Incarceration has been proposed to be a driving factor in the disproportionate impact of HIV in African-American communities. However, few data have been reported on disparities in criminal justice involvement by race among men who have sex with men (MSM). To describe history of arrest and associated factors among, we used data from CDC’s National HIV Behavioral Surveillance system. Respondents were recruited by time–space sampling in venues frequented by MSM in 15 US cities from 2003 to 2005. Data on recent arrest (in the 12 months before the interview), risk behaviors, and demographic information were collected by face-to-face interview for MSM who did not report being HIV-positive. Six hundred seventy-nine (6.8%) of 10,030 respondents reported recent arrest. Compared with white MSM, black MSM were more likely to report recent arrest history (odds ratio (OR), 1.6; 95% confidence interval (CI), 1.3–2.1). Men who were less gay-identified (bisexual [OR, 1.5; 95% CI, 1.1–1.9] or heterosexual [OR, 2.0; 95% CI, 1.2–3.5]) were more likely to report recent arrest than homosexually identified men. In addition, men who reported arrest history were more likely to have used non-injection (OR, 3.0; 95% CI, 2.4–3.6) and injection (OR, 4.7; 95%, 3.3–6.7) drugs, exchanged sex (OR, 2.7; 95% CI, 2.1–3.4), and had a female partner (OR, 1.5; 95% CI, 1.2–2.0) in the 12 months before interview. Recent arrest was associated with insertive unprotected anal intercourse in the 12 months before interview (OR, 1.4; 95% CI, 1.2–1.7). Racial differences in arrest seen in the general US population are also present among MSM, and history of arrest was associated with high-risk sex. Future research and interventions should focus on clarifying the relationship between criminal justice involvement and sexual risk among MSM, particularly black MSM.

Keywords

Black MSM Sexual identity Incarceration Risk behavior HIV/AIDS 

Required disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Introduction

The HIV epidemic has disproportionately impacted black men who have sex with men (MSM) in the USA.1, 2, 3, 4, 5 However, a recent qualitative review found black MSM to have comparable or lower rates of HIV-risk behaviors than white MSM despite a high prevalence of sexually transmitted diseases and unrecognized HIV infection.6 This suggests that much remains to be learned about the disparity in HIV/AIDS among black MSM beyond individual risk behaviors.

In CDC’s “Heightened National Response to the HIV Crisis in African Americans,” incarceration is proposed as one factor that elevates HIV risk among black Americans.7Indeed, black men represent the largest proportion of all incarcerated men in federal or state prisons and local jails.8 The overall incarceration rate for black men in 2008 was 6.5 times the rate of white men.9 In addition, black men in state and federal prisons represent the largest proportion to report being HIV-positive among inmates who had ever been tested for HIV.10However, the pathways by which incarceration may increase HIV risk is unclear, and it is unknown whether these mechanisms may be different for black MSM and blacks with other primary risks for HIV acquisition, such as injection drug use.

To determine whether the stark disparities by race in criminal justice involvement evident in the US population also exist among MSM, we sought to describe factors associated with history of recent arrest among MSM. Specifically, our null hypothesis was that black MSM were no more likely than white MSM to report history of arrest. Our secondary goal was to describe whether recent arrest was associated with high-risk sex; our null hypothesis for this goal was that MSM with a history of arrest were no more likely than MSM with no history of arrest to report engaging in unprotected anal intercourse (UAI) in the past 12 months. We tested our hypotheses by analyzing data collected in the Centers for Disease Control and Prevention (CDC) National HIV Behavioral Surveillance System (NHBS) from MSM in 15 US cities from 2003 to 2005.

Methods

Study Population

We conducted a secondary analysis of data from MSM who participated in the first cycle of National HIV Behavioral Surveillance (NHBS-MSM1) from November 2003 to April 2005 in 15 US metropolitan statistical areas (MSAs). Analyses were conducted on data from the following 15 MSAs: Atlanta, GA; Baltimore, MD; Boston, MA; Chicago, IL; Denver, CO; Fort Lauderdale, FL; Houston, TX; Los Angeles, CA; Miami, FL; Newark, NJ; New York City, NY; Philadelphia, PA; San Diego, CA; San Francisco, CA; and San Juan, PR. NHBS is an ongoing behavioral surveillance system established by CDC in 2003 to assess trends in HIV-risk behaviors, testing, and HIV prevention services among three groups: MSM, injecting drug users, and heterosexuals at increased risk.11 NHBS data are collected in rotating cycles, approximately once every 3 years from each of the three groups. NHBS is conducted in cities with high AIDS prevalence (where approximately 60% of all cases of AIDS are reported).11

A venue-based, time–space sampling strategy was used to systemically recruit participants in venues frequented by MSM in these cities. These venues include bars, dance clubs, fitness clubs, Gay Pride events, parks or beaches, raves or circuit parties, restaurants or cafes, retail businesses, sex establishments or sex environments, social organizations, street locations, or other venue types. The NHBS sampling strategy and rationale have been described previously.12

Within selected venues, men were approached and screened for eligibility. Men were considered eligible if they were at least 18 years of age, a current resident of a participating MSA and able to provide informed consent. Men who were determined to be eligible were invited to participate in a face-to-face interview. For the present analyses, we included only men who reported at least one male sex partner in the 12 months before the interview and excluded men who reported being HIV-infected. This exclusion was necessary in order to identify factors potentially associated with outcomes for persons at risk for acquiring HIV infection.

NHBS-MSM1 was determined to be non-research by the CDC Institutional Review Board (IRB). Each local NHBS site reviewed the CDC study protocol and returned a determination from their respective IRB.

Measures

The NHBS survey consists of questions concerning participants’ sociodemographic characteristics (race/ethnicity, age, education, city, and the venue type in which the participants were recruited), HIV-risk related behaviors, sexual identity, HIV testing behaviors, and history of incarceration. Participants are asked about behaviors during three time frames: ever (at any point in the participant’s lifetime), during the 12 months prior to the interview, and most recent (the most recent time the participant engaged in the behavior).

The primary analytic outcome of interest for this analysis was history of arrest. Arrest history in the past 12 months was used as a proxy measure for history of criminal justice involvement. History of recent arrest was assessed by the following question: “In the past 12 months, have you been arrested—that is, picked up by the police?”

Our secondary analytic outcome related to high-risk sexual behaviors. Men were asked several questions about their sexual behavior in the previous 12 months. Men were asked with how many male partners they had anal or oral sex. Male sex partners were further defined as main or casual partners. The overall number of male partners was recorded for casual and main partner types. Men were asked whether they had had oral, anal or vaginal sex with a female partner, and were asked if they engaged in UAI with a male partner. In our analysis, UAI was defined as having any unprotected anal intercourse, whether receptive or insertive, with a male partner during the past 12 months.

Several explanatory variables were included in our analysis because of their known associations with incarceration. These variables included drug use,13, 14, 15 exchange sex,13 , 16 and sexual risk behavior13, 14, 15 , 17 , 18 in the previous 12 months. Men were asked about their drug use history and whether they had engaged in exchange sex.

Data Analyses

Analytic methods were similar for the analyses of factors associated with recent arrest and of the relationship between UAI and recent arrest. In both cases, to determine whether to treat variables collected as continuous measures (age, number of male partners) as continuous or categorical variables in our multivariate logistic regression analysis, we produced estimated logit plots. Variables that demonstrated a non-linear relationship with the outcome were treated as categorical or were transformed. Otherwise, variables that demonstrated a linear relationship with the outcome were treated as continuous. To assess bivariate relationships for non-normally distributed continuous variables with the outcome, we performed the Wilcoxon rank-sum test.

To report bivariate associations with the outcomes, crude odds ratios and 95% confidence intervals (CIs) were calculated versus referent groups. Variables that were significantly (P < 0.10) associated with arrest in bivariate analyses were eligible for consideration for inclusion in the final model. To control for possible confounding of demographic and behavioral covariates, we performed multivariate logistic regression to obtain adjusted odds ratios (aOR) and 95% CIs. MSA was included in all models. The variables were assessed for collinearity and screened using the backward selection method of SAS version 9.2 (SAS Institute, Cary, NC, USA). All possible two-way interactions of retained main effects were assessed for significance using forward selection; to account for assessment of a large number of potential interactions, the experiment-wise alpha was set at 0.05 using a Bonferroni-type correction. Interaction terms that were significant according to the adjusted P value were retained in subsequent models.

Further analyses were conducted to describe the association between arrest and UAI (any, insertive, and receptive), while controlling for demographic and behavioral covariates and including history of arrest as a covariate. The modeling procedures were the same as described for the model of factors associated with recent arrest.

Results

Overall, 23,861 men were approached in gay-identified venues; 17,322 (73%) were eligible to participate, and 13,670 (79% of eligible) agreed to participate and completed an interview. In addition to the eligibility criteria, we restricted our analysis to 10,030 (73% of interviewed) men who reported being male, having had at least one male sex partner during the 12 months prior to the interview, and did not report being infected with HIV.

Six hundred seventy-nine (6.8%) of the men reported recent arrest. Table 1 summarizes demographic and behavioral characteristics of respondents included in the analysis. The participants reported a median age of 33.0 years. Nearly half of the men identified as non-Hispanic white, with lower numbers of non-Hispanic black, and Hispanic men. The majority of men identified as homosexual, although over one in six identified as bisexual. Most men were recruited in bars, dance clubs, raves, and circuit parties. The majority of men reported completing more than high school. Nearly half of men reported non-injection drug use, but few men reported injection drug use, in the past 12 months.