Background Black men who have sex with men (BMSM) disproportionately report a history of traumatic life events including incarceration. Incarceration, by increasing distress and psychopathology, may increase risk-taking and infection. Pre-incarceration trauma may exacerbate the impact of incarceration on STI/HIV risk among BMSM.
Methods Using data from HIV Prevention Trials Network (HPTN) 061, we used inverse probability of treatment weighted Poisson regression models to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for associations between recent incarceration and incident STI (gonorrhea, chlamydia, and syphilis) and sexual risk behavior (sex trade defined as selling/buying sex, multiple partnerships, condomless sex) measured six months after incarceration assessment (n=1189). We tested the significance of interaction terms between incarceration and trauma to assess whether associations differed significantly by trauma history (e.g., experiencing a robbery, natural disaster, sexual/physical assault).
Results Approximately 93% reported at least one traumatic event and 14% had been recently incarcerated. Incarceration was associated with STI among those with prior trauma (RR: 1.10, 95% CI: 1.00–1.22) but not among those with no prior trauma (RR: 0.91, 95% CI: 0.75–1.09); associations differed significantly (interaction term p=0.036). Incarceration was linked to increased risk of sex trade involvement among those with prior trauma (RR: 1.08, 95% CI: 1.00–1.15) and decreased risk among those with no prior trauma (RR: 0.95, 95% CI: 0.90–1.00) (interaction term p=0.002). Incarceration was associated with increased risk of multiple partnerships among those with prior trauma (RR: 1.24; CI: 1.10, 1.40) but not among those with no prior trauma (RR: 0.85, 95% CI: 0.32–2.25), though the RRs were not significantly different (interaction term p=0.224). Incarceration was not associated with condomless sex, regardless of prior trauma.
Conclusion BMSM with prior trauma appear to face disproportionate vulnerability to STI/HIV risk after release from incarceration. Trauma-informed STI/HIV care and prevention interventions for BMSM with recent justice involvement are warranted.
Disclosure No significant relationships.
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