HIV-Positive and in Jail: Race, Risk Factors, and Prior Access to Care Open Access

Stein, Matthew Samuel (2012)

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Introduction: Black individuals represent 13% of the US population but 46% of HIV-
positive persons and 40% of incarcerated persons. The national EnhanceLink project
evaluated characteristics of jail entrants at ten sites and explored associations between
race and HIV disease state.
Methods: Between 1/2008 -10/2011, 1,270 study participants provided demographic and
clinical data. Adjusted odds ratios (aORs) were calculated for advanced HIV disease
(CD4 < 200 cells/mm3) and uncontrolled viremia (viral load > 400 copies/ml) for Black
(n=807) versus non-Black (n=426) participants.
Results: Sixty-five percent of HIV-positive jail participants self-identified as Black.
Among all participants, fewer than half had a high school diploma or GED, the mean
number of lifetime arrests was over 20, and major mental illness and substance abuse
were common. Black participants were more likely to be older than non-Black
participants, and less likely to have health insurance (70% vs 83%) or an HIV provider
(73% vs 81%) in the prior 30 days. Among all male study participants (n=870), 20% self-
identified as homosexual or bisexual. Black male particpants were more likely to be
homosexual or bisexual (22% vs 16%) and less likely to have a history of injection drug
use (20% vs 50%) than non-Black male participants. Advanced HIV disease was
associated with self-identification as Black (aOR = 1.84, 95% CI 1.16 - 2.93). Identifying
as Black was not associated, however, with an increased likelihood of having
uncontrolled viremia at entry, after controlling for other factors.
Conclusions: The racial disparities of HIV and incarceration among Blacks is
underscored by the finding that 65% of HIV-positive jail participants self-identified as
Black in this ten-site study. The finding that 22% of Black male participants also self-
identified as men who have sex with men (MSM) supports jails as strategic venues to
reach HIV-positive Black MSM. Among HIV-positive jail entrants, Black individuals
had more advanced HIV disease. Self-identification as Black was associated with a lower
likelihood of having health insurance or an HIV provider prior to incarceration. HIV care
and linkage interventions are needed within jails to better treat HIV and to address these
racial disparities.

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