History of Incarceration and HIV/STD Risk Among Black Men Who Have Sex with Men in Massachusetts

Background: Elevated rates of HIV and STDs have been observed among incarcerated populations, but little is known specific to Black men who have sex with men (MSM).

Objectives: To assess prior incarceration and its association to HIV and STD risk among Black MSM.  

Methods: Between January and July 2008, 197 Black MSM were recruited via modified respondent-driven sampling and completed an interviewer-administered quantitative assessment and optional pre- and post-test HIV counseling and testing. Bivariate and multivariable logistic regression procedures examined the associations of demographics, behavioral risk factors, and psychosocial variables to incarceration history. This study was funded by the Massachusetts Department of Public Health.

Results: Fifty-one percent of participants reported a history of incarceration; 26% had spent 90 days or more in jail during last incarceration. In bivariate analysis, the following factors were significantly associated with an increased odds of incarceration for 90 days or more: (1) Demographics: older age (OR=1.05; p=0.004), self-identifying as bisexual or heterosexual (OR=4.17, p=0.0002), being publicly insured (OR=3.79; p=0.004), history of STDs (OR=2.40; p=0.02); (2) Psychosocial issues: history of injection drug use (OR=9.39; p=0.0001), history of alcohol/drug treatment (OR=6.67; p=0.0001), higher levels of depression (OR=1.03; p=0.03); (3) Sexual risk behavior: unprotected sex with a female partner in the past 12 months (OR=3.02; p=0.001) and unprotected sex with a transgender partner in the past 12 months (OR=7.60; p=0.02). In the final multivariable adjusted model, significant predictors of incarceration included: self-identifying as bisexual or heterosexual (AOR=3.24; p=0.005), history of alcohol/drug treatment (AOR=8.66; p=0.0001), and history of STDs (AOR=2.48; p=0.05).

Conclusions: Findings suggest that formerly incarcerated Black MSM engage in risk behaviors that place themselves and their partners at increased risk for HIV and STDs.

Implications for Programs, Policy, and/or Research: HIV prevention programs for Black MSM with incarceration histories may benefit from including STD screening and treatment as well as referrals to substance abuse and mental health services.