The association between serious mental impairment and sexual risk behaviors prior to incarceration among HIV-positive jail detainees: A cross-sectional observational study Public

Miller, Kimberly Dawn (2013)

Permanent URL: https://etd.library.emory.edu/concern/etds/0p0967160?locale=fr
Published

Abstract

Background: Mental illness and history of incarceration have been linked separately to increased engagement in unsafe sexual behaviors, including concurrent partners and sex without a condom. Although sexual risk behaviors among human immunodeficiency virus (HIV)-positive jail inmates pre- and post-release have been examined, there is a paucity of data regarding the impact of mental impairment on sexual risk behaviors among this population.

Methods: We performed a cross-sectional secondary analysis of baseline data from the EnhanceLink demonstration project. Data were available on 185 sexually-active jail detainees enrolled at five jail systems between 2008 and 2011. Serious mental impairment was defined as having an Addiction Severity Index psychiatric composite score ≥0.22; higher scores indicated poor mental health and social functioning. Multiple logistic regression was used in four separate models to analyze the associations of serious mental impairment with four unsafe sexual risk behaviors: 1) sexual intercourse under the influence of drugs or alcohol, 2) concurrency, 3) failure to use a condom during last sexual intercourse, and 4) having two or more unsafe sexual risk behaviors.

Results: Serious mental impairment (ASI psychiatric CS ≥0.22) was common. A high ASI psychiatric composite score (≥0.22) was associated with increased odds of having had sexual intercourse under the influence of drugs or alcohol (adjusted odds ratio (aOR): 3.90; 95% confidence interval (CI): 1.64-9.27) and concurrency (aOR: 2.56; 95% CI: 1.08-6.08), but was not associated with failure to use a condom (aOR: 1.15; 95% CI: 0.47-2.81).

Conclusion: Serious mental impairment is associated with unsafe sexual risk behaviors. Substance use in tandem with sexual intercourse is common among incarcerated populations and poses a transmission risk for HIV-positive jail detainees, as substance use may also increase likelihood of sex with individuals of unknown HIV status. Future initiatives directed towards improving safe sex behaviors among HIV-positive jail populations should consider these issues when designing interventions.

Table of Contents

CHAPTER 1: BACKGROUND AND LITERATURE REVIEW ....................................................................... 1
HIV/AIDS in Jails ...................................................................................................................... 2
Serious Mental Impairment ......................................................................................................... 3
Serious Mental Impairment: Definition and Measures ....................................................................... 3
Serious Mental Impairment: Associations with Serious or Severe Mental Illness .................................... 5
Mental Illness: Potential HIV Mechanisms and Implications for HIV Treatment ...................................... 6
Mental Illness and Substance Abuse: Co-occurring disorders ............................................................ 8
Prevalence of Mental Illness among the General Population and Incarcerated Persons ........................... 9
Sexual Risk Behaviors .............................................................................................................. 10
HIV Acquisition and Definitions .................................................................................................. 10
Prevalence of Sexual Risk Taking Behaviors among the General Population, Incarcerated Persons, and Individuals with Mental Illness ................................................................................................. 10
CHAPTER 2: MANUSCRIPT ........................................................................................................ 14
INTRODUCTION ...................................................................................................................... 14
METHODS ............................................................................................................................. 15
Study population, design, and data collection .............................................................................. 15
Variables .............................................................................................................................. 17
Statistical Analysis ................................................................................................................. 19
RESULTS .............................................................................................................................. 20
Demographics ....................................................................................................................... 20
Unsafe sexual risk behaviors during the reporting period ................................................................ 21
DISCUSSION ......................................................................................................................... 24
Limitations ........................................................................................................................... 26
Conclusion ........................................................................................................................... 27
REFERENCES ........................................................................................................................ 29
TABLES AND FIGURES ............................................................................................................ 41
APPENDIX ........................................................................................................................... 51

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