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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

Sexually Transmitted Diseases: March 2006 - Volume 33 - Issue 3 - p 175-180
doi: 10.1097/01.olq.0000187232.49111.48

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.

A study of young men's behaviors before incarceration found that correlates of unprotected sex with multiple partners included heavy alcohol use, having a risky partner, and unstable housing.

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:

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

© Copyright 2006 American Sexually Transmitted Diseases Association