Social Networks: A Mediator in the Association Between Incarceration and HIV Risk Behaviors Among Homeless Women

Background: There is a dearth of social network research to specifically understand homeless women’s experiences with the criminal justice system. Research on women with histories of homelessness shows both higher rates of incarceration and higher rates of sexual risk behaviors associated with STI/HIV infection. In an effort to enhance approaches to risk reduction among homeless women, we ask whether history of incarceration may contribute to risk behaviors among women who are already vulnerable due to homelessness. Further, we explore whether social networks mediate the potential effect of incarceration on risk behaviors.

Method: Participants in this study were 445 homeless women who were randomly sampled in temporary shelter settings in Los Angeles County between June 2007 and March 2008. Women were asked whether they had ever been incarcerated in their lifetimes. Social network characteristics, which included number of network members who had risky sexual behaviors and number of network members who had ever been incarcerated, were included as mediators. Risk behaviors included having multiple sex partners in the previous 6 months and having need-based sex in the previous 6 months. Age, education, race, total months homeless and history of child abuse were also included as covariates. Correlations and regressions were run using STATA 12.0.

Results: Multivariate regressions showed that incarceration was significantly associated with number of alters who engaged in risky sex (p<.05) and number of alters who were ever incarcerated (p<.01).  Likewise, logistic regressions showed that women with network members who engaged in risky sex were more likely to have multiple partners (p<.01) and more likely to engage in sex trade or need-based sex (p<.01).

Discussion: The analysis shows that incarceration predicts social networks that are in turn associated with risk behaviors. This enumerates a cycle among women that has previously only been discussed conceptually. Though limited by the temporal structure of the data, associations between incarceration, social networks and risk behaviors suggest that incarceration has a potentially insidious impact on women’s social networks. Social network interventions might then be a more appropriate means for addressing risk among women who have experienced the dual traumas of incarceration and homelessness.