Assessing behavioral HIV risk factors among black women who report recent sex partners with a history of incarceration: Implications for targeted HIV prevention interventions.

Background/Objectives
From 2001-2005, black women accounted for 67% of all women living with HIV/AIDS and approximately 70% of infections were due to heterosexual contact (CDC, March 2007). 

Associated factors such as substance abuse, high rates of sexually transmitted diseases (STDs), and poverty-related issues have been well documented.  However, little is known about black women who report having sexual encounters with men who have a history of incarceration. HIV rates in jails and prisons are 14 times higher than the general population.  The objective of this study was to examine demographic characteristics, HIV-related behavioral risk factors, and perceptions of risk among black women living in three U.S. cities.

Methods
Women living in Washington DC; Jackson, Mississippi; and Oakland, California were recruited.  They completed an Audio Computer-Assisted Self Interview (ACASI) assessing demographic and HIV behavioral risk factors. 

Data were reviewed for those women reporting sex with individuals with a history of incarceration and those who did not. Analyses were conducted using SPSS.

Results
Of the 903 Black women enrolled, 199 (22.1%) reported having heterosexual sex in the three months prior to enrollment with someone with a history of incarceration. 

This group of women were more likely to be unemployed or under-employed (p=.034) and earn less income annually (p=.032) when compared with women who did not report sex with someone who had been incarcerated.  

This group was also more likely to have:
injected drugs (p<0.0001),
used crack cocaine (p<.0001),
had sex with someone with an STD (p<0.0001),
had an STD (p<0.0001),
had sex with someone who injected drugs (p<0.0001),
and exchanged sex (p<0.0001) in the 3 months prior to participation in the study.

While most reported inconsistent condom use (53.8%) or never using condoms (16.6%), these women were more likely to perceive themselves to be at greater risk for HIV (p<0.0001) and to have been screened for HIV (p=.013) than women not reporting sex with someone with a history of incarceration.

 A subset of women, 75 of 199 (37%), reported having sex with someone with a history of incarceration as their only risk factor.  These women were more likely to be employed (p=.014) and to perceive their risk for HIV infection to be low (p<0.0001) as compared to those women who reported more than one HIV-related risk factor.  This group also reported inconsistent condom use (52%) or never using condoms (12%). 

Conclusions/Implications
Women who reported having sex with someone with a history of incarceration and other risk factors (e.g., IDU, exchanging sex, etc.) appear to be more aware of their risk for HIV, are screened more often, yet continue to report inconsistent condom use.  Women who only reported having sex with someone with a history of incarceration perceive themselves to be at low risk for HIV and also report inconsistent condom use. 

Given the high rates of HIV infection among the incarcerated and the significant impact of HIV among black women, more prevention and screening efforts are needed in jails and prisons and more education and support is needed for their female sex partners.