Transcript Prevalence and Correlates of HIV Risk Behaviors of Inmates

Prevalence and Correlates of HIV
Risk Behaviors of Inmates in a
State Prison System
Titilayo Abiona, MD, FMCPH
Adedeji Adefuye, MD, MPH, FRIPH
Joseph Balogun, PT, PhD, FACSM
Patricia Sloan, EdD, RN, FAAN
College of Health Sciences, Chicago State University
1
Background
• Higher HIV/AIDS rates among inmates vs.
general population
• HIV prevalence ~ 4 & 10x higher among
inmates than in the general population
• What is the exact mechanism linking
incarceration with HIV infection?
2
Conceptual Model
3
Background
• Inmates engage in risk behaviors before,
during & after incarceration
• Examining risk behaviors of inmates is
essential for understanding the role of
incarceration in HIV infection
4
Specific Objectives
• Describe pre-incarceration risk behaviors
of inmates
• Identify and quantify risk behaviors during
incarceration
• Determine the socio-demographic
characteristics associated with risk
behaviors during incarceration
5
Methods
• Study Location
– 17 randomly selected Illinois Correctional Facilities
• Study Design
– Cross-Sectional Descriptive
• Study Population
–
–
–
–
Male and female inmates
18 years of age or older
Continuously incarcerated for at least six months
Able to speak and write English
6
Methods
• Sample Size Determination
–
–
–
–
Computer Programs for Epidemiologists (PEPI) version 4.0
A minimum sample size of 1025 was calculated
Over-sampling done to adjust for non-participation
2,000 inmates finally selected
• Multi-stage sampling technique
• Data collected with a structured questionnaire
• Statistical Analysis: SPSS 15. Descriptive and Inferential
Analysis done
• Study protocol approved by the CSU IRB
7
Results
• 1,819 participants: 1, 293 (71.1%)men and 526
(28.9%) women completed the survey
• Response rate = 91%
• Overall average response rate to survey
questions = 96%
• Number of participants that responded to each
question varied
• 71% (1293)of participants were men
8
Table 1: Socio-demographic Characteristics of Participants
Characteristic
Women,% n=526
Men, % n=1293
P-Value
Mean Age (SD)
36.4 (9.7)
35.4 (10.1)
0.05
Marital Status
Never Married
Married/Cohabiting
Previously Married
50.1
21.9
28.0
56.1
19.7
24.2
0.07
Ethnicity
White
African American
Hispanic/Latino
Other (Native Americans etc)
39.1
51.3
4.6
5.0
26.6
57.2
11.0
5.2
No. of Times Incarcerated
1-3
4-6
7 and more
85.2
12.8
2.0
77.6
17.3
5.1
<0.001
<0.001
9
Table 1: Sociodemographic Characteristics of Participants Cont’d
Characteristic
Women,%
n=526
Men, %
n=1293
No. of Years Spent in Prison
during Current Sentence
<1
1-3
4-6
7 or more
40.1
30.9
10.8
18.2
20.9
29.8
16.7
32.0
Ever Had HIV Testing
Yes
No
91.1
8.9
84.5
15.5
P-Value
<0.001
<0.001
10
Table 2: Pre-Incarceration Risk Behaviors
Behavior
Sample
Size
Frequency
Percentage
2 or more Vaginal Partners in the 6 months
before arrest
1762
1037
58.9
2 or more Anal Partners in the 6 months before 1741
arrest
333
19.1
Never/Rarely Used Condoms for Vaginal Sex
in the 6 months before arrest
1653
1097
66.4
Never/Rarely Used Condoms for Anal Sex in
the 6 months before arrest
781
547
70.0
Ever Injected Drugs
1740
255
14.7
Ever Shared Needles
255
142
55.7
Obtained Tattoo from non-professional artist
1100
799
72.6
Obtained Body Piercing from non-professional
artist
878
364
41.4
11
Figure 1: % of Respondents who never/rarely used Condoms in the 6
Months before Arrest
100
80
P < 0.05
64.8
69.6
69.7
70.8
60
40
20
0
Vaginal Sex
Anal Sex
Male
Female
12
Figure 2: % of Respondents who did not use Condoms during last
Sexual Intercourse
Percentage
100
79.7
82.2
82.4
80.4
76.3
78.1
80
60
40
20
0
Vaginal Sex
Male
Anal Sex
Female
Overall
13
Figure 5: % of Respondents who had ever Injected Drugs
Percentage
25
20.5
P < 0.001
20
15
12.1
10
5
0
Male
Female
14
Figure 9 % of Respondents who obtained Tattoos and Body Piercing
from non-professional artists
Percentage
100
77
80
P < 0.001
P < 0.001
62.3
48.1
60
32.2
40
20
0
Tattoo
Body Piercing
Male
Female
15
Table 3: Risk Behaviors during Incarceration
Behavior
Sample Size Frequency
Percentage
Sexual Intercourse
1783
158
8.9
Injection Drug Use
1754
15
0.9
Needle Sharing
1754
10
0.6
Tattooing
1777
295
16.6
Body Piercing
1766
24
1.4
16
Figure 10: Types of Sexual Intercourse during Incarceration
(n=158)
Vaginal
41.8
Oral
54.4
Anal
14.6
0
10
20
30
40
50
Percentage
17
60
Figure 11: Context of Sexual Intercourse during Incarceration (n=158)
Consensual
93%
Forced
7%
18
Table 4: Characteristics and Behaviors Associated with Sexual Intercourse during
Incarceration
Characteristic
Frequency (%)
Unadjusted
Odd’s
Ratio (CI)
Adjusted Odd’s
Ratio (CI)
Level of Prison Security
Maximum
Medium
Minimum
21/327 (6.4)
39/911 (4.3)
89/554 (16.1)
1
0.65 (0.38-1.13)
1.02 (1.70-4.58)
1
0.60 (0.29-1.24)
0.90 (0.37-2.16)
No. of Years spent in Prison During Current Incarceration
<1
1 or more
11/475 (2.3)
138/1306 (10.6)
1
4.98 (2.67-9.29)
1
10.57 (3.60-31.04)
No. of Times Incarcerated
1-3
4 or more
135/1370 (9.9)
9/348 (2.6)
1
0.24 (0.12-0.48)
1
0.36 (0.16-0.79)
Gender
Female
Male
90/521 (17.3)
56/1250 (4.5)
1
0.23 (0.16-0.32)
1
0.47 (0.21-1.03)
Ethnicity
White
African American
Hispanic/Latino
Others- Native Americans, Asian Americans etc.
46/533 (8.6)
86/973 (8.8)
8/164 (4.9)
9/92 (9.8)
1
1.03 (0.71-1.49)
0.54 (0.25-1.18)
1.15 (0.54-2.43)
1
1.26 (0.70-2.27)
0.59 (0.20-1.75)
1.59 (0.52-4.84)
P < 0.001; P <0.05
19
Table 4: Characteristics and Behaviors Associated with Sexual Intercourse during
Incarceration Cont’d
Characteristic
Frequency (%)
Unadjusted Odd’s
Ratio (CI)
Adjusted Odd’s
Ratio (CI)
Marital Status
Never Married
Married/Living with someone as Married
Previously Married
96/957 (10.0)
23/364 (6.3)
28/452 (6.2)
1
0.61 (0.38-0.97)
0.59 (0.38-0.92)
1
0.53 (0.23-1.20)
0.74 (0.37-1.48)
Sexual Orientation
Heterosexual
Bisexual
Gay/Lesbian
61/1368 (4.5)
62/161 (38.5)
19/51 (37.3)
1
13.42 (8.92-20.18)
12.72 (6.82-23.72)
1
11.84 (5.73-24.47)
6.72 (2.32-19.40)
Age
<40
40 or more
108/1164 (9.3)
39/579 (6.7)
1
0.71 (0.48-1.03)
1
1.25 (0.66-2.39)
Got Tattoos in Prison
No
Yes
57/915 (6.2)
51/300 (17.0)
1
3.13 (2.04-4.55)
1
3.83 (2.20-6.65)
P < 0.001
20
Conclusions
• Inmates engage in risk behaviors before
and during incarceration
• Longer duration of stay in prison, non
heterosexual orientation and receiving a
tattoo in prison were associated with
sexual intercourse in prison
• Findings support both the importation and
deprivation models of inmate behavior
21
Recommendations
• HIV prevention interventions should be
commenced as soon as possible after
incarceration
• Current policies about risk reduction
mechanisms in prison need review
22
Study Limitations
• Possible Underreporting- Social Desirability Bias
• Use of a self administered questionnaire and Social
desirability bias may affect results and generalizability of
findings
• Non response to questions may be a source of bias
• The small numbers of inmates reporting HIV risk
behaviors in prison prevented the identification of
independent risk factors for some behaviors
• Inmates who were selected but refused to participate in
the study may differ significantly from those who
participated. This may have affected the prevalence of
the risk behaviors reported.
23
Future Research
• The role of tattooing in HIV transmission:
risk marker or mode of transmission?
• Risk behaviors of partners of inmates
• Spatial analysis of inmate residencies after
release, distribution of HIV cases, and HIV
prevention services in Illinois
24
Acknowledgements
• Illinois General Assembly and the Illinois Department of
Public Health- Funding
• Dr. Mainza Lukobo-Durrell- contribution to
conceptualizing the study
• Research assistants –Josie McDonald, Wayne ScottWilliams, Jerry Goldstein and Emmanuel Osunkoya- for
their dedication throughout the period of the study
• State Representative Constance Howard- co-sponsoring
the bill which created the African American HIV/AIDS
Response Act and for her personal involvement in
establishing the collaboration between the Institute and
IDOC
• IDOC officials-support in facilitating data collection
25
26
27