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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

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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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Acknowledgements

We are thankful to the following groups who made possible the HPTN 061 study: HPTN 061 study participants; HPTN 061 Protocol co-chairs, Beryl Koblin, PhD, Kenneth Mayer, MD, and Darrell Wheeler, PhD, MPH; HPTN061 Protocol team members; HPTN Black Caucus; HPTN Network Laboratory, Johns Hopkins University School of Medicine; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Statistical and Data Management Center, Statistical Center for HIV/AIDS Research and Prevention; HPTN CORE Operating Center, Family Health International (FHI) 360; Black Gay Research Group; clinical research sites, staff, and Community Advisory Boards at Emory University, Fenway Institute, GWU School of Public Health and Health Services, Harlem Prevention Center, New York Blood Center, San Francisco Department of Public Health, the University of California, Los Angeles, Center for Behavioral and Addiction Medicine, and Cornelius Baker, FHI 360. We are thankful to Sam Griffith, Senior Clinical Research Manager, FHI 360, and Lynda Emel, Associate Director, HPTN Statistical and Data Management Center, Fred Hutchinson Cancer Research Center, for their considerable assistance with HPTN 061 data acquisition and documentation.

Funding

This research was supported by the National Institute on Drug Abuse grant ‘Stop-and-Frisk, Arrest, and Incarceration and STI/HIV Risk in Minority MSM’ (Principal Investigator: Maria Khan; R01 DA044037). This research uses data from the HIV Prevention Trials Network 061 (HPTN 061) study. HPTN 061 grant support was provided by the National Institute of Allergy and Infectious Disease (NIAID), National Institute on Drug Abuse (NIDA) and National Institute of Mental Health (NIMH): Cooperative Agreements UM1 AI068619, UM1 AI068617, and UM1 AI068613. Additional site funding included Fenway Institute Clinical Research Site (CRS): Harvard University CFAR (P30 AI060354) and CTU for HIV Prevention and Microbicide Research (UM1 AI069480); George Washington University CRS: District of Columbia Developmental CFAR (P30 AI087714); Harlem Prevention Center CRS and NY Blood Center/Union Square CRS: Columbia University CTU (5U01 AI069466) and ARRA funding (3U01 AI069466-03S1); Hope Clinic of the Emory Vaccine Center CRS and The Ponce de Leon Center CRS: Emory University HIV/AIDS CTU (5U01 AI069418), CFAR (P30 AI050409) and CTSA (UL1 RR025008); San Francisco Vaccine and Prevention CRS: ARRA funding (3U01 AI069496-03S1, 3U01 AI069496-03S2); UCLA Vine Street CRS: UCLA Department of Medicine, Division of Infectious Diseases CTU (U01 AI069424). The funder had a role in the design of the study by providing input into the design. The funder did not have a role in the data collection and analysis, decision to publish, or preparation of the manuscript. The funding agencies had no role in designing the research, data analyses and preparation of the report. Maria Khan, Charles Cleland, and Joy Scheidell received support from the New York University Center for Drug Use and HIV Research (P30 DA011041). Maria Khan additionally was supported by the New York University-City University of New York (NYU-CUNY) Prevention Research Center (U48 DP005008). Typhanye Dyer and Rodman Turpin were supported by the University of Maryland Prevention Research Center (U48 DP006382). Russell Brewer was supported by a grant from NIDA (P30 DA027828-08S1).

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Authors and Affiliations

  1. Department of Population Health, New York University Grossman School of Medicine, 227 East 30th St, #617J, New York, NY, 10016, USA

    MacRegga Severe, Joy D. Scheidell, Alberta Negri, Kailyn E. Young, Charles M. Cleland & Maria R. Khan

  2. Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA

    Typhanye V. Dyer & Rodman E. Turpin

  3. Department of Medicine, University of Chicago, Chicago, IL, USA

    Russell A. Brewer

  4. Black AIDS Institute, Los Angeles, CA, USA

    Christopher Hucks-Ortiz

  5. The Fenway Institute, Boston, MA, USA

    Kenneth H. Mayer

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  1. MacRegga Severe
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Severe, M., Scheidell, J.D., Dyer, T.V. et al. 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 25, 1507–1517 (2021). https://doi.org/10.1007/s10461-020-02989-w

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