Background. Because Black men who have sex with men (BMSM) experience high rates of both HIV and incarceration relative to other groups, the various stages of criminal justice involvement may serve as important intervention points for addressing HIV and related conditions in this group. Although systematic reviews of HIV interventions targeting MSM in general and BMSM in particular exist, no review has explored the range and impact of HIV, sexually transmitted infection (STI), and substance use prevention and care continuum interventions focused on criminal justice–involved (CJI) populations. Objectives. To describe the range and impact of published HIV, STI, and related substance use interventions for US-based CJI populations and to understand their relevance for BMSM. Search Methods. We conducted systematic searches in the following databases: PubMed, MEDLINE, Cochrane, CINAHL, and PsycINFO, covering the period preceding December 1, 2016. Selection Criteria. We selected articles in scientific publications involving quantitative findings for studies of US-based interventions that focused on CJI individuals, with outcomes related to sexual or substance use risk behaviors, HIV, or STIs. We excluded studies if they provided no demographic information, had minimal representation of the population of interest (< 30 African American or Black male or transgender participants), had study populations limited to those aged younger than 18 years, or were limited to evaluations of preexisting programs. Data Collection and Analysis. We abstracted data from these articles on study design; years covered; study location; participant number, demographics, and sexual orientation (if available); criminal justice setting or type; health condition; targeted outcomes; and key findings. We scored studies by using the Downs and Black quality and bias assessment. We conducted linear regression to examine changes in study quality by publication year. Main Results. Fifty-eight articles met inclusion criteria, including 8 (13.8%) modeling or cost-effectiveness studies and 13 (22.4%) randomized controlled trials. Just 3 studies (5.2%) focused on sexual or gender minorities, with only 1 focused on BMSM. In most studies (n = 36; 62.1%), however, more than 50% of participants were Black. The most common intervention addressed screening, including 20 empirical studies and 7 modeling studies. Education-focused interventions were also common (n = 15) and usually employed didactic rather than skill-building approaches. They were more likely to demonstrate increases in HIV testing, knowledge, and condom-use intentions than reductions in sex- and drug-risk behaviors. Screening programs consistently indicated cost-effectiveness, including with BMSM. Care continuum interventions for people living with HIV showed mixed results; just 3 involved randomized controlled trials, and these interventions did not show significant differences compared with control conditions. A minority of programs targeted non–custody-based CJI populations, despite their constituting a majority of the CJI population at any given time. Authors’ Conclusions. Screening CJI populations for HIV and other STIs is effective and cost-efficient and holds promise for reducing HIV in BMSM. Education-based and care provision interventions also hold promise for addressing HIV, STIs, mental health, and substance use in CJI populations. Additional empirical and modeling studies and results specific to sexual minorities are needed; their paucity represents a disparity in how HIV is addressed. Public Health Implications. HIV and STI screening programs focused on CJI populations should be a priority for reducing HIV risk and numbers of undiagnosed infections among BMSM. Funding agencies and public health leaders should prioritize research to improve the knowledge base regarding which care continuum intervention approaches are most effective for BMSM with criminal justice involvement. Developments in modeling approaches could allow researchers to simulate the impacts and costs of criminal justice involvement–related interventions that might otherwise be cost, time, or ethically prohibitive to study empirically.
Black men who have sex with men (MSM) and transgender women are disproportionately affected by criminal justice involvement (CJI) and HIV. This study recruited 618 young Black MSM and transgender women in Chicago, IL, using respondent-driven sampling between 2013 and 2014. Random effects logistic regression evaluated predictors of incident CJI over 18 months of follow-up. Controlling for respondent age, gender and sexual identity, spirituality (aOR 0.56, 95% CI 0.33-0.96), and presence of a mother figure (aOR 0.41, 95% CI 0.19-0.89) were protective against CJI. Economic hardship (financial or residential instability vs. neither aOR 2.23, 95% CI 1.10-4.51), two or more past episodes of CJI vs. none (aOR 2.66, 95% CI 1.40-5.66), and substance use (marijuana use vs. none aOR 2.79, 95% CI 1.23-6.34; other drug use vs. none aOR 4.49, 95% CI 1.66-12.16) were associated with CJI during follow-up. Research to identify and leverage resilience factors that can buffer the effects of socioeconomic marginalization may increase the effectiveness of interventions to address the socio-structural factors that increase the risk for CJI among Black MSM and transgender women. Given the intersection of incarceration, HIV and other STIs, and socio-structural stressors, criminal justice settings are important venues for interventions to reduce health inequities in these populations.
Black men who have sex with men (BMSM) and Black transgender women (BTW) are impacted by dual epidemics of HIV and incarceration. We advanced understanding of the relationship between criminal justice involvement, HIV, and other key HIVrelated characteristics among these key populations in the US. We conducted a systematic review up to 2018 and 47 articles met the inclusion criteria of scientific publications involving quantitative findings of US-based HIV-related studies focused on criminal justice-involved (CJI) BMSM and BTW. Overall, there was a dearth of studies focused specifically on BTW. Criminal justice involvement was relatively high among BMSM and BTW and more pronounced among BTW. The current evidence favors no association between incarceration and HIV acquisition among BMSM with limited information about BTW. Criminal justice involvement was associated with a greater likelihood of STIs among BMSM with mixed results for sexual risk behaviors. Criminal justice settings served as an important venue for HIV testing/diagnosis for both BMSM and BTW. However, these settings were not conducive for subsequent stages of the HIV care continuum. Studies pointed to an independent association between criminal justice involvement, substance use, housing instability, and greater odds of incarceration among BMSM who were unemployed and had limited education. Future incarceration was associated with high levels of perceived racism among BMSM. Among young BMSM, high network criminal justice prevalence was also associated with sexual risk behaviors, poorer mental health outcomes, drug use, and housing instability. CJI BMSM and BTW represent a critical subpopulation to end the HIV epidemic in the US.Keywords HIV . Criminal justice-involved . Corrections . Black men who have sex with men . Black transgender women * Russell Brewer
Objectives: We examined whether molecular cluster membership was associated with public health identification of HIV transmission potential among named partners in Chicago.Design: Historical cohort study. Methods:We matched and analyzed HIV surveillance and partner services data from HIV diagnoses (2012)(2013)(2014)(2015)(2016) prior to implementation of cluster detection and response interventions. We constructed molecular clusters using HIV-TRACE at a pairwise genetic distance threshold of 0.5% and identified clusters exhibiting recent and rapid growth according to the Centers for Disease Control and Prevention definition (three new cases diagnosed in past year). Factors associated with identification of partners with HIV transmission potential were examined using multivariable Poisson regression.Results: There were 5208 newly diagnosed index clients over this time period. Average age of index clients in clusters was 28; 47% were Black, 29% Latinx/Hispanic, 6% female and 89% MSM. Of the 537 named partners, 191 (35.6%) were linked to index cases in a cluster and of those 16% were either new diagnoses or viremic. There was no statistically significant difference in the probability of identifying partners with HIV transmission potential among index clients in a rapidly growing cluster versus those not in a cluster [adjusted relative risk 1.82, (0.81-4.06)]. Conclusion:Partner services that were initiated from index clients in a molecular cluster yielded similar new HIV case finding or identification of those with viremia as did interviews with index clients not in clusters. It remains unclear whether these findings are due to temporal disconnects between diagnoses and cluster identification, unobserved cluster members, or challenges with partner services implementation.
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