HIV Risk Behaviors and HIV-Related Morbidity in a Cohort of Incarcerated Women in Massachusetts
Due to the nature of the crimes for which women are incarcerated, the seroprevalence of HIV is alarmingly high in women's prisons. We assessed HIV risk behaviors and HIV-related morbidity in a cohort of 291 HIV seropositive (HIV+) women inmates (WI) followed over 3.5 years at the HIV clinic of a large state prison for women in Massachusetts.
We examined date of HIV diagnosis, race, ethnicity, and T cell count decline for a cohort of 291 HIV+ WI. In addition, 160 WI (111 HIV+ WI and 49 HIV seronegative WI)
participated in case-controlled interviews that examined risk-taking behaviors, sexual abuse history, and gynecological infection history.
The HIV seroprevalence rate at the prison during the study period ranged from 13 to 20% (voluntary testing) in the study period, and our best estimate of the seroconversion rate among previously HIV seronegative women returning to prison was 6 to 16 percent. Latina WI were 1.5 times more likely (95% CI 1.0 to 2.3) to be identified as HIV-seropositive than white WI; African American WI were less likely than white women (POR 0.4, 95% CI 0.2 to 0.8) to be identified as HIV-seropositive. HIV seropositivity was 2.0 times more prevalent (95 % CI 1.0 to 3.9) among women reporting exchanging sex for drugs or money; 14.8 times more prevalent (95% CI 6.5 to 33.7) among women who reported injection drug use; and less likely (POR 0.5, 95% CI 0.2 to 0.9) among women who reported having had unprotected sex at the time of their last encounter, than among women who did not report these histories. HIV seropositivity was 2.8 times more prevalent (95% CI 1.0 to 7.4) among women who reported a history of childhood sexual abuse, and these women were 4.6 times more likely (95% CI 1.4 to 15.2) to have participated in three HIV risks (sex work, injection drug use, and unprotected sexual contact), than women who did not have a history of sexual abuse. HIV+ Latina WI and African American women were not more likely to experience a decrease in their CD4 slope, than the reference group (HIV+ white WI). Sexually transmitted disease history (STD) was prevalent in this population: 62% of HIV+ women and 68 % of HIV-women (n=88) reported having had an STD within three months prior to the interview.
HIV risk reduction is a critically important intervention for women who are incarcerated, and must take into consideration the long term effects of prior sexual abuse. Differential risks for HIV infection and indicators of HIV progression by race and ethnicity deserve further investigation. The opportunity to provide under-served and high risk women access to effective HIV education, prophylaxis, and treatment in the prison setting should not be missed.
Anne S. De Groot
TB/HIV Research Laboratory
International Health Institute
Brown University School of Medicine
Box GB 473, Providence RI 02912.
Telephone (401) 863-3875 Fax 863-1243
Anne_DeGroot @ postoffice.brown.edu