Send to

Choose Destination
J Womens Health (Larchmt). 2019 Aug;28(8):1083-1093. doi: 10.1089/jwh.2018.7454. Epub 2019 May 17.

History of Incarceration Among Women with HIV: Impact on Prognosis and Mortality.

Author information

1Department of Medicine, Stroger Hospital, Cook County Bureau of Health Services, Chicago, Illinois.
2Hektoen Institute of Medicine/Cook County Health and Hospitals System, Chicago, Illinois.
3Division of General Internal Medicine and Geriatrics, Northwestern University, Feinberg School of Medicine, Chicago, Illinois.
4Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland.
5Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia.
6Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York.
7Institute for Health Promotion and Disease Prevention Research, University of Southern California, Los Angeles, California.
8Department of Medicine, University of North Carolina School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
9Departments of Family, Community and Health Systems, Health Behavior, Epidemiology and Medicine, University of Alabama at Birmingham, Birmingham, Alabama.
10Department of Medicine and College of Nursing, SUNY at Downstate, Brooklyn, New York.
11Department of Clinical Pharmacy, University of California, San Francisco, California.
12Department of Medicine, Emory University, Atlanta, Georgia.
13Department of Medicine, Montefiore Medical Center Bronx, New York.
14Department of Preventive Medicine, Northwestern University Institute for Public Health and Medicine, Chicago, Illinois.


Objectives: To identify factors associated with incarceration among women and examine the relationship between incarceration and human immunodeficiency virus (HIV)-related outcomes. Materials and Methods: We analyzed longitudinal data from 3324 women (2372 with HIV and 952 uninfected) from 2007 to 2016 in the Women's Interagency HIV Study, a U.S. cohort of women with and without HIV. Lifetime history of incarceration before first study visit was used as the outcome and then as a predictor for HIV outcomes and mortality. Using multivariable models, we assessed associations between socio-demographic, behavioral, and clinical characteristics and incarceration, and between incarceration and HIV outcomes, including mortality. Results: Overall, 1256 (38%) of women reported ever being incarcerated. Women who had a history of drug use had a 44% greater prevalence of incarceration compared with those who did not use drugs. Sexual minority women and women who experienced physical and sexual abuse had a 47% and 28%, respectively, greater prevalence of incarceration than heterosexual women and those not abused. For the 862 women with HIV and a history of incarceration, having an incarceration history was independently associated with less viral suppression (adjusted prevalence ratios = 0.95; confidence intervals [CI]:0.90-1.00 p = 0.04) and higher likelihood of death (adjusted hazard ratios = 1.39; CI:1.04-1.86 p = 0.03). Conclusions: Incarceration is common in this cohort and may put women with HIV at increased odds of worse HIV outcomes and mortality than those without a history of incarceration. Addressing the intersecting epidemics of HIV, substance use, and incarceration by providing needed treatment and resources and avoiding criminalization may improve health outcomes in vulnerable women with HIV.


HIV; incarceration; mortality; women

[Available on 2020-08-01]

Supplemental Content

Full text links

Icon for Atypon
Loading ...
Support Center