The associations of incarceration and depression with healthcare experiences and utilization among Black men who have sex with men in HPTN 061

ABSTRACT

Associations of incarceration with healthcare access and utilization among Black sexual minority men (BSMM) and differences in association among those with and without pre-incarceration symptoms of depression were measured. Secondary analysis using survey data from the longitudinal cohort HIV Prevention Trials Network 061 study was conducted among 1553 BSMM from six major U.S. cities from 2009 to 2011. We used modified log-binomial regression with robust standard errors to estimate associations of incarceration (reported at 6 month follow-up) on next six-month healthcare utilization and access (reported at the 12 month follow-up). We tested the significance of baseline depressive symptoms by incarceration interaction and reported differences in associations when observed. Participants with a history of incarceration were more likely to have depressive symptoms at baseline compared to those without. Recent incarceration was associated with almost twice the risk of mistrust in healthcare providers and emergency room utilization. Among men reporting depressive symptoms, a history of incarceration was associated with almost tripled risk of reporting providers do not communicate understandably. Among those with depression, one in five reported a missed visit regardless of incarceration status.

KEYWORDS:

• Health care utilization
• Black sexual minority men
• incarceration
• depression
• health care access

Acknowledgements

This manuscript is a product of authors and has not been reviewed by and does not necessarily represent the views of the HPTN 061 protocol team, the HPTN or the study sponsor/funders. We are thankful to the following groups who made possible the HPTN 061 study: HPTN 061 study participants; HPTN 061 Protocol co-chairs, Beryl Koblin, PhD, Kenneth Mayer, MD, and Darrell Wheeler, PhD, MPH; HPTN061 Protocol team members; HPTN Black Caucus; HPTN Laboratory Center, Johns Hopkins University School of Medicine; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Statistical and Data Management Center, Statistical Center for HIV/AIDS Research and Prevention; HPTN CORE Operating Center, Family Health International (FHI) 360; Black Gay Research Group; clinical research sites, staff, and Community Advisory Boards at Emory University, Fenway Institute, GWU School of Public Health and Health Services, Harlem Prevention Center, New York Blood Center, San Francisco Department of Public Health, the University of California, Los Angeles, Center for Behavioral and Addiction Medicine, and Cornelius Baker, FHI 360. We are thankful to Sam Griffith, Senior Clinical Research Manager, FHI 360, and Lynda Emel, Associate Director, HPTN Statistical and Data Management Center, Fred Hutchinson Cancer Research Center, for their considerable assistance with HPTN 061 data acquisition and documentation.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available on request from The HIV Prevention Trials Network (https://www.hptn.org/research/studies/hptn061/accesstostudydata) but restrictions apply to the availability of these data which prevent the authors from providing de-identified datasets.

Additional information

Funding

This research was supported by the National Institute on Drug Abuse grant “Stop-and-Frisk, Arrest, and Incarceration and STI/HIV Risk in Minority MSM” (Principal Investigator: MRK; R01DA044037). This research uses data from the HIV Prevention Trials Network 061 (HPTN 061) study. HPTN 061 grant support was provided by the National Institute of Allergy and Infectious Diseases Disease (NIAID), National Institute on Drug Abuse (NIDA) and National Institute of Mental Health (NIMH): Cooperative Agreements UM1 AI068619, UM1 AI068617, and UM1 AI068613. Additional site funding included Fenway Institute Clinical Research Site (CRS): Harvard University CFAR (P30 AI060354) and CTU for HIV Prevention and Microbicide Research (UM1 AI069480); George Washington University CRS: District of Columbia Developmental CFAR (P30 AI087714); Harlem Prevention Center CRS and NY Blood Center/Union Square CRS: Columbia University CTU (5U01 AI069466) and ARRA funding (3U01 AI069466-03S1); Hope Clinic of the Emory Vaccine Center CRS and The Ponce de Leon Center CRS: Emory University HIV/AIDS CTU (5U01 AI069418), CFAR (P30 AI050409) and CTSA (UL1 RR025008); San Francisco Vaccine and Prevention CRS: ARRA funding (3U01 AI069496-03S1, 3U01 AI069496-03S2); UCLA Vine Street CRS: UCLA Department of Medicine, Division of Infectious Diseases CTU (U01 AI069424). The funder had a role in the design of the study by providing input into the design. The funder did not have a role in the data collection and analysis, decision to publish, or preparation of the manuscript. The funding agencies had no role in designing the research, data analyses and preparation of the report. Maria Khan, Charles Cleland, and Joy Scheidell received support from the New York University Center for Drug Use and HIV Research (P30 DA011041). MRK additionally was supported by the New York University-City University of New York (NYU-CUNY) Prevention Research Center (U48 DP005008). Typhanye Dyer and Rodman Turpin were supported by the University of Maryland Prevention Research Center (U48 DP006382). Russell Brewer was supported by a grant from NIDA (P30DA027828-08S1).