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Comparisons of associations between incarceration and sexual risk behavior and STI/HIV among Black sexual minority men in Six U.S. cities (HPTN 061)

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BACKGROUND: Few studies have evaluated longitudinal associations between incarceration and post-release STI/HIV risk among Black sexual minority men (BSMM). We measured associations between recent incarceration and STI/HIV-related sexual risk behavior and incident STI/HIV in the six months post release among BSMM.
METHODS: We used data from the HIV Prevention Trials Network (HPTN) 061 study conducted among BSMM in six US cities (Atlanta, Boston, Los Angeles, New York City, San Francisco, and Washington D.C.), restricting to those who returned for the six-month follow-up visit (N=1169). Recent incarceration was defined as having spent '¥one night in jail/prison in the past six months at six-months follow-up. Outcomes were measured at the 12-month follow-up and included multiple ('¥two) partners; selling or buying sex; condomless anal intercourse with an HIV-positive or unknown status partner; and rectal and/or urethral infection with chlamydia and/or gonorrhea, syphilis infection, or HIV acquisition. We calculated adjusted risk ratios (ARRs) and 95% confidence intervals (CIs) to measure associations between recent incarceration and post-release STI/HIV risk using inverse probability of treatment weighting. We explored differences by city, and among BSMM who had sex with men only (BSMMO), BSMM who had sex with men and women (BSMMW), and Black transgender people (BT).
RESULTS: Approximately 14% reported incarceration in the past six months. Incarceration was associated with selling sex (aRR=1.80, 95%CI: 1.12, 2.86) with strong associations in Washington DC (aRR=7.62, 95%CI: 1.58, 36.72) and Boston (aRR=3.09, 95%CI: 1.41, 6.79). Incarceration was associated with multiple partnerships among BSMMW (aRR=1.35, 95%CI: 1.12, 1.64) and BT (aRR=1.74, 95%CI: 1.21, 2.50). Incarceration was associated with incident gonorrhea (aRR=2.44, 95%CI: 0.99, 5.99), with particularly strong associations observed in Los Angeles (aRR=6.48, 95%CI: 1.48, 28.42).
CONCLUSIONS: There is evidence the inequitable burden of incarceration among BSMM plays a role in sexual risk-taking and STI/HIV risk in this population. Researchers, practitioners, and policy makers should establish and maintain collaborative relationships with criminal justice systems to expand provision of STI/HIV services (e.g., STI testing and treatment), and there is a need for social justice efforts and intentional criminal justice reform to focus on the needs of Black people to improve health equity.