Session: Criminal Justice Involvement and HIV Risk among Men: Implications for HIV Prevention (Research that Promotes Sustainability and (re)Builds Strengths (January 15 - 18, 2009))

This symposium addresses an important and timely public health issue: sexually transmitted HIV risk among men with criminal justice involvement (CJI). The criminal justice system has become an epicenter of the U.S. HIV/AIDS epidemic over the past decade. An estimated 25% of all HIV-infected Americans pass through the U.S. correctional system annually, and HIV prevalence among prisoners is three to four times that of the general population. The importance of this issue is increasing, as there are currently more individuals in the U.S. involved in the criminal justice system than at any time in history; over 7 million adults are under some form of criminal justice supervision, the majority of which are men.

Heightened awareness of this disparity has led to the identification of the criminal justice system as a critical venue for HIV prevention. However, considering the vast and varied criminal justice population in the U.S., there are relatively few studies that have explored the context of sexual HIV risk for men with CJI, and HIV prevention interventions targeting justice-involved men are rare. Grasping the complexity of sexual HIV risk for men with CJI requires the examination of a confluence of factors including substance use/abuse, race/ethnicity, mental illness, relationship characteristics, and the potential influence of CJI itself on risk behavior. Building the knowledge base in this area is vital for designing HIV prevention models for this vulnerable population.

Addressing the HIV disparity among men with CJI has powerful implications not only for these men but also for their sexual partners, who are predominately women. Studies of recently incarcerated men demonstrate high rates of post-release unprotected sex with primary female partners, and having a partner with an incarceration history has been associated with increased sexually transmitted infections for women. Some have suggested heterosexual transmission by men with CJI to their female partners is a major contributor to the high rates of HIV among women.

The papers in this symposium examine the relationship between CJI and HIV risk for men in the criminal justice system in the context of sexual relationships, utilizing a variety of samples representing men at different phases of criminal justice involvement. The first study on young incarcerated men describes pre-incarceration substance use and sexual behaviors, as well as associations between alcohol and marijuana use and sexual risk. Our second presentation draws from a nationally representative sample stratified by history of illicit drug use and examines the association between incarceration and multiple and concurrent sexual partnerships. The third study applies a mixed methods approach to explore pre- and post-incarceration differences in relationship stability, partner characteristics, and condom use among men currently on probation or parole. The final presentation utilizes a longitudinal study to isolate and test the effect of arrest and incarceration on subsequent sexual HIV risk behaviors among men with substance abuse histories.

Although the presentations in this symposium employ diverse samples and methodologies, they are united in a single aim: Illuminating the sexual HIV risk contexts for men with CJI to inform targeted HIV prevention intervention.