Home Current Issue Previous Issues Published Ahead-of-Print For Authors Journal Info
Skip Navigation LinksHome > March 2006 - Volume 33 - Issue 3 > Unprotected Sex With Multiple Partners: Implications for HIV...
Sexually Transmitted Diseases:
doi: 10.1097/01.olq.0000187232.49111.48
Article

Unprotected Sex With Multiple Partners: Implications for HIV Prevention Among Young Men With a History of Incarceration

Margolis, Andrew D. MPH*; MacGowan, Robin J. MPH*; Grinstead, Olga PHD†; Sosman, James MD‡; Kashif, Iqbal MPH*; Flanigan, Timothy P. MD§; the Project START Study Group

Free Access
Article Outline
Collapse Box

Author Information

From the *Division of HIV/AIDS Prevention, National Center for HIV, STD, TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia; the †Center for AIDS Prevention Studies, University of California-San Francisco, San Francisco, California; the ‡Department of Medicine, University of Wisconsin Medical School, Madison, Wisconsin; and the §Department of Medicine, The Miriam Hospital and Brown Medical School, Providence, Rhode Island

The authors thank the study participants and the members of the Project START Study group for their contributions to the study. Project START Study Group members are John Askew, Lisa Belcher, Gina Best, Diane Binson, Jessica Berzowski, Don Bourque, Jeff Buckles, Mark Charles, Achintya N. Dey, Melissa Dispigno, Gloria Eldridge, Christine Fitzgerald, Timothy Flanigan, Marty Fortenberry, Juarlyn Gaiter, Kellie Green, Olga Grinstead, Jacki Hecht, Kashif Iqbal, Daryl Johnson, Jaclynn Kurpewski, Deborah Kacanek, Anthony King, Carolyn King, Katie Kramer, Melanie Krapf, Annette Lerma, Ricky Lugo, Moribe Lumumba, Robin MacGowan, Kelly Malen, Andrew Margolis, Tim McAuliffe, Kathleen McCartney, Jax McKee-Shapter, Jill Nealey-Moore, Kathleen Morrow, Susan Moss, Mobette Nacua, Ann O'Leary, Stephanie Paton, Michael Patterson, Barbara Reed, Ricardo Reed, Merjo Roca, Noel Rosado, David Seal, Rodney Simms, James Sosman, Kimberly Starr, Daniel Strother, Jerry Vardaman, John M. Williamson, Richard Wolitski, Meghan Woods, William Woods, and Barry Zack. The authors also thank Marie Morgan, Cari Courtenay-Quirk, and Lee Warner (all CDC) for their critical review of the manuscript.

This study was funded by CDC through cooperative agreement number 97,050.

All research activities were approved by Institutional Review Boards at the CDC, Jackson State University, Medical College of Wisconsin, Brown University/the Miriam Hospital, and the University of California San Francisco. All participants provided written consent. Data was protected by a Federal Certificate of Confidentiality. The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Correspondence: Andrew D. Margolis, MPH, Prevention Research Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, TB Prevention, Centers for Disease Control and Prevention, 1600 Clifton Road, Mail Stop E-37, Atlanta, GA 30333. E-mail: AMargolis@cdc.gov.

Received for publication April 29, 2005, and accepted July 19, 2005.

Collapse Box

Abstract

Objectives: The objectives of this study were to describe preincarceration risk behaviors of young men and identify correlates of unprotected sex with multiple partners during the 3 months before incarceration.

Study: Data on preincarceration risk behaviors were obtained from 550 men, aged 18 to 29 years, in state prisons in California, Mississippi, Rhode Island, and Wisconsin. Correlates of unprotected sex with multiple partners were determined by logistic regression.

Results: Of 550 participants, 71% had multiple sex partners, 65.1% had sex with a partner they perceived as risky, and 45.3% engaged in unprotected sex with multiple partners. Men who drank heavily (odds ratio [OR], 1.68; 95% confidence interval [CI], 1.11–2.54) or who had a risky partner (OR, 3.90; 95% CI, 2.60–5.85) were more likely to report unprotected sex with multiple partners. Men who attended religious gatherings (OR, 0.66; 95% CI, 0.46–0.96) or lived in stable housing (OR, 0.69; 95% CI, 0.48–1.00) were less likely to report unprotected sex with multiple partners.

Conclusions: Most participants engaged in behaviors that could result in a sexually transmitted disease, including HIV. Prevention programs should address the relationship between heavy alcohol use and risky sexual behavior. Discharge planning should address housing needs. Faith-based community organizations may play an important role for some young men in their transition to the community.

IN THE UNITED STATES, APPROXIMATELY 2 million persons are incarcerated.1 An additional 4 million persons are on parole or probation. In 2001, the rate of incarceration was one of every 146 U.S. residents,1 a rate surpassing that of any other industrialized nation.2 Black and Latino men are disproportionately represented among people incarcerated.1 Most incarcerated men are eventually released,3 and many are reincarcerated.4

Most persons entering correctional facilities have a history of high-risk sexual behaviors and substance abuse.5–10 High rates of sexually transmitted diseases (STDs), including HIV infection, have been documented among persons entering the correctional system.11,12 Correctional systems have the potential to make important contributions to public health by providing much-needed prevention services to this otherwise hard-to-reach high-risk population. However, the extent of these services has primarily been limited to HIV testing and counseling13–15 and other programs that concentrate more on education than on behavior change.16 Few correctional systems have been able to institute comprehensive HIV prevention and treatment programs.16 Factors such as overcrowding, staff availability, budget restrictions, and a primary focus on custody and security have limited the provision of comprehensive HIV prevention services.17

A broader understanding of the sexual practices among incarcerated men before incarceration may help researchers design innovative, cost-effective, and population-specific HIV-prevention programs that address the needs of these men after release and that are also suitable for the operational constraints of the correctional environment.

In this article, we explore the sexual risk behaviors practiced before incarceration by young men who were recruited into Project START, a federally funded research study comparing the efficacy of 2 HIV, STD, and hepatitis prevention interventions for young men being released from prison. The study was conducted by researchers at the Centers for Disease Control and Prevention (CDC), Jackson State University (Jackson, MS), the Miriam Hospital/Brown Medical School (Providence, RI), the Medical College of Wisconsin Center for AIDS Intervention Research (Milwaukee, WI), the University of California-San Francisco Center for AIDS Prevention Studies (San Francisco, CA), and Centerforce—a community-based organization (San Rafael, CA).

Back to Top | Article Outline

Methods

Study participants were recruited from one state prison in Rhode Island, Mississippi, and California and from 5 state prisons in Wisconsin. Participants were men who were 1) 18 to 29 years of age at the time of enrollment, 2) incarcerated for at least 90 days, 3) scheduled to be released from prison within 14 to 60 days, 4) able to provide informed consent, 5) able and willing to provide basic personal postrelease contact information, 6) able to communicate in English, and 7) released to an unrestricted environment within a site-specified catchment area.

Potential study participants were identified by reviewing monthly prison lists containing the names of men who were 18 to 29 years of age and who were scheduled for release. When the number of potentially eligible participants exceeded recruitment goals, potential participants were approached according to their release date or randomly selected for approach.

All interviews were conducted in prison by using laptops and audio-computer-assisted self-interview (ACASI) technology (Nova Research Co., Bethesda, MD) in Mississippi, Rhode Island, and Wisconsin, and through interviewer-administered questionnaires in California (where correctional restrictions prohibited computers in the prison). The assessment items addressed sexual behavior, substance use, resource utilization, lifetime testing for infectious diseases, and other demographic characteristics. Men who completed the survey were provided a $30 incentive in Mississippi and Wisconsin and a $40 incentive in the other 2 sites. Participants obtained the funds after they were released from prison.

The sexual behavior survey assessed behaviors during the 3 months before incarceration. Partner-by-partner behaviors included an assessment of the frequency of sexual activity (oral, vaginal, and anal sex) and condom use with the 2 most recent main partners and the 2 most recent casual partners. For example, “During the 3 months before your incarceration, about how many times did you and [your partner] have vaginal sex?” and “Of the [number] times that you and [your partner] had anal sex, about how many times did you wear a condom?” A main sex partner was defined as someone to whom the participant felt a special emotional attachment or commitment, and a casual partner was defined as someone with whom the participant did not have a committed relationship. Sexual behaviors with additional partners were assessed collectively for main partners and collectively for casual partners. Partner-specific risk was assessed by asking participants whether they thought any of the following were true for their partner(s): injected drugs, smoked crack cocaine, traded sex for drugs or money, had multiple sex partners, had been diagnosed with an STD, or was HIV-positive. For the purpose of these analyses, a partner with any of these characteristics was defined as a risky sex partner. Unprotected sex with multiple partners was defined as having unprotected vaginal or anal intercourse with 2 or more partners during the 3 months before incarceration.

Alcohol and drug use referred both to lifetime behaviors and activities engaged in during the 3 months before incarceration. Substances were assessed separately: alcohol, marijuana, crack cocaine, powder cocaine, heroin, PCP (phencyclidine), LSD (lysergic acid diethylamide), amphetamines (speed, speedball), ecstasy, or sedatives. For example, “Have you ever injected drugs, including steroids?” and “During the 3 months before your incarceration, how often did you use crack?” Heavy alcohol use was defined as 5 or more drinks 1 or more days per week.

For the purpose of these analyses, stable housing was defined as living in one house or apartment and whether the participant or someone else owned or rented it. Unstable housing was defined as living in any place that was not a house or apartment (e.g., motel, boarding house, jail, drug treatment facility, or on the street) or living in multiple dwellings during the 3 months before incarceration. Employment was defined as a full-time or part-time job. Accessing health-related services encompassed general medical care; testing or educational services for HIV, an STD, or hepatitis; alcohol or drug treatment; child or family programs; anger-management programs; or other programs. Involvement in religious services, prayer ceremonies, or meetings referred to attendance at such gatherings during the 3 months before incarceration.

Data analyses were conducted by using SPSS software (Statistical Package for the Social Sciences, version 12.0). The chi-squared test was used to determine significant findings at the univariate level (P ≤0.05). All significant univariate associations were entered into a stepwise logistic regression model (P ≤0.05). The final model includes variables associated with unprotected sex with multiple partners.

Back to Top | Article Outline

Results

A total of 591 men were eligible for the study; however, 30 (5.1%) refused participation. The remaining 561 men were enrolled in the study, and 550 (98%) completed the assessment and met all of the other Project START eligibility requirements (Table 1). The age of the participants ranged from 18 to 29 years (mean, 23.1 years). Just over half (51.8%) of the men were black. Total time incarcerated since the age of 18 ranged from 2 to 155 months (median, 32.5 months). Most of the men were not married (92.9%), and more than one third (36.0%) reported having been given a diagnosis of an STD, including 2 participants who were HIV-positive, 3 who had hepatitis B infection, and 6 who had hepatitis C infection. Injection drug use (past or present) was reported by 8%.

Table 1
Table 1
Image Tools
Table 1
Table 1
Image Tools

Most of the men (71.8%) reported marijuana use (77.5%) and heavy alcohol consumption (71.8%) during the 3 months before incarceration. Half (49.8%) of the men also reported using other drugs (crack cocaine, powder cocaine, heroin, PCP, LSD, amphetamines, ecstasy, or sedatives). Almost half (48.2%) of the men reported unstable housing. Many (58.4%) had accessed health-related services in the community during the reporting period.

Most (95.7%) of the men were sexually active during the 3 months before their current incarceration; all but 12 (2.2%) reported sex only with female partners. Almost three fourths (71.3%) of the men reported multiple sex partners (median, 4; range, 2–123), and nearly two thirds (65.1%) reported having had a partner they perceived to be risky.

Almost half (45.3%) of the men reported unprotected sex with multiple partners during the 3 months before incarceration (Table 2). Almost all had vaginal sex (98.4%), and approximately half (46.2%) had anal sex (data not shown). Participants reporting unprotected sex with multiple partners included approximately half of those who reported having ever had an STD (53.0%), and slightly more than half reporting a risky sexual partner (57.0%). There were significant differences in unprotected sex with multiple partners by site; race/ethnicity; STD diagnosis; stable housing; attending religious services, prayer ceremonies, or meetings; heavy alcohol use; and having a risky sexual partner. Specifically, men who had ever had an STD diagnosis or who had reported unstable housing, heavy alcohol use, a risky sex partner, or no attendance at religious services, prayer ceremonies, or meetings during the 3 months before incarceration were more likely to report unprotected sex with multiple partners.

Table 2
Table 2
Image Tools

The variables that were independently associated with unprotected sex with multiple partners in multivariate analyses were having a risky partner; heavy alcohol use; attending religious services, prayer ceremonies, or meetings; and stable housing. Men who reported having had a risky sexual partner (odds ratio [OR], 3.90; 95% confidence interval [CI], 2.60–5.85), compared with men who did not, were more likely to report unprotected sex with multiple partners. Men who reported heavy alcohol use (OR, 1.68; 95% CI, 1.11–2.54), compared with those who did not, were also more likely to have had unprotected sex with multiple partners. Men who attended religious services, prayer ceremonies, or meetings (OR, 0.66; 95% CI, 0.46–0.96), compared with those who did not, were less likely to have had unprotected sex with multiple partners. Additionally, men with stable housing (OR, 0.69; 95% CI, 0.48–1.00), compared with men with unstable housing, were less likely to report unprotected sex with multiple partners.

Back to Top | Article Outline

Discussion

Many of the incarcerated young men in our study reported preincarceration sexual risk behaviors that could result in HIV/STD transmission. Most of these risk behaviors involved sex with female partners. These findings support research that has demonstrated significant risk behavior and infectious disease history among men entering prison.7,10,18 In this cohort, heavy alcohol consumption, risky sexual partnerships, lack of involvement in organized religion, and lack of stable housing appear to be associated with sexual risk. Having ever had an STD did not significantly reduce the likelihood of engaging in unprotected sex with multiple partners.

The variables most strongly associated with increased unprotected sex with multiple partners were a risky sex partner and heavy alcohol use. Nearly half of the men who drank heavily reported engaging in unprotected sex with multiple partners, as did slightly more than half of the men with a risky partner. Our findings related to increased sexual risk among men with risky partners may be explained by social network research, which has found that persons typically choose sex partners who are likely to engage in sexual behaviors similar to their own.19,20 Although research findings related to alcohol use and sexual risk behavior have varied, depending on the specific population being studied,21 a recent review of studies in which event-level methods were used suggests that alcohol use is typically associated with high-risk sexual behavior.22 In formative research with men released from prison, we found that for men with multiple partners, alcohol and drug use in conjunction with sex was the only factor independently associated with unprotected vaginal sex with at least one partner.5 Additionally, research involving sentenced male prisoners showed a trend toward increased HIV risk among men who drank alcohol heavily (4 or more drinks/day).18

Men who attended religious services, prayer ceremonies, or meetings were significantly less likely to engage in unprotected sex with multiple partners. A possible explanation for this may be that involvement in religious services, prayer ceremonies, or meetings brought these young men into contact with persons (e.g., clergy, congregants) who provided a positive influence. However, this association remains somewhat unclear given that attendance at these events could be a marker for other influences that were not quantitatively measured (e.g., faith or religiosity, effect of family, core group of friends, maturity, social responsibility, or participation in other structured activities). A correlation has been found between religious faith and fewer HIV risk behaviors among a sample of injection drug users,23 and more recently, an inverse relationship has been found between HIV-risk behavior and strength of spirituality and religious faith among inner-city cocaine users.24

In our sample, stable housing was independently associated with less sexual risk. Although studies have documented the concurrence of HIV infection and homelessness,25,26 the relationship between housing stability and HIV/STD prevention is less well defined. In a recent study, housing status was strongly associated with sexual risk behaviors: homeless and marginally housed persons were at greater risk than those who were stably housed.27 However, investigators did not establish a causal relationship between housing status and HIV risk. In another study, housing was associated with better health outcomes among people transitioning from prison to the community.28 Nonetheless, the provision of adequate housing for men who have been incarcerated is difficult in many communities because of limited resources, long waiting lists, and policies that exclude persons with felony convictions.29 As a result, men returning to the community are often forced to live with friends or relatives who may have contributed to their substance abuse and sexual risk-taking behaviors before incarceration.30

Although unadjusted associations were observed between race/ethnicity, geographic site, and sexual risk, these associations did not remain significant in multivariate analyses. Although it is difficult to offer compelling explanations for these observations, the associations suggest important areas of focus for further research and are likely to have important implications for the refinement of prevention programs for this population.

Using health-related services in the community seemed to be acceptable to these young men. However, the use of health services was not associated with lower rates of unprotected sex with multiple partners. This could be because these services may not have addressed the reduction of sexual risk. Allowing community-health service providers, particularly those that provide HIV/STD prevention, to serve men during incarceration, could further facilitate the use of these services after release. This could also reduce correctional facility costs associated with the provision of comprehensive prevention programs during incarceration.

Reaching young men at risk for HIV, hepatitis, and STDs before incarceration is ideal but may not always be possible. However, correctional facilities offer an opportunity to engage these men in prevention programs.31 A new emphasis on providing incarcerated people with comprehensive prevention programs has been emerging. The Centers for Disease Control and Prevention and the Health Resources and Services Administration funded demonstration projects to develop comprehensive programs to prevent HIV/STD, tuberculosis, hepatitis, and substance abuse and to promote health care; these programs would begin during incarceration and continue after release.32 The Jacksonville Jail, Duval County Florida, for example, has integrated an open-door policy, which allows access to incarcerated men by community-based organizations and other medical and mental health professionals.33 As a result, these providers are able to maintain continuity of care during incarceration.33 The Hampden County, Massachusetts, Correctional Center has integrated into its system a public health model that includes disease screening, patient health education, prevention, treatment, discharge planning, and continuity of care after release.34 These examples indicate a willingness on the part of correctional systems to collaborate with community-based health services agencies and represent a positive direction that can have an important effect on public health.

Our study had limitations. Because the lengths of incarceration differed, the reporting of substance use and sexual behaviors during the 3 months before incarceration may not be accurate for all men. Men who were incarcerated for a longer period may have had more difficulty recalling activities they engaged in during the 3 months before incarceration. All data were reported by young men during incarceration, and therefore, may have been influenced by social desirability responses and other situational biases. The use of A-CASI in sites permitting this technology may have allowed for greater privacy to participants, thereby minimizing some of these concerns to the extent possible. Additionally, this study involved young men 18 to 29 years of age recruited from 4 state prison systems; therefore, research findings may not be representative of all correctional populations.

The advancement of prevention programs in correctional institutions requires a progressive approach on the part of correctional administrators and community-based healthcare providers and the support of the public health research community. The high prevalence of sexual risk in this sample suggests that prevention programs should incorporate basic prevention messages, condom skills-building exercises, and population-specific behavioral risk-reduction planning. The relationship between heavy alcohol use and risky sexual behavior should be emphasized. Postrelease transition planning should include referrals to services that can help these men find stable housing. Faith-based community organizations may play an important role for some young men in their transition to the community.

Back to Top | Article Outline

References

1. Harrison P, Beck A. Prisoners in 2002. Washington, DC: US Department of Justice, Office of Justice Programs, 2003: NCJ 200248. Available at: http://www.ojp.usdoj.gov/bjs/pub/pdf/p02.pdf. Accessed April 14, 2005.

2. International Centre for Prison Studies. World Prison Brief—Highest to Lowest Rates. Available at: http://www.prisonstudies.org/. Accessed April 12, 2005.

3. Bureau of Justice Statistics. Reentry Trends in the US: Releases From State Prison. Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics; 2004. Available at: http://www.ojp.usdoj.gov/bjs/reentry/release.htm. Accessed April 14, 2005.

4. Petersilia J. When Prisoners Return to the Community: Political, Economic, and Social Consequences. Washington, DC: US Department of Justice, Office of Justice Programs, National Institute of Justice, 2000, No. 9. Available at: http://www.ncjrs.org/pdffiles1/nij/184253.pdf. Accessed April 14, 2005.

5. MacGowan RJ, Margolis A, Gaiter J, et al. Predictors of risky sex of young men after release from prison. Int J STD AIDS 2003; 14:519–523.

6. Chen JL, Bovee MC, Kerndt PR. Sexually transmitted diseases surveillance among incarcerated men who have sex with men—An opportunity for HIV prevention. AIDS Educ Prev 2003; 15(suppl A):117–126.

7. Conklin TJ, Lincoln T, Turnhill RW. Self-reported health and prior health behaviors of newly admitted correctional inmates. Am J Public Health 2000; 90:1939–1941.

8. Beck A, Bonczar T, Ditton P, et al. Correctional Populations in the United States, 1997. Washington, DC: US Department of Justice, 2000. Available at: http://www.ojp.usdoj.gov/bjs/pub/pdf/cpus97.pdf. Accessed April 14, 2005.

9. Wilson D. Drug Use, Testing, and Treatment in Jails. Washington, DC: US Department of Justice, Office of Justice Programs, 2000: 1–11. Available at: http://www.ojp.usdoj.gov/bjs/pub/pdf/duttj.pdf. Accessed April 14, 2005.

10. Wohl AR, Johnson D, Jordan W, et al. High-risk behaviors during incarceration in African-American men treated for HIV at three Los Angeles public medical centers. J Acquir Immune Defic Syndr 2000; 24:386–392.

11. Centers for Disease Control and Prevention. Sexually Transmitted Disease Surveillance, 2002. Atlanta: Department of Health and Human Services, Centers for Disease Control and Prevention, 2003.

12. Solomon L, Flynn C, Muck K, Vertefeuille J. Prevalence of HIV, syphilis, hepatitis B, and hepatitis C among entrants to Maryland correctional facilities. J Urban Health 2004; 81:25–37.

13. Bureau of Justice Statistics. Prison Statistics. Washington, DC: US Department of Justice, Office of Justice Programs, Bureau of Justice Statistics, 2004. Available at: http://www.ojp.usdoj.gov/bjs/prisons.htm. Accessed April 14, 2005.

14. Ehrmann T. Community-based organizations and HIV prevention for incarcerated populations: Three HIV prevention program models. AIDS Educ Prev 2002; 14(suppl B):75–84.

15. MacGowan RJ, Khan R, Margolis AD, et al. HIV C&T among incarcerated young men in US prisons. In: Program and Abstracts of the National HIV Prevention Conference, 2003, Atlanta, GA.

16. Centers for Disease Control and Prevention and Academy for Educational Development. Drug Use, HIV, and the Criminal Justice System. August 2001. Available at: http://www.cdc.gov/idu/criminaljustice.htm. Accessed April 14, 2005.

17. Braithwaite RL, Arriola K. Male prisoners and HIV prevention: A call for action ignored. Am J Public Health 2003; 93:759–763.

18. Altice FL, Mostashari F, Selwyn PA, et al. Predictors of HIV infection among newly sentenced male prisoners. J Acquir Immune Defic Syndr 1998; 18:444–453.

19. Garnett GP, Hughes JP, Anderson RM, et al. Sexual mixing patterns of patients attending sexually transmitted disease clinics. Sex Transm Dis 1996; 23:248–257.

20. Rosenberg MD, Gurvey JE, Adler N, Dunlop MB, Ellen JM. Concurrent sex partners and risk for sexually transmitted diseases among adolescents. Sex Transm Dis 1999; 26:208–212.

21. Hirshfield S, Remien RH, Humberstone M, Walavalkar I, Chiasson MA. Substance use and high-risk sex among men who have sex with men: A national online study in the USA. AIDS Care 2004; 16:1036–1047.

22. Weinhardt LS, Carey MP. Does alcohol lead to sexual risk behavior? Findings from event-level research. Annu Rev Sex Res 2000; 11:125–157.

23. Des Jarlais DC, Vanichseni S, Marmor M, et al. ‘Why I am not infected with HIV’: Implications for long-term HIV risk reduction and HIV vaccine trials. J Acquir Immune Defic Syndr 1997; 16:393–399.

24. Avants SK, Marcotte D, Arnold R, Margolin A. Spiritual beliefs, world assumptions, and HIV risk behavior among heroin and cocaine users. Psychol Addict Behav 2003; 17:159–162.

25. Smereck GD, Hockman EM. Prevalence of HIV infection and HIV risk behaviors associated with living place: On-the-street homeless drug users as a special target population for public health intervention. Am J Drug Alcohol Abuse 1998; 24:299–319.

26. Susser E, Miller MP, Valencia E, Colson P, Roche B, Conover S. Injection drug use and risk of HIV transmission among homeless men with mental illness. Am J Psychol 1996; 153:794–798.

27. Aidala A, Cross JE, Stall R, Harre D, Sumartojo E. Housing status and HIV risk behaviors: Implications for prevention and policy. AIDS and Behavior. In press.

28. Zack B, Myers J, Kramer K, Gardner M. Housing is associated with better outcomes among individuals transitioning from prison setting to the community. In: Program and Abstracts of the XV International Conference on AIDS, 2004, Bangkok, Thailand.

29. Bonin E, Brehove T, Kline S, et al. Adapting Your Practice: General Recommendations for the Care of Homeless Patients. Nashville: Health Care for the Homeless Clinicians' Network, National Health Care for the Homeless Council, Inc, 2004.

30. Seal DW, Margolis AD, Sosman J, Kacanek D, Binson D. The Project START Study Group. HIV and STD risk behavior among 18- to 25-year-old men released from US prisons: Provider perspectives. AIDS and Behavior 2003; 7:131–141.

31. Glaser JB, Greifinger RB. Correctional health care: A public health opportunity. Ann Intern Med 1993; 118:139–145.

32. Laufer FN, Arriola KR, Dawson-Rose CS, et al. From jail to community: Innovative strategies to enhance continuity of HIV/AIDS care. The Prison Journal 2002; 82:84–100.

33. Florida Department of Health. Florida Corrections Programs. Available at: http://www.doh.state.fl.us/Disease_ctrl/aids/corrections/corrindex.html. Accessed April 12, 2005.

34. Conklin TJ, Lincoln T, Flanigan TP. A public health model to connect correctional health care with communities. Am J Public Health 1998; 88:1249–1250.

Cited By:

This article has been cited 14 time(s).

American Journal of Public Health
Relative efficacy of a multisession sexual risk-reduction intervention for young men released from prisons in 4 states
Wolitski, RJ
American Journal of Public Health, 96(): 1854-1861.
10.2105/AJPH.2004.056044
CrossRef
AIDS and Behavior
Substance use and sexual behavior during incarceration among 18-to 29-year old men: Prevalence and correlates
Seal, DW; Margolis, AD; Morrow, KM; Belcher, L; Sosman, J; Askew, J
AIDS and Behavior, 12(1): 27-40.
10.1007/s10461-007-9217-8
CrossRef
Journal of Womens Health
Gender Differences in HIV Risk Behaviors of Inmates
Abiona, TC; Adefuye, AS; Balogun, JA; Sloan, PE
Journal of Womens Health, 18(1): 65-71.
10.1089/jwh.2008.0941
CrossRef
Substance Use & Misuse
The Relationship Between Housing Status and HIV Risk Among Active Drug Users: A Qualitative Analysis
Dickson-Gomez, J; Hilario, H; Convey, M; Corbett, AM; Weeks, M; Martinez, M
Substance Use & Misuse, 44(2): 139-162.
10.1080/10826080802344823
CrossRef
Journal of Psychoactive Drugs
Substance Use, Mental Health Problems, and Behavior at Risk for HIV: Evidence from CJDATS
Pearson, FS; Cleland, CM; Chaple, M; Hamilton, Z; Prendergast, ML; Rich, JD
Journal of Psychoactive Drugs, 40(4): 459-469.

Substance Use & Misuse
Can Drug Users be Effective Change Agents? Yes, But Much Still Needs to Change
Dickson-Gomez, J
Substance Use & Misuse, 45(): 154-160.
10.3109/10826080903080656
CrossRef
Journal of the National Medical Association
Incarceration, African Americans and HIV: Advancing a research agenda
Harawa, N; Adimora, A
Journal of the National Medical Association, 100(1): 57-62.

AIDS Education and Prevention
Pairing Hiv-Positive Prisoners With Volunteer Life Coaches to Maintain Health-Promoting Behavior Upon Release: A Mixed-Methods Needs Analysis and Pilot Study
Spaulding, AC; Sumbry, AR; Brzozowski, AK; Ramos, KL; Perez, SD; Maggio, DM; Seals, RM; Wingood, GM
AIDS Education and Prevention, 21(6): 552-569.

Journal of Womens Health
Improving Healthcare for Incarcerated Women
Springer, SA
Journal of Womens Health, 19(1): 13-15.
10.1089/jwh.2009.1786
CrossRef
Journal of Urban Health-Bulletin of the New York Academy of Medicine
Examining the Temporal Relationship Between Criminal Justice Involvement and Sexual Risk Behaviors among Drug-Involved Men
Epperson, MW; El-Bassel, N; Chang, MW; Gilbert, L
Journal of Urban Health-Bulletin of the New York Academy of Medicine, 87(2): 324-336.
10.1007/s11524-009-9429-5
CrossRef
AIDS Patient Care and Stds
Health and health behaviors in HIV-infected jail inmates, 1999 and 2005
White, MC; Tulsky, JP; Estes, M; Jamison, R; Long, HL
AIDS Patient Care and Stds, 22(3): 221-231.
10.1089/apc.2007.0043
CrossRef
American Journal of Public Health
Moving upstream: Ecosocial and psychosocial correlates of sexually transmitted infections among young adults in the United States
Buffardi, AL; Thomas, KK; Holmes, KK; Manhart, LE
American Journal of Public Health, 98(6): 1128-1136.
10.2105/AJPH.2007.120451
CrossRef
Social Science & Medicine
A longitudinal, qualitative analysis of the context of substance use and sexual behavior among 18-to 29-year-old men after their release from prison
Seal, DW; Eldrige, GD; Kacanek, D; Binson, D; MacGowan, RJ
Social Science & Medicine, 65(): 2394-2406.
10.1016/j.socscimed.2007.06.014
CrossRef
Sexually Transmitted Diseases
Is Jail Screening Associated With a Decrease in Chlamydia Positivity Among Females Seeking Health Services at Community Clinics?—San Francisco, 1997–2004
Barry, PM; Kent, CK; Scott, KC; Goldenson, J; Klausner, JD
Sexually Transmitted Diseases, 36(2): S22-S28.
10.1097/OLQ.0b013e31815ed7c8
PDF (424) | CrossRef
Back to Top | Article Outline

© Copyright 2006 American Sexually Transmitted Diseases Association

Login