Incarceration and Sexually Transmitted Infections: A Neighborhood Perspective

Abstract

The social dynamics of some communities are affected by the loss of significant numbers of people to prison and by the release of others who encounter the challenge of coping with the negative effects of the incarceration experience. The effects on communities are evident, in part, in the high rates of sexually transmitted infections (STIs) in North Carolina (NC) counties that have a high rate of incarceration. In the present study, we examined whether the same associations can be observed at the census tract level in one urban city of NC. To identify the mechanisms by which incarceration can affect the transmission of STIs, we conducted ethnographic interviews with ex-offenders and people who lost a sexual partner to prison. We found that census tract rates of incarceration were consistently associated with gonorrhea rates in the subsequent year. An increase of the percentage of census tract person-time spent in prison from 2.0% to 2.5% corresponded to a gonorrhea rate increase of 7.1 cases per 100,000 person-years. The people interviewed spoke of sexual partnership changes including those left behind finding new partners, in part for help in making financial ends meet; men having sex with men for the first time in prison; and having multiple new partners upon reentry to the community. The statistical associations and stories of the effects of incarceration on sexual relationships provide additional evidence of unintended community health consequences of high rates of incarceration.

Health Disparities and the Criminal Justice System: An Agenda for Further Research and Action

“…[34][35][36][37] Iguchi and colleagues described the adverse effects of criminalization of drug users on health through decreased access to health benefits, housing, and employment, as well as subsequent impacts on families and communities. 38 In 2001, Freudenberg extensively reviewed the mechanisms by which the criminal justice system adversely impacted health in urban communities.…”

“…39 Rates of sexually transmitted diseases and teenage pregnancy have been shown to be associated with community incarceration rates. 35 Urban neighborhoods whose inhabitants have high rates of incarceration and many returning inmates 40 experience a phenomenon similar to "forced migration" which disrupts social, family, and sexual networks and has secondary effects on the health of the community. 36 For instance, community members find new sexual partners when prior partners go to prison.…”

“…Former inmates may have multiple partners on return to the community after release, putting themselves and others at risk for acquiring HIV. 35 Despite these potentially detrimental effects of criminal justice involvement, interventions with criminal justice involved populations could play a pivotal role in the identification and reduction of racial/ethnic disparities in health care and outcomes. Alternatively, if the health problems of individuals in the criminal justice system are neglected, disparities could be perpetuated or worsened.…”

Heterosexual HIV and Sexual Partnerships Between Injection Drug Users and Noninjection Drug Users

“…17,18 Sex partnerships of varying risk levels have been documented, for example, between low-risk women and men with histories of bisexuality or incarceration. 19,20 Another example, and the focus of this study, is partnerships between IDU and non-IDU heterosexuals. Despite decreases in injection-related HIV risk, many IDU still engage in sexual risk behaviors.…”

Social policy, imperiled communities and HIV/AIDS transmission in prisons: a call for zero tolerance

“…While no studies currently explore the explicit relationship between lower gender ratios of men to women and an increase in the transmission of HIV, the increasing rates of other STIs in African-American communities is suggestive [12]. Research does support the contention that the loss of African-American men from communities has lowered the ratio of African-American men to women, and has disrupted sexual partnerships and networks in ways that exacerbate STI transmission and likely HIV infection [13,14]. AIDS is the leading cause of death among 25-44 year old African-American men and HIV rates are rapidly rising among heterosexual African-American women [15].…”