Criminal Justice Involvement and HIV Risk Model: A Novel Conceptual Model That Describes the Influence of Arrest and Incarceration on STI/HIV Transmission

Background: Criminal justice involvement (CJI) is an independent correlate of sexual risk behavior and HIV. There is a need for a conceptual model that elucidates the pathways through which CJI may work to influence infection. Methods: Informed by research in epidemiology, criminology, and sociology, we developed a model which suggests that CJI influences infection by affecting proximate determinants of transmission. Results: The CJI and HIV Risk Model suggests that CJI may influence a former offender's HIV risk by working through a number of pathways. First, CJI disrupts existing sexual networks which may lead to increases in sex partnership exchange. Second, CJI may increase involvement in high-risk networks, thereby increasing the likelihood of contact with an HIV-infected partner. Third, CJI weakens social cohesion and support, which inhibits the ability to cope during the stressful periods of incarceration and reentry, thereby resulting in known determinants of HIV risk, such as diminished mental health, increased self-medication with drugs, and elevated levels of sex partnerships. Fourth, CJI further diminishes employment prospects and financial solvency, inhibiting the formation of stable partnerships that may serve to protect against multiple partnerships, or encouraging multiple partnerships as a means of meeting basic needs. Fifth, criminal justice involvement contributes to social instability and disenfranchisement, which may diminish access to care and timely STI treatment, thereby increasing the duration of infectiousness. Conclusions: The CJI and HIV Risk Model provides guidance on future research that should be conducted to better understand the ways in which CJI influences infection risk.