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. DOI: 10.1016/S0027-9684(15)31175-5
Source: PubMed


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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    • "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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    • "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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