Incarceration and Sex-Related HIV Risk among CT Men on Probation or Parole

Background

At the aggregate level, there is an association between incarceration and HIV. While this association may signify risk within the prison environment, of greater interest in this paper is how movement in and out of prison/jail impacts on HIV risk. Incarceration may produce risk for HIV outside the prison walls through its impact on concurrency, relationship stability, the characteristics of partners, and the negotiation of condom use. We examine relationship and partner characteristics pre- and post-incarceration and their association with condom use practices of men recently released to probation or parole.

Methods

Data for this analysis come from a survey (administered using ACASI) of probationers and parolees in New Haven, CT who were released from prison or jail within 12 months of enrollment in the study. Eligibility was confirmed using records from the CT Departments of Corrections and Court Support Services. We also draw from longitudinal, semi-structured interviews conducted with 48 probationers and parolees at 6 month intervals over a one year period.

Results

130 eligible individuals completed the survey, of whom 105 were men. Most respondents (63.1%) had never been married, 10.8% were currently married. In the 30 days prior to their most recent incarceration, respondents reported a total of 156 sexual partners. 34.6% of these were in committed relationships (including marriage) with the respondents. 22.2% of them represented one-time sexual encounters. Relationships with 38% of these 156 partners were not continued upon respondents' release from prison, 25.0% were resumed the first day of release.

There was no significant difference in concurrency rates pre- and post-incarceration. Overall, in the 30 days prior to incarceration 39.6% of male respondents reported consistent condom use (CCU, always using condoms). CCU was significantly less likely in committed relationships. In partnerships that were resumed after incarceration, overall rates of CCU were almost the same but, for the first time respondents had sex with the partner, there was no significant difference in CCU based on degree of commitment,. For respondents who perceived partner infidelity during their incarceration, 45.8% used condoms consistently post-release, compared to 13.6% among respondents who did not perceive partner infidelity (p=0.026). CCU was not associated with respondent fidelity since release. Overall CCU with new sexual partners since incarceration was 40%, but it was higher in committed relationships. Among respondents who reported different sexual partners before and after incarceration, partners post incarceration were less likely to use drugs and to live with respondents, but in most other ways were similar to preincarceration partners.

Conclusions

Rates of CCU are low in this sample, and respondents appear to make judgments about the “riskiness” of their partners, with partners in committed relationships viewed as less risky, except immediately upon release from prison. CCU is not associated with respondent fidelity, but it is higher when a respondent perceives that his partner has not been monogamous during his incarceration. Qualitative data indicate that partners from committed relationships are not necessarily less risky than other partners, and they show some of the factors that affect decision-making regarding CCU.