Incarceration, African Americans and HIV: Advancing a research agenda

Department of Research, Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA.
Journal of the National Medical Association (Impact Factor: 0.96). 02/2008; 100(1):57-62.
Source: PubMed

ABSTRACT Incarceration is a crisis among African Americans, and the prevalence of HIV/AIDS in incarcerated men and women is 3-5 times that of the general population. We explore the potential implications of the widespread incarceration of African Americans on HIV risk and HIV outcomes in: 1) the current and formerly incarcerated, 2) their sexual partners, and 3) the communities impacted by incarceration. We set forth a research agenda for understanding and ameliorating the negative impacts incarceration and conclude that the African-American population's ability to successfully address the HIV/AIDS epidemic requires a coordinated and evidence-based response to the challenge of effectively preventing, managing and treating HIV in populations affected by incarceration.

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    • "as shown in Figure 1, and more than half of persons who tested positive were MSM. This is consistent with the current HIV literature that reflects an overrepresentation of positive MSM and minority males, as well as disparities, discrimination, and social inequalities that may contribute to disproportionately high rates of HIV/AIDS in the Black/AA population in the South [40] [45] [46]. Additionally, as only 14% of persons who tested positive in this sample were motivated for testing by perceived high risk behavior, and timely utilization of HIV testing services among MSM has been observed in other studies, it may be valuable to expand high impact prevention strategies for this population by providing individual and couples testing services for MSM as well as offering PrEP to persons with higher risk behaviors [47] [48] [49]. "
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    ABSTRACT: The Southern states experience the highest rates of HIV and AIDS in the US, and point-of-care (POC) testing outside of primary care may contribute to status awareness in medically underserved populations in this region. To evaluate POC screening and linkage to care at an urban south site, analyses were performed on a dataset of 3,651 individuals from an integrated rapid-result HIV testing and linkage program to describe this test-seeking cohort and determine trends associated with screening, results, and linkage to care. Four percent of the population had positive results. We observed significant differences by test result for age, race and gender, reported risk behaviors, test location, and motivation for screening. The overall linkage rate was 86%, and we found significant differences for clients who were linked to HIV care versus persons whose linkage could not be confirmed with respect to race and gender, location, and motivation. The linkage rate for POC testing that included a comprehensive intake visit and colocated primary care services for in-state residents was 97%. Additional research on integrated POC screening and linkage methodologies that provide intake services at time of testing is essential for increasing status awareness and improving linkage to HIV care in the US.
    AIDS research and treatment 09/2013; 2013:789413. DOI:10.1155/2013/789413
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    • "For instance, high incarceration rates among Black men, including Black men who have sex with men, are attributable to the cumulative effects of poverty, under-education, racialized policing, disparate sentencing laws and discrimination within the criminal justice system (Harawa and Adimora 2008). These factors related to race contribute to increased risk for HIV among Black men who have sex with men (Harawa and Adimora 2008). In addition, cultural and institutionalized homophobia is a driving factor in the disproportionate impact of HIV among men who have sex with men (Stall et al. 2003). "
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    ABSTRACT: This study investigated the role of incarceration in HIV/STD risk among 197 Black men who have sex with men in Massachusetts, USA. More than half (51%) reported a history of incarceration (28% < 90 days in jail/prison; 23% ≥ 90 days in jail/prison). Multivariable logistic regression models adjusted for age and sexual orientation examined associations between demographic, behavioural, social-psychological and cultural factors and incarceration history. Factors associated with < 90 days of incarceration were: unprotected sex with a man, STD history, injection drug use and substance abuse treatment. Factors associated with ≥ 90 days of incarceration were: unprotected sex with a woman, crack use during sex, STD history, injection drug use, substance abuse treatment, depressive symptoms, post-traumatic stress symptoms, HIV fatalism and social capital. Black men who have sex with men with incarceration histories may be at increased risk for HIV/STDs compared to those without such histories. HIV prevention efforts that focus on individual risk and cultural-contextual issues among Black men who have sex with men are warranted.
    Culture Health & Sexuality 12/2011; 14(3):329-45. DOI:10.1080/13691058.2011.639902 · 1.55 Impact Factor
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    • "However, the formation of bridges between inmates' risk networks when an adequate proportion of susceptible inmates exists may lead to efficient infection transmission [52,99]. In contrast, studies have shown that many inmates, following re-entry in the community, revert to pre-incarceration habits and engage in high rates of unsafe sexual and intravenous drug use behaviors [122-126], as suggested, for instance, by high frequency of anal sex reporting [124], excess occurrence of drug overdose [125-127], and high risk for mortality [80,128-130] at post release. Among the four studies on inmates released and reincarcerated, those reporting the highest post-release incidence rates followed recidivist female IVDU [34] and recidivist MSM [36]. "
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    ABSTRACT: High Human Immunodeficiency Virus (HIV) prevalence and high risk behaviors have been well documented within United States (US) correctional systems. However, uncertainty remains regarding the extent to which placing people in prison or jail increases their risk of HIV infection, and regarding which inmate populations experience an increased incidence of HIV. Describing these dynamics more clearly is essential to understanding how inmates and former detainees may be a source for further spread of HIV to the general US population. The authors conducted a systematic review and meta-analysis of studies describing HIV incidence in US correctional facility residents and, for comparison, in high risk groups for HIV infection, such as non-incarcerated intravenous drug users (IVDU) and men who have sex with men (MSM) in the US. HIV incidence rates were further compared with Hepatitis B and Hepatitis C Virus rates in these same populations. Thirty-six predominantly prospective cohort studies were included. Across all infection outcomes, continuously incarcerated inmates and treatment recruited IVDU showed the lowest incidence, while MSM and street recruited IVDU showed the highest. HIV incidence was highest among inmates released and re-incarcerated. Possible sources of heterogeneity identified among HIV studies were risk population and race. Although important literature gaps were found, current evidence suggests that policies and interventions for HIV prevention in correctional populations should prioritize curtailing risk of infection during the post-release period. Future research should evaluate HIV incidence rates in inmate populations, accounting for proportion of high risk sub-groups.
    BMC Public Health 12/2010; 10(1):777. DOI:10.1186/1471-2458-10-777 · 2.26 Impact Factor
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