Behaviors that put women in danger of acquiring HIV are common among jail detainees, but some groups of women in jail engage in riskier behaviors than others.1 White women report having had more sexual partners in the past year than blacks or Hispanics, and they are more likely to ever have traded sex for drugs or money. On the other hand, greater proportions of Hispanic female jail detainees than of white or black women report never using protection during oral or vaginal sex. White women, women with prior arrests, those arrested for only misdemeanor crimes and those with severe mental disorders score higher than others on a scale measuring sexual behaviors associated with HIV transmission.
To examine which subgroups of female jail detainees are at greatest risk of acquiring HIV, researchers interviewed women entering the Cook County Department of Corrections in Chicago between 1991 and 1993. During private and confidential interviews, participants were asked questions regarding their criminal history, sexual behaviors and injection-drug use. Researchers calculated summary scores of sexual and drug-related risk factors to determine which subgroups were most likely to acquire HIV. These summary scores, ranging on a scale of 0-100, provide a continuous measure of the extremity of behaviors; therefore, higher scores are associated with riskier behaviors.
The initial sample included 1,272 female jail detainees. Participants' ages ranged from 17 to 67; the mean age was 29. Forty percent of the women were black, 34% were white, 25% were Hispanic and 1% were members of other racial and ethnic groups. Four-fifths of the women were unemployed; on average, participants had had 11 years of schooling.
Researchers collected complete data on sexual behavior and drug use for 940 women. The overwhelming majority (97%) of these detainees reported having had vaginal intercourse in the past year; 46% had had oral sex, and 5% had had anal sex. Between 32% and 74% had never used protection during recent sexual activities; 22-45% had always used protection. Forty-three percent had had one sexual partner in the past year, 27% between two and three, 24% between four and 100, and 3% more than 100. One-third ever had traded sex for money or drugs, and one-quarter had done so at least weekly.
A greater proportion of white women (10%) than of blacks (1%) or Hispanics (4%) had had more than 100 sexual partners in the past year. In addition, white women were more likely than others to report ever having had oral or anal sex and having traded sex for money or drugs. Greater proportions of Hispanic women than of whites or blacks reported never using protection during vaginal or oral sex.
White women had significantly higher mean sexual summary risk scores (33) than blacks (25) or Hispanics (24) and, thus, were at the greatest risk of acquiring HIV; the overall mean sexual risk score was 26. Women arrested for misdemeanor crimes had higher sexual risk scores than those charged with felonies (29 vs. 24), and women with prior arrests (juvenile or adult) had higher sexual risk scores than those without (28 vs. 18). Female jail detainees with severe mental illness had a higher mean sexual risk score than did those with no severe disorder (33 vs. 20), and had the highest 90th percentile sexual risk score of any subgroup studied (64).
Nineteen percent of the sample had ever used injection drugs, and 9% had ever shared needles; substantially greater proportions of white women than of blacks and Hispanics had participated in these activities. Injection-drug use risk scores were elevated among white women; those 30 or older; those arrested on drug charges; those with any prior arrests; those with prior arrests for drug possession, drug sales, prostitution or theft; and those with a lifetime history of substance dependence.
The researchers note that many women who are at high risk of acquiring HIV, such as those trading sex for money or drugs and those with severe mental illness, will likely spend some time in jail during their lifetime. In addition, women jailed for less-serious crimes "engage in the most serious HIV and AIDS risk behaviors" and "will return to the community the soonest." Consequently, the researchers conclude that "providing HIV and AIDS education to jail detainees could reduce the HIV and AIDS epidemic in the population as a whole."--J.Rosenberg
1. McClelland GM et al., HIV and AIDS risk behaviors among female jail detainees: implications for public health policy, American Journal of Public Health, 2002, 92(5):818-825.