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AIDS Care. 2018 Aug 1:1-8. doi: 10.1080/09540121.2018.1499861. [Epub ahead of print]

Past year and prior incarceration and HIV transmission risk among HIV-positive men who have sex with men in the US.

Author information

1
a Division of Comparative Effectiveness and Decision Science, Department of Population Health , New York University School of Medicine , New York , NY , USA.
2
b VA Connecticut Healthcare System , West Haven , CT , USA.
3
c CUNY Graduate School of Public Health and Health Policy & The CUNY Institute for Implementation Science and Population Health , New York , NY , USA.
4
d Department of Internal Medicine , Yale University School of Medicine , New Haven , CT , USA.
5
e Center for Interdisciplinary Research on AIDS , Yale School of Public Health , New Haven , CT , USA.
6
f Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial VA Medical Center , Bedford , MA , USA.
7
g Department of Health Law, Policy, and Management , Boston University School of Public Health , Boston , MA , USA.

Abstract

Three quarters of new HIV infections in the US are among men who have sex with men (MSM). In other populations, incarceration is a social determinant of elevations in viral load and HIV-related substance use and sex risk behavior. There has been limited research on incarceration and these HIV transmission risk determinants in HIV-positive MSM. We used the Veterans Aging Cohort Study (VACS) 2011-2012 follow-up survey to measure associations between past year and prior (more than one year ago) incarceration and HIV viral load and substance use and sex risk behavior among HIV-positive MSM (N = 532). Approximately 40% had ever been incarcerated, including 9% in the past year. In analyses adjusting for sociodemographic factors, past year and prior incarceration were strongly associated with detectable viral load (HIV-1 RNA >500 copies/mL) (past year adjusted odds ratio (AOR): 3.50 95% confidence interval (CI): 1.59, 7.71; prior AOR: 2.48 95% CI: 1.44, 4.29) and past 12 month injection drug use (AORs > 6), multiple sex partnerships (AORs > 1.8), and condomless sex in the context of substance use (AORs > 3). Past year incarceration also was strongly associated with alcohol and non-injection drug use (AOR > 2.5). Less than one in five HIV-positive MSM recently released from incarceration took advantage of a jail/prison re-entry health care program available to veterans. We need to reach HIV-positive MSM leaving jails and prisons to improve linkage to care and clinical outcomes and reduce transmission risk upon release.

KEYWORDS:

HIV; Incarceration; men who have sex with men

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