Time in Jail or Prison Is Associated With an Increased Risk of STDs
History of incarceration is associated with STD infection, as well as with STD risk factors. Compared with their counterparts who had never been in jail or prison, residents of Brooklyn, New York, who had been incarcerated for a cumulative total of less than a year had an approximately 30% increased risk of currently having an STD, including HIV, and those who had been incarcerated for a year or more had an approximately 40% increased risk.1 In addition, individuals who had been incarcerated for less than a year were more likely than those who had never been to have had at least one recent sex partner who currently had an STD; having at least one recent sex partner with a history of incarceration was positively associated with recently having had sex with an infected partner.
To ascertain whether a history of incarceration is associated with STD, researchers recruited 112 males and females older than age 18 living in Brooklyn, New York, between 2002 and 2004 through random sampling on selected blocks and through convenience sampling of injection-drug users and individuals involved in the local group sex party culture. An additional 353 people were recruited after being identified by initial participants as individuals with whom they had had sex, injected drugs or attended a group sex event in the previous three months. All 465 participants completed a survey that included questions about their incarceration, sexual and drug use histories, and their social and demographic characteristics; in addition, participants gave blood and urine for STD testing. For analysis, the sample was restricted to the 343 respondents who were involved in at least one sexual partnership for which interview data for both partners were available. Bivariate analyses were conducted to examine relationships between participants’ characteristics and STD status, and multivariate analyses were conducted to examine associations between incarceration and both STD infection and sex with an infected partner.
Overall, 53% of participants were male; 70% were Latino, 21% were black, 6% were white and 3% belonged to another racial or ethnic group. Seventy-three percent reported ever having used noninjected crack, cocaine or heroin, and 38% had ever used injection drugs. Forty-five percent of participants had ever been in jail or prison; 13% had been incarcerated for a cumulative total of less than one year, and 33% for a year or more. Some 55% had had sex in the past three months with a partner who had ever been incarcerated. The STD prevalence among the sample was 56%; 50% tested positive for herpes, 11% for HIV, 6% for chlamydia, 3% for syphilis and 1% for gonorrhea. Fifty-seven percent had recently had sex with a partner who tested positive for an STD.
Having an STD was positively associated in bivariate analyses with being female, black (compared with Latino) or older than age 18–24; having ever used crack, cocaine, heroin or injection drugs; being a man who had ever had sex with a man; and having had two or more sexual partners within the past three months (prevalence ratios, 1.3–2.0). In analyses controlling for respondent and partner social and demographic characteristics, substance use history and history of same-sex partnership, those who had been incarcerated for less than one year and those who had been incarcerated for a year or more were more likely than those who had never been in jail or prison to currently have an STD (1.3 and 1.4, respectively). Having been incarcerated for less than a year was positively associated with having at least one recent sexual partner who tested positive for an STD (1.3); in addition, those who had one or more recent partners who had ever been incarcerated had an increased risk of having sex with an infected partner (1.4 and 1.9, respectively).
While acknowledging that the cross--sectional nature of their data is a limitation that must be considered when interpreting their findings, the authors suggest that "incarceration may be a risk factor not only of sexual risk behaviors but also of biologically confirmed infection with an [STD] or HIV." They conclude that their results "underscore the importance of correctional facility settings as priority venues for [STD] prevention interventions and highlight the urgent need for the development of community-based interventions for those affected by incarceration.—J. Rosenberg