P. Medina

  2. Division of General Internal Medicine and Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    C. E. Golin

  3. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    C. E. Golin

  4. National Development and Research Institutes, New York, NY, USA

    S. R. Friedman

  5. Division of Infectious Disease, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    A. A. Adimora, S. Judon-Monk, M. M. Hobbs, G. Dockery, S. Griffin, K. K. Oza, D. Myers & D. A. Wohl

  6. Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    A. A. Adimora

  7. Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, USA

    H. Hu

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Khan, M.R., Golin, C.E., Friedman, S.R. et al. 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 19, 1478–1490 (2015). https://doi.org/10.1007/s10461-015-1062-6

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