Assessing Criminal Justice Involvement as An Indicator of HIV Risk Among Drug-Involved Women

Background: An investigation of the links between female criminal justice involvement and sexual risk behavior is an important undertaking for public health research. Research suggests that the prevalence of human immunodeficiency virus (HIV) in women in the criminal justice system is up to 10 times higher than that of the general population. However, the causes of these disproportionately higher rates are not clearly understood; previous work has suggested the destabilizing effects of arrest or incarceration, the co-incidence of drug use among women at risk for criminal justice involvement and HIV contraction, and psychological stress as candidate mechanisms linking HIV and criminal justice involvement.

Methods: Building on previous research, this study examined the relationship between criminal justice involvement and high-risk sexual partnerships among a random sample of 416 women in methadone treatment in New York City. We used logistic regression models to assess whether recent criminal justice involvement – measured as arrest or incarceration in the past 6 months --- was associated with having recent high-risk sexual partnerships, including having multiple sex partners, engaging in sex trading, having sex with a risky partner, or having unprotected sex in the context of any of other three risky partnerships. To avoid confounding with possible pathways identified in previous research, we re-estimated all models after controlling for psychological distress (measured using the Brief Symptom Inventory), for recent regular drug use (use of either heroin, stimulants, crack cocaine, marijuana, drugs without a prescription, or any injection drug once or more per week in the past 6 months), as well as for background characteristics.

Results: Because of the high-risk nature of this sample, many sample women were HIV positive and a substantial portion had had some criminal justice involvement: 76 (18%) self-reported as being infected with HIV, 294 (71%) had ever been arrested or incarcerated, and 46 (11%) had been arrested or incarcerated in the previous 6 months. Uncontrolled estimates indicated that women who had been recently arrested or incarcerated had significantly higher odds of engaging in each of these partnerships. After the inclusion of all controls, criminal justice involvement was still significantly associated with increased odds of having multiple sex partners (Odds Ratio [OR] = 3.02), having a risky sex partner (OR = 2.54), and having unprotected sex and a high-risk partnership (OR = 2.32). Recent drug use, particularly crack cocaine and injection drug use, appeared to confound the relationship between criminal justice involvement and sex trading.

Conclusions: This study highlights criminal justice involvement as a significant correlate of high-risk sexual partnerships among drug-involved women, which points to the need for targeted HIV prevention interventions for these women as well as the need for investigation into the role of arrest and incarceration as factors that may contribute to HIV infection. Because most (80%) of the female correctional population is not incarcerated, HIV prevention efforts must expand beyond the walls of the jails and prisons into the community to adequately address the substantial level of risk for this population.