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Incarceration, Sexual Risk-Related Behaviors, and HIV Infection Among Women at Increased Risk of HIV Infection, 20 United States Cities

Wise, Akilah PhD; Finlayson, Teresa PhD; Nerlander, Lina BMBCh; Sionean, Catlainn PhD; Paz-Bailey, Gabriela PhD, MDfor the NHBS Study Group

JAIDS Journal of Acquired Immune Deficiency Syndromes: July 1st, 2017 - Volume 75 - Issue - p S261–S267
doi: 10.1097/QAI.0000000000001401
Supplement Article

Background: Women involved in the criminal justice system experience multiple risk factors that increase the likelihood of acquiring HIV infection. We evaluated the prevalence of incarceration and compared behaviors among women with and without an incarceration history.

Methods: We use the 2013 National HIV Behavioral Surveillance data, which uses respondent-driven sampling. We evaluate the association between incarceration and the following past 12 months outcomes: exchange sex, multiple casual sex partners (≥3), multiple condomless sex partners (≥3), HIV test, and sexually transmitted infection diagnoses. Log-linked Poisson regression models, adjusted for demographics and clustered on city, with generalized estimating equations were used to estimate adjusted prevalence ratios (aPRs) and 95% confidence intervals.

Results: Of 5154 women, 11% were incarcerated within the previous year, 36% were ever incarcerated but not in the past 12 months, and 53% were never incarcerated. Prevalence of exchange sex (aPR 1.32, 1.20–1.46), multiple casual partners (aPR 1.59, 1.2–2.1), multiple casual condomless partners (aPR 1.47, 1.07–2.03), and sexually transmitted infection diagnosis (aPR 1.61, 1.34–1.93) were all higher among recently incarcerated women compared with those never incarcerated. We also found higher prevalence of recent HIV testing among women recently incarcerated (aPR 1.30, 1.18–1.43).

Discussion: Nearly half of women in our study had been incarcerated. Recent incarceration was associated with several factors that increase the risk of HIV acquisition. HIV prevention, testing, and early treatment among women with a history of incarceration can maximize the effectiveness of the public health response to the HIV epidemic.

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Division of HIV/AIDS Prevention, National Center for HIV, Viral Hepatitis, STD and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA.

Correspondence to: Akilah Wise, PhD, 1600 Clifton Road, MS-E46, Atlanta, GA 30329 (e-mail:

Supported in part by an appointment to the Research Participation Program at the CDC administered by the Oak Ridge Institute for Science and Education through an interagency agreement between the U.S. Department of Energy and CDC.

The authors have no conflicts of interest to disclose.

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 (CDC).

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