Timing and Duration of Incarceration and High-Risk Sexual Partnerships Among African Americans in North Carolina

Khan, Maria R.; Miller, William C.; Schoenbach, Victor J.; Weir, Sharon S.; Kaufman, Jay S.; Wohl, David A.; Adimora, Adaora A.

doi:10.1016/j.annepidem.2007.12.003

« Previous Next »Annals of Epidemiology
Volume 18, Issue 5 , Pages 403-410, May 2008

Timing and Duration of Incarceration and High-Risk Sexual Partnerships Among African Americans in North Carolina

Maria R. Khan, PhD
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, NC
- Address correspondence to: Maria Khan; National Development and Research Institutes, 71 West 23rd Street, New York, NY, 10010. Tel.: 919-306-6368; fax: 917-438-0894.
William C. Miller, MD, PhD
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC
Victor J. Schoenbach, PhD
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC
Sharon S. Weir, PhD
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, NC
Jay S. Kaufman, PhD
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC
- Carolina Population Center, University of North Carolina at Chapel Hill, NC
David A. Wohl, MD
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC
Adaora A. Adimora, MD, MPH
- Department of Epidemiology, University of North Carolina at Chapel Hill, NC
- Division of Infectious Diseases, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, NC

Received 21 August 2007; accepted 4 December 2007. published online 07 April 2008.

Purpose

Incarceration may contribute to HIV transmission by disrupting stable partnerships and promoting high-risk partnerships. We investigated incarceration and high-risk partnerships among African Americans in North Carolina.

Methods

We conducted a weighted analysis using the North Carolina Rural Health Project (N = 320), a population-based case-control study of HIV among African Americans. We measured associations between timing and duration of incarceration and high-risk partnerships (multiple partnerships or sex trade for money or drugs).

Results

Duration of incarceration appeared to be more important than how long ago incarceration occurred. After adjustment for sociodemographic indicators, high-risk partnerships were associated with short-term (<1 month) incarceration of the respondent versus no respondent incarceration (men: adjusted prevalence ratio (aPR) 1.9, 95% confidence interval (95% CI) 1.2–2.8; women: aPR 3.1, 95% CI 1.2–8.3). High-risk partnerships also were associated with incarceration of a partner versus no partner incarceration (men: aPR 1.8, 95% CI 1.1–3.0; women: aPR 2.0, 95% CI 1.1–3.8). Among men, associations remained when adjusting for substance use. Among women, adjustment for substance use weakened estimates due to the strong correlation between substance use and incarceration.

Conclusions

HIV-prevention programs targeting currently and formerly incarcerated individuals and their partners may decrease HIV in African American communities with high incarceration rates.

Key Words: Incarceration, Poverty, Sexual Behavior, HIV, Sexually Transmitted Infections, African Americans, Southern U.S., North Carolina

Selected Abbreviations and Acronyms: HIV, human immunodeficiency virus, AIDS, acquired immunodeficiency syndrome, STI, sexually transmitted infection, RHP, Rural Health Project, NC, North Carolina, DIS, Disease Intervention Specialist, PR, prevalence ratio, 95% CI, 95% confidence interval