Timing and Duration of Incarceration and High-Risk Sexual Partnerships
Among African Americans in North Carolina
MARIA R. KHAN,
, WILLIAM C. MILLER,
, VICTOR J. SCHOENBACH,
SHARON S. WEIR,
, JAY S. KAUFMAN,
, DAVID A. WOHL,
AND ADAORA A. ADIMORA,
PURPOSE: Incarceration may contribute to HIV transmission by disrupting stable partnerships and pro-
moting high-risk partnerships. We investigated incarceration and high-risk partnerships among African
Americans in North Carolina.
METHODS: We conducted a weighted analysis using the North Carolina Rural Health Project (N Z
320), a population-based case-control study of HIV among African Americans. We measured associations
between timing and duration of incarceration and high-risk partnerships (multiple partnerships or sex trade
for money or drugs).
RESULTS: Duration of incarceration appeared to be more important than how long ago incarceration
occurred. After adjustment for sociodemographic indicators, high-risk partnerships were associated with
short-term (!1 month) incarceration of the respondent versus no respondent incarceration (men: adjusted
prevalence ratio (aPR) 1.9, 95% conﬁdence interval (95% CI) 1.2–2.8; women: aPR 3.1, 95% CI 1.2–8.3).
High-risk partnerships also were associated with incarceration of a partner versus no partner incarceration
(men: aPR 1.8, 95% CI 1.1–3.0; women: aPR 2.0, 95% CI 1.1–3.8). Among men, associations remained
when adjusting for substance use. Among women, adjustment for substance use weakened estimates due
to the strong correlation between substance use and incarceration.
CONCLUSIONS: HIV-prevention programs targeting currently and formerly incarcerated individuals
and their partners may decrease HIV in African American communities with high incarceration rates.
Ann Epidemiol 2008;18:403–410. Ó 2008 Elsevier Inc. All rights reserved.
: Incarceration, Poverty, Sexual Behavior, HIV, Sexually Transmitted Infections, African
Americans, Southern U.S., North Carolina.
The prevalence of human immunodeﬁciency virus (HIV) is
disproportionately high among African Americans. Al-
though African Americans represented 12% of the United
States population in 2005 (1), they accounted for nearly
half of persons living with HIV/acquired immunodeﬁciency
syndrome (AIDS) in 33 states that year (2) and 74% of het-
erosexually transmitted HIV cases in 29 states from 1999 to
Incarceration, which is endemic in many African Amer-
ican communities, may contribute to the racial disparity in
HIV infection by disrupting stable sexual partnerships and
promoting high-risk partnerships (4–6). Previous studies
measured associations between incarceration history and
participation in concurrent sexual partnerships (7–9) and
sex work (10). These studies, however, did not evaluate
the duration of incarceration or its timing during the indi-
vidual’s life course, both of which could be important factors
in incarceration’s potential contribution to sexual risk be-
haviors. A more complete understanding of the dimensions
of incarceration and its relationship to risk behaviors may
improve HIV prevention programs.
We investigated cross-sectional associations between
incarceration and high-risk sexual partnerships among Af-
rican Americans in North Carolina (NC), a state with
high rates of sexually transmitted infection (STI), includ-
ing HIV (11, 12). We analyzed data from the NC Rural
Health Project (RHP), a population-based case-control
study conducted to investigate heterosexual transmission
of HIV among African Americans in NC (13). The pur-
pose of the current analysis was to capitalize on the
RHP’s measurement of the timing and duration of the
respondent’s incarcerationda unique component of its
sexual behavioral questionnairedand explore associations
between multiple dimensions of incarceration and high-
From the Department of Epidemiology (M.K., W.C.M., V.J.S., S.S.W.,
J.S.K., A.A.A.), Carolina Population Center (M.R.K., S.S.W., J.S.K.),
and Division of Infectious Diseases, Department of Medicine, School of
Medicine (W.C.M., D.A.W., A.A.A.), University of North Carolina at
Chapel Hill, NC.
Address correspondence to: Maria Khan; National Development and Re-
search Institutes, 71 West 23rd Street, New York, NY, 10010. Tel.: 919-
306-6368; fax: 917-438-0894. E-mail: email@example.com.
Received August 21, 2007; accepted December 4, 2007.
Ó 2008 Elsevier Inc. All rights reserved. 1047-2797/08/$–see front matter
360 Park Avenue South, New York, NY 10010 doi:10.1016/j.annepidem.2007.12.003