Maria R. Khan, PhD – Grants and Contracts
Relationship Disruption during Incarceration and HIV Risk in African American Men
R01DA028766 (August 1, 2010 – July 31, 2015)
African American men released from prison face disproportionate HIV risk. Preventing HIV sexual risk behavior and drug use in this group is critical to reducing the race disparity in HIV. However, research on the factors that drive and protect against HIV risk among African American male releasees is limited. Returning to a committed partner after release may be an important protective factor against HIV risk among African American male releasees during reentry. However, incarceration destabilizes committed relationships. Though 50-80% of men enter prison in a committed relationship, we estimate that half of these relationships end by the time of release. Upon release, loss of a partner may lead men to seek multiple, new partners to meet companionship needs or may lead to distress and, in turn, self-medication with drugs or sex. No prior study has evaluated the degree to which partner loss during incarceration influences post-release HIV risk. The present mixed method study is designed to address this gap in the current field of HIV prevention science. This study seeks to examine the hypothesis that dissolution of stable intimate relationships during incarceration elevates sexual risk behavior and drug use among inmates upon their release. The specific aims are: Primary Quantitative Aims: Aim 1. Among African American men in relationships at the time of prison entry, to describe the associations between dissolution of relationships during incarceration and HIV sexual risk behavior (unprotected sex; multiple sex partnerships; buying sex for money or drugs) and drug use (crack use; binge drinking). Aim 2. To assess whether diminished mental health (low coping; increased depression; increased anxiety) due to dissolution of relationships during incarceration results in HIV sexual risk behavior and drug use. Aim 3. To evaluate whether the association between dissolution of relationships during incarceration and HIV sexual risk behavior and drug use varies by respondent and relationship characteristics. Qualitative Aim: To qualitatively explore the social context of post-release and men’s perceptions of the factors and processes driving post-release sexual risk behavior and drug use. To accomplish these study aims, we propose to recruit 400 African American male inmates who are scheduled to be released from prison and who were in stable intimate heterosexual relationships at the time of prison entry. Our pilot work suggests that ~50% of relationships will have ended during the incarceration. We will follow men after their release to assess whether post-release sexual risk behavior and drug use are higher among men whose relationships ended during incarceration versus men whose relationships remained intact. The proposed study is designed to inform development of policies and interventions that minimize the destabilizing effects of criminal justice involvement on relationships and health. PUBLIC HEALTH RELEVANCE: Since more than 800,000 African American men are incarcerated in prison at any given time, and hundreds of thousands return home to their communities each year, policies and programs that are effective in reducing HIV risk in this group would prevent substantial numbers of new infections among African American men and members of their sexual networks annually. This research will determine whether dissolution of committed relationships during incarceration is a risk factor for post-release HIV sexual risk behavior and drug use among African American male releasees and will describe the pathways through which relationship dissolution may work to influence HIV risk. Study findings may highlight the need for implementation of criminal justice policies that reduce network disruption and may inform HIV prevention interventions, including in-prison programs for inmates and their partners that foster communication and prevent relationship dissolution, and pre-release HIV prevention education for men who have lost a committed partner during incarceration.
Longitudinal Study of Substance Use, Incarceration, and STI in the US
R03DA026735-01 (April 15, 2009 – March 31, 2012)
We propose to conduct secondary data analysis to examine the longitudinal relationships among incarceration, substance use, and STI/HIV risk. In 2008 more than 2 million adults in the United States were behind bars. Jail and prison inmates, often among the most economically and socially disadvantaged segment of our population, also face disproportionate infectious disease risk. Sexually transmitted infections (STIs), including HIV, cluster in incarcerated populations. Prisoners’ spouses, sexual partners, and other members of their sexual networks also experience high risk of infection. In some populations, incarceration rates are staggering and communities experience continual migrations of substantial segments of the population in and out of the criminal justice system. STIs and HIV thrive on sexual network disruption. Thus, disruption of sexual networks due to incarceration may lead to new, multiple, and concurrent sexual partnerships, all of which fuel STI/HIV transmission. Does the disruptive effect of incarceration contribute to STI/HIV risk? Or, do adverse economic and social factors such as drug use-that may have led to the incarceration-drive high sexual risk and STI/HIV levels among current and former inmates and members of their sexual networks? We do not know- the strong association between incarceration and STI/HIV remains unexplained and warrants investigation. Using the National Longitudinal Study of Adolescent Health, we will apply advanced statistical procedures to measure the effects of adolescent substance use on multiple (e 2) sexual partnerships and biologically confirmed infection with chlamydia, gonorrhea, or trichomoniasis in adulthood. We will evaluate the degree to which incarceration in adulthood mediates the relationship between substance use and STI/HIV risk. The STIs we will study have clear public health relevance not only because they contribute to substantial morbidity but because they increase HIV transmission. The specific aims of the proposed study are to: Aim 1: Measure longitudinal associations between adolescent substance use and multiple sexual partnerships and STI in adulthood and evaluate whether race or criminal justice involvement moderates the relationships. Aim 2: Measure associations between incarceration and multiple sexual partnerships and STI in adulthood. Aim 3: Evaluate the degree to which incarceration in adulthood mediates the relationships between adolescent substance use and multiple sexual partnerships and STI in adulthood. This research is innovative in its unique synthesis of and public health relevance to STI and drug dependence epidemiology and the criminal justice field. The proposed analyses are designed to provide an empirical basis for development of larger R01s to (1) examine the effect of disruptions in intimate partnerships at the time of incarceration on STI/HIV risk and (2) test the effectiveness of STI/HIV prevention interventions that aim to mitigate the deleterious effects of incarceration and drug dependence. PUBLIC HEALTH RELEVANCE: By identifying ways that incarceration and substance use work independently and together to increase STI/HIV risk, we will better understand whether scarce prevention resources should be prioritized for: substance use prevention and treatment, development and implementation of interventions that mitigate the disruptive effects of incarceration, or both. Since more than 2 million adults are in United States jails and prisons at any given time, even modest effects of incarceration on STI/HIV risk have significant ramifications at the population level. Hence, interventions effective in reducing incarceration-related STI/HIV transmission that may be developed, in part, based on this research would prevent substantial numbers of new infections.