Relationship dependence: Mediators of incarceration and sexual risk behaviors among adults in drug involved sexual partnerships

Background: Although incarceration has been consistently found to be associated with sexual risk behaviors among drug using adults, few have thoroughly examined interpersonal level mediation chains linking criminal justice involvement and sexual risk outcomes. This study represents an examination of relationship dependencies (or the degree of dependence on a sexual partner for drugs and resources) as a mediator linking prior incarceration and sexual risk outcomes among a sample of drug involved couples where at least one partner has reported a history of drug abuse. Methods: Baseline data from 343 HIV negative heterosexual couples recruited for a randomized clinical trial testing the effectiveness of a couple-based HIV prevention intervention were analyzed for the current investigation. Participants' reported sociodemographics, incarceration history, levels of dependence on their sexual partner, number of sexual partners, episodes of unprotected sex and drug use in the past 30 days was collected. Results: Mulitivariate logistic regression models revealed that incarceration, drug use and relationship dependencies represented key risk factors of HIV risk for women. For men, both drug use and relationship dependencies were found to be associated with HIV risk, no significant results were found implicating incarceration as a risk factor. Conclusion: Findings will inform the development of interpersonal level HIV prevention and drug treatment initiatives as well as policies that facilitate the reintegration of adults being released from correctional institutions.