The association between substance use and sexual HIV risk behaviors among young incarcerated men

Background: Incarcerated men in the U.S. display HIV rates 3-5 times that of the general population, which is often attributed to high levels of substance abuse. Understanding how the association between HIV and criminal justice involvement develops for justice-involved men suggests exploring structural, systemic factors that place them in the path of both the epidemic and the correctional system. Because men tend to initiate both criminal justice involvement and HIV risk in late adolescence/early adulthood, it is important to explore these issues among younger men. This study examines the relationship between substance use and sexual HIV risk behaviors among young incarcerated men and addresses the following questions: What are the substance use and HIV risk characteristics of incarcerated young men of color? Is there an association between substance use and engaging in sexual HIV risk behaviors among these young men?

Methods: A sample of 552 males age 16-18 were interviewed while incarcerated at Rikers Island Detention Center regarding behaviors occurring prior to incarceration. Interviews included questions on demographics, criminal justice involvement, health, substace use, sexual behavior, education and employment histories. Bivariate analyses were performed to examine demographic and HIV-risk behavior differences between men with and without recent alcohol and marijuana use. Logistic regression was used to examine associations between alcohol and marijuana use and sexual HIV risk behaviors in the 90 days prior to incarceration. To test for differential effects of alcohol and marijuana use intensity, separate models were conducted for “any” use and “intense” use.

Results: Respondents were predominantly Black (57%) or Hispanic (37%), with a mean age of 17.4 years. The most common substances used were marijuana (82%) and alcohol (65%). Rates of sexual activity and inconsistent condom use were quite high, and the average age of sexual initiation was 13 years. Alcohol use prior to incarceration was significantly associated with having three or more sexual partners in the same period (adjusted OR=2.40, p<.001) as well as with having unprotected sex with a long-term partner (adjusted OR=1.72, p<.01). Marijuana use was significantly associated with having multiple sex partners (adjusted OR=1.55, p<.01). Intense alcohol and marijuana use did not result in a greater likelihood of sexual risk behaviors when compared to “any” use.

Conclusions: High rates of substance use and unprotected sex may have unintended health consequences for young incarcerated men. Although both alcohol and marijuana use were related to sexual risk behaviors, severity of substance use did not appear to be a significant predictor of risk behaviors, suggesting the importance of contextual and social factors. This relationship warrants further development in models of alcohol and other substance use examining distal and proximal factors that indirectly and directly influences behavior among low-income young who have been incarcerated. Results highlight the need for targeted HIV prevention efforts for this population that address the intersection of substance use and sexual behaviors. Such interventions with younger criminal justice populations are critical, given the marked disparities in HIV for older justice-involved men.