The High Prevalence of Incarceration History Among Black Men Who Have Sex With Men in the United States: Associations and Implications

Objectives. We examined lifetime incarceration history and its association with key characteristics among 1553 Black men who have sex with men (BMSM) recruited in 6 US cities.Methods. We conducted bivariate analyses of data collected from the HIV Prevention Trials Network 061 study from July 2009 through December 2011 to examine the relationship between incarceration history and demographic and psychosocial variables predating incarceration and multivariate logistic regression analyses to explore the associations between incarceration history and demographic and psychosocial variables found to be significant. We then used multivariate logistic regression models to explore the independent association between incarceration history and 6 outcome variables.Results. After adjusting for confounders, we found that increasing age, transgender identity, heterosexual or straight identity, history of childhood violence, and childhood sexual experience were significantly associated with incarceration history. A history of incarceration was also independently associated with any alcohol and drug use in the past 6 months.Conclusions. The findings highlight an elevated lifetime incarceration history among a geographically diverse sample of BMSM and the need to adequately assess the impact of incarceration among BMSM in the United States.In the United States, an estimated 1.5 million adults are in prisons, 700 000 are in local jails, and an additional 4.8 million are on parole or probation.1 Black Americans are disproportionately affected by incarceration.2–5 In 2011, more than 580 000 Black men and women were in state or federal prisons.2 Both Black men and women were imprisoned at higher rates in all age groups, with the highest imprisonment rate by gender, sex, and age group occurring among Black men aged 25 to 39 years.2 In terms of incarceration history, Black men are also more likely than White men to have a previous history of incarceration. In 2001, almost 17% of Black men had a previous incarceration experience compared with only 2.6% of White men.6 A 31% incarceration history has also been documented in the United States among Black men who have sex with men (BMSM).7Black Americans are also significantly affected by HIV infection. Representing just 14% of the US population, Blacks accounted for almost half (44%) of all new HIV infections as well as almost half of all people living with HIV in 2010.8 Individuals in the correctional system have a higher prevalence of HIV infection than the general US population.9 The 2007 prevalence of AIDS cases among incarcerated individuals in prisons was 2.4 times higher than that in the general population.9 Among individuals in the correctional system, Black men represent the largest proportion of HIV-infected men in state and federal prisons.10 Individuals living with HIV infection are frequently incarcerated during the course of their disease, with an estimated 25% of all Americans living with HIV infection incarcerated at some point during the past year.3,11Incarcerated populations also experience a high prevalence of other conditions that are often related to HIV infection, including elevated sexually transmitted infection (STI) rates,3, 2,5,11–15 prior sexual abuse and assault as a child and as an adult,3,16 mental illness,3,11,17 substance abuse,3,11,18,19 low socioeconomic status,2,16 and a history of survival sex, exchange of sex for money or drugs, and multiple sex partners.3,20,21 Moreover, elevated incarceration and recidivism rates among Black men and women have contributed to a variety of negative health and socioeconomic consequences including high unemployment, reduced opportunities for educational and economic advancement, limited housing, disenfranchisement, poor health, inadequate access to health services, disruption of relationships and family lives, and altered norms related to sexual behavior, concurrency, violence, and drug use.3,4,22–25The impact of incarceration and HIV among Black Americans has been well documented,2–6,8–10,26 but little is known about the relationship between incarceration history, HIV, and demographic and psychosocial characteristics specifically among BMSM, a subgroup that is disproportionately affected by HIV in the United States.7,27–35 We determined lifetime incarceration history among the largest cohort of BMSM to date in the United States and describe the correlates of incarceration history among BMSM enrolled in the HIV Prevention Trials Network (HPTN) 061 study in 6 cities. We focused on the relationship between incarceration history and key demographic and psychosocial characteristics among BMSM that can be used to inform future research and prevention efforts among BMSM.