Male Incarceration, the Health Care Service Environment and Sexual Health Público

Abstract

Compared to areas with low rates of incarceration, areas with higher rates of incarceration have higher and increasing rates of sexually transmitted infections (STIs). Few studies have examined this relationship and even fewer studies have explored the pathways through which higher incarceration rates may shape HIV/STI-risk. For this dissertation, qualitative and quantitative methods were used to examine rates of male incarceration, health care service accessibility and the prevalence of newly-diagnosed STIs. The qualitative phase involved in-depth interviews with 33 heterosexual Black women living in two neighborhoods: one with a high rate of male incarceration and low sex ratio and one with lower rate of male incarceration and a more equitable sex ratio. The quantitative phase used decennial data, STI surveillance data, incarceration data and an inventory of health care service locations.

The first paper examined how local male incarceration rates and sex ratios influenced perceptions of partner availability and the nature of partnerships for heterosexual Black women. High rates of male incarceration and low sex ratios: 1) reduced the number of available, desirable male partners, 2) impacted the structure and purpose of partnerships and 3) influenced the risk characteristics of male sexual partners.

The second paper explored the longitudinal relationship between the local rate of male incarceration and the prevalence of newly-diagnosed STIs. Census tracts with higher baseline rates and faster increasing rates of male incarceration had a prevalence of newly-diagnosed STIs that was higher at baseline and increased more rapidly over time. Census tracts with higher baseline rates of male incarceration did not have a faster increase in their prevalence of newly-diagnosed STIs.

The third paper examined the relationship between rates of male incarceration and of STIs, and whether spatial access to health care moderated this relationship. As spatial access to sexual health services worsened, the magnitude of the relationship between rate of male incarceration and prevalence of newly-diagnosed STIs decreased.

This dissertation study strengthens the evidence that rates of male incarceration have negative consequences on sexual health outcomes and advances current understandings of the pathways through which incarceration and sex ratios may contribute to a vulnerability to STIs.

Table of Contents

Table of Contents

Chapter 1: Introductory Literature Review
Introduction ……………………………………………………………………………………… 1
HIV and Sexually Transmitted Infections ……………………….………….………… 3
Social and Contextual Determinants of Health …….…………………………….…. 4
Male Incarceration ………………………………………………………….……………….... 5
Research Linking Incarceration and the Transmission of HIV and
other STIs ...................................................................................................... 6
Mechanisms of STI and HIV transmission: Sex Ratios, Sexual Networks,
Relationship Dynamics and Male Incarceration …………………………………… 8
The Service Environment: Spatial Access to Health Care Services …………. 11
Gaps in the Literature ………………………………….…………………….……………… 12
Conceptual Model and Theoretical Framework …………………….……………… 14
Significance of the Research ………………………….…………………………………… 16
References ……………………………………………………………………………………….. 20

Chapter 2: Collateral consequences: The implications of male incarceration rates, imbalanced sex ratios and partner availability among heterosexual Black women …………………………..……………………………………………………………….. 37
Abstract …………………………..……………………………………………………………….. 37
Introduction …………………..…………………………………………………………………. 38
Methods ………………………..………………………………………………………………….. 40
Results ...………………………..…………………………………………………………………. 46
Discussion ………………………..………………………………………………………………..63
References ……………………..…………………………………………………………………..74

Chapter 3: Male incarceration rates and the prevalence of sexually transmitted infections: Results from a longitudinal analysis in a South-Eastern city ………………………………………………………………………..…………………….. 81
Abstract …………………………..……………………………………………………………….. 81
Introduction …………………..…………………………………………………………………. 83
Methods ………………………..…………………………………………………………………. 85
Results ...………………………..…………………………………………………………………. 89
Discussion ………………………..………………………………………………………………. 93
References ……………………..…………………………………………………………………. 104

Chapter 4: Male incarceration rates, spatial access to sexual health care and
sexually transmitted infections: A moderation analysis ………………………. 111
Abstract …………………………..……………………………………………………………….. 111
Introduction …………………..…………………………………………………………………. 112
Methods ………………………..…………………………………………………………………. 115
Results ...………………………..…………………………………………………………………. 117
Discussion ………………………..………………………………………………………………. 122
References ……………………..…………………………………………………………………. 135

Chapter 5: Summary and Conclusion ..…………………………………………………… 145
Evaluation of the Dissertation Research ………………………………………………. 149
Implications for Research and Practice ………………………………………………… 152
Conclusion ..………………………………………………………………………………………. 155
References …………..……………………………………………………………………………. 157

About this Dissertation

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School	Laney Graduate School
Degree	PhD
Submission	Dissertation
Language	English
Research Field	Health Sciences, Public Health
Palabra Clave	African Americans Sexual behavior Incarceration Qualitative methods Neighborhood characteristics HIV/STIs Geographic information systems Longitudinal analyses Spatial access to care
Committee Chair / Thesis Advisor	Cooper, Hannah, Emory University
Committee Members	Elifson, Kirk, Emory University Jacob Arriola, Kimberly R, Emory University Wingood, Gina M, Emory University

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