Abstract
BackgroundThe United States has the highest incarceration rate in the world. Incarceration can increase HIV risk behaviors for individuals involved with the criminal justice system and may be a driver of HIV acquisition within the community.MethodsWe used an agent-based model to simulate HIV transmission in a sexual-contact network representing heterosexual African American men and women in Philadelphia to identify factors influencing the impact of male mass incarceration on HIV acquisition in women. The model was calibrated using surveillance data and assumed incarceration increased the number of sexual contacts and decreased HIV care engagement for men post-release. Incarceration of a partner increased the number of sexual contacts for women. We compared a counterfactual scenario with no incarceration to scenarios varying key parameters to determine what factors drove HIV acquisition in women.ResultsSetting the duration of male high-risk sexual behavior to two years post-release increased the number of HIV transmissions to women by more than 20%. Decreasing post-release HIV care engagement and increasing HIV acquisition risk attributable to sexually transmitted infections (STIs) also increased the number of HIV transmissions to women. Changing the duration of risk behavior for women, the proportion of women engaging in higher risk behavior, and the relative risk of incarceration for HIV-infected men had minimal impact.ConclusionThe mass incarceration of African American men can increase HIV acquisition in African American women on a population-level through factors including post-release high-risk behaviors, disruption of HIV care engagement among formerly incarcerated men, and increased STI prevalence. These findings suggest that the most influential points of intervention may be programs seeking to reduce male risk behaviors and promote HIV care engagement post-release, as well as STI testing and treatment programs for recently incarcerated men, as well as women with incarcerated partners.
Highlights
The United States has the highest incarceration rate in the world
The model was successfully calibrated to reflect Human immunodeficiency virus (HIV) prevalence and incidence trends for African American men and women living in Philadelphia from 2005 to 2015
Using Philadelphia as a case study, we found that the mass incarceration of African American men can substantially increase the number of HIV transmissions to African American women within the community
Summary
The United States has the highest incarceration rate in the world. Incarceration can increase HIV risk behaviors for individuals involved with the criminal justice system and may be a driver of HIV acquisition within the community. Heterosexual African Americans with a history of incarceration are six times more likely to be HIV-infected compared to those with no incarceration history, and numerous observational studies suggest a history of incarceration is a strong and consistent risk factor for high-risk sexual behaviors post-release [6, 11,12,13,14,15,16,17]. Incarcerated HIV-infected men are more likely to disengage from HIV care and experience viral rebound post-release, which in turn increases HIV-related morbidity and the likelihood of HIV transmission to their sexual and drugusing partners [18,19,20,21,22,23,24]. The mass incarceration of men may be a major driver of HIV acquisition for women
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