Prevalence and Correlates of HIV Risk Behaviors of Inmates in a State Prison System

Background: The high HIV prevalence rate among inmates compared to the general United States population necessitates studies of their HIV risk behaviors. Previous studies had focused on pre-incarceration risk behaviors. However, to fully understand the role of incarceration in HIV transmission, risk behaviors of currently incarcerated individuals need to be studied.

Methods: A survey of 1, 819 inmates randomly selected from correctional facilities in Illinois was conducted. Self-reported HIV risk behaviors of 526 women and 1,293 men before and during incarceration were obtained. Data were analyzed using descriptive and inferential statistics. HIV risk behaviors prior to and during incarceration were presented as frequency tables. Logistic regression analysis was used to test the association of selected independent variables with having sexual intercourse during incarceration.

Results: Over 70% of participants were men. The mean age of women was higher than that of men (p=0.05) and more than half of the participants were African Americans. Fifty nine percent and 19% of participants reported that they had two or more vaginal and anal sexual partners prior to incarceration respectively. Sixty five percent of participants who had ever had vaginal or anal sex never or rarely used condoms and 75% of them did not use condoms during their last sexual intercourse. Fourteen percent of participants reported ever injecting drugs and 57% of these had shared needles for injection. Regarding risk behaviors during incarceration, injection drug use was reported by 1% of participants; two thirds of these individuals reported sharing needles. Sexual intercourse was reported by 8% of participants; 40% was vaginal sex and 15% was anal sex. Risk factors for sexual intercourse in prison were length of stay of one year or more, bisexual orientation and receiving a tattoo in prison. Seventeen percent of 68% of participants who had tattoos got them in prison.

Conclusions: Inmates exhibited HIV risk behaviors prior to and during incarceration. Sexual intercourse during incarceration was associated with longer length of stay in prison. These findings support the importation and deprivation models used to explain inmate behavior. We recommend that HIV prevention interventions be commenced as soon as possible after incarceration.