Gender and risk behaviors for HIV and sexually transmitted infections among recently released inmates: A prospective cohort study

Abstract

Women in prison have a higher prevalence of HIV than men. After release from prison, former inmates have the opportunity to engage in risk behaviors for HIV and other sexually transmitted infections (STI). We sought to assess change in risk behaviors over time and the association of gender with risk behavior in the post-release period. In this prospective cohort study, we interviewed 200 former inmates (51 women) approximately 2 weeks (baseline) and 3 months (follow-up) after release and tested them for HIV infection at follow-up. We examined the association of gender with unprotected vaginal or anal sex in the last seven days using chi-square and Fisher’s exact tests and multivariable logistic regression. At baseline, 22% of men and 41% of women reported unprotected vaginal sex (p<0.01) and 5% of men and 8% of women reported unprotected anal sex (p=0.51). Being younger (OR for each decade increase 0.48, 95% CI 0.29-0.80), being gay/lesbian or being bisexual (compared with being heterosexual, OR=4.74 95% CI 1.01–22.17, OR=3.98, 95% CI 1.41–11.26, respectively), or reporting a drug of choice of heroin/speedballs or cocaine/crack (compared with marijuana/no drug of choice, OR=24.00, 95% CI 5.15–111.81 and OR=3.49, 95% CI 1.20–10.18, respectively) were associated with unprotected vaginal or anal sex after adjusting for race, homelessness, and hazardous drinking. At follow-up, 21% of men and 44% of women reported unprotected sex (p=0.005), and female gender (OR=4.42, 95% CI 1.79–10.94) and hazardous drinking (compared with not meeting criteria for hazardous drinking, OR=3.64, 95% CI 1.34–9.86) were associated with unprotected sex, adjusting for race and homelessness. In this population with a high prevalence of HIV, we demonstrated persistent engagement in sexual risk behavior during the post-release period. Enhanced efforts to promote sexual health and reduced risk behavior among both male and female current and former prison inmates are needed, including improved access to preventive care and HIV and STI screening, testing and treatment.

Health Priorities among Women Recently Released from Jail

“…13,18-20 The literature also shows that the risk of death, drug use, overdose, and HIV are great for both women and men in the days and weeks immediately after release from jail or prison. 19,21,22 The few studies of women's priorities after release from jail reflect the reality of logistical barriers to reentry success, though do not highlight women's acknowledgment of these dangerous post-release health outcomes. 13,14 We also found little evidence that women's priorities mirrored the reality of poor post-release health outcomes documented in the literature.…”

“…13,14 We also found little evidence that women's priorities mirrored the reality of poor post-release health outcomes documented in the literature. 19,21,22 The distinction between a woman's real health risks after jail and her priorities is important – ultimately, her set of priorities will drive her actions. 16 The alignment of risks, priorities, and reentry realities for women could be examined further in future studies.…”

Gender differences in HIV risk behaviors in individuals recently released from prison: results of a pilot study

“…Some studies found that men engage in higher rates of drug-related HIV risk behavior in comparison with women; others showed that women are more likely to engage in transactional and unprotected sex. (Oser et al 2006; Binswanger et al 2014; Khan et al 2008; L. M. Adams et al 2013). These studies have primarily focused on individual risk behaviors, with few exploring how specific factors mediate increased risk for HIV by gender.…”

Tobacco Use Among People Who Have Been in Prison: Relapse and Factors Associated with Trying to Quit

“…This study is a secondary analysis of data that was originally collected to examine the HIV risk behaviours of people recently released from prison (Binswanger, Mueller, Beaty, Min, & Corsi, 2014). The original study was a prospective cohort study of people released from a western state prison system to a single metropolitan area.…”