Elevated sexually transmitted infection risk associated with criminal justice involvement in the US

Background: US incarcerated populations are disproportionately infected with sexually transmitted infections (STIs). Community-based offenders also may experience elevated STIs, yet research on STI risk in this group is limited. We measured associations between involvement in the criminal justice system and STI risk. Methods: We used Wave III (2001-2002) of the National Longitudinal Study of Adolescent Health (N=14,322) to estimate associations between criminal justice system involvement and multiple (two or more) sex partnerships in the previous year and current biologically-confirmed infection with chlamydia, gonorrhea, or trichomoniasis. Results: The overall prevalence of STI was 6.3%. Respondents who had ever been stopped by the police, versus those who had not, had elevated levels of multiple partnerships (Prevalence Ratio (PR): 1.7, 95% confidence interval (CI): 1.6-1.9) and STI (PR: 1.4, 95% CI: 1.1-1.8). History of arrest as a minor was associated with multiple partnerships (PR: 1.7, 95% CI: 1.6-1.9) and STI (PR: 1.6, 95% CI: 1.1-2.3); those who were arrested two or more times as a minor were nearly twice as likely to be STI-infected in adulthood as those with no history of arrest as a minor (PR: 1.9, 95% CI: 1.0-3.4). Arrest in adulthood was associated with multiple partnerships (PR: 1.7, 95% CI: 1.6-1.9) and STI (PR: 1.4, 95% CI: 1.1-1.9). Conclusions: Community-based offenders constitute a priority population for STI control. Failure to use the criminal justice system as an infrastructure for STI control efforts constitutes a missed opportunity to reach a vulnerable, underserved population in need of STI testing, treatment, and prevention.