Past year and prior incarceration and HIV transmission risk among HIV-positive men who have sex with men in the US^*

* Meeting Presentations: Preliminary results were presented at the 2017 SGIM Annual Meeting.

ABSTRACT

Three quarters of new HIV infections in the US are among men who have sex with men (MSM). In other populations, incarceration is a social determinant of elevations in viral load and HIV-related substance use and sex risk behavior. There has been limited research on incarceration and these HIV transmission risk determinants in HIV-positive MSM. We used the Veterans Aging Cohort Study (VACS) 2011-2012 follow-up survey to measure associations between past year and prior (more than one year ago) incarceration and HIV viral load and substance use and sex risk behavior among HIV-positive MSM (N = 532). Approximately 40% had ever been incarcerated, including 9% in the past year. In analyses adjusting for sociodemographic factors, past year and prior incarceration were strongly associated with detectable viral load (HIV-1 RNA >500 copies/mL) (past year adjusted odds ratio (AOR): 3.50 95% confidence interval (CI): 1.59, 7.71; prior AOR: 2.48 95% CI: 1.44, 4.29) and past 12 month injection drug use (AORs > 6), multiple sex partnerships (AORs > 1.8), and condomless sex in the context of substance use (AORs > 3). Past year incarceration also was strongly associated with alcohol and non-injection drug use (AOR > 2.5). Less than one in five HIV-positive MSM recently released from incarceration took advantage of a jail/prison re-entry health care program available to veterans. We need to reach HIV-positive MSM leaving jails and prisons to improve linkage to care and clinical outcomes and reduce transmission risk upon release.

KEYWORDS:

• Incarceration
• HIV
• men who have sex with men

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

* Meeting Presentations: Preliminary results were presented at the 2017 SGIM Annual Meeting.

Additional information

Funding

COMpAAAS/Veterans Aging Cohort Study, a CHAART Cooperative Agreement, is supported by the National Institutes of Health: National Institute on Alcohol Abuse and Alcoholism (U24-AA020794 (PI: A Justice), U01-AA020790 (PI: A Justice), U24-AA022001 (PI: A Justice), U10 AA013566-completed (PI: A Justice)) and in kind by the US Department of Veterans Affairs. Additional funding was provided by the National Institute on Drug Abuse (R03DA031592, PI: E Wang) and by the Yale Clinical Center of Investigation’s CTSA Grant (UL1 RR024319). MR Khan was partially supported by P30DA011041. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the U.S. Department of Veterans Affairs.