Compared to areas with low rates of incarceration, areas with higher rates of incarceration have higher and increasing rates of sexually transmitted infections (hereafter STIs).[1,2] One study also found a statistically significant association between rates of male incarceration and rates of Human Immunodeficiency Virus (HIV).[1] Few studies have examined these relationships and even fewer studies have been conducted to explore the reasons for these higher rates. This proposed mixed-method study will use the Social Cognitive Theory and the Social Ecological Model to fill this critical gap. The following three research aims seek to look beyond the individual and consider environmental contextual factors:
Aim 1 : Using qualitative methods, examine and compare the processes through which male: female sex ratios influence sexual networks and partnership formation and maintenance among heterosexual African-American women living in two types of census tracts: a tract that has higher male incarceration rates and a tract that has lower male incarceration rates;
Aim 2 : Investigate the relationship between male incarceration rates and rates of HIV and other STIs in Atlanta census tracts over time (2005- 2010);
Aim 3 : Explore health care service availability as a moderator of the relationship between rates of male incarceration and rates of HIV and other STIs. The long term objective of this study is to gain a greater understanding of how male incarceration rates and the health care service environment influence individuallevel sexual and reproductive health. The information gained by achieving the aims of this study could be used to inform the development of programs and policies aimed at mitigating the adverse impact of rates of male incarceration on the transmission of HIV and other STIs. The principal investigator (hereafter PI) will use qualitative methods to achieve Aim 1 and quantitative methods to achieve Aims 2 and 3. Qualitative methods are best suited to address Aim 1 because these methods are particularly useful for understanding contextual influences and also for discovery,[3-5] both of which are important for emerging research on the macro-social determinants of STIs and HIV. The PI will interview women from two Atlanta, GA census tracts, one that has a high male incarceration rate and a low male: female sex ratio, and the other that has a low male incarceration rate and a male: female sex ratio close to 1.00. Interviews will focus on sexual networks and romantic partnership formation and maintenance. To achieve Aims 2 and 3, U.S. decennial data, STI and HIV/AIDS surveillance data, incarceration data and an inventory of health care service locations will be used to analyze the relationship between incarceration rates and STI/HIV rates in Atlanta GA census tracts, and to investigate whether spatial access to healthcare moderates these relationships. Geographic Information Software (GIS), PASW Statistics 18 (SPSS) and Hierarchical Linear Modeling (HLM) software will be used in these analyses.
Rates of HIV and other STIs are at epidemic proportions in African American populations in the U.S.[6,7] There have been calls in the literature, from the CDC and from the White House's National HIV/AIDS Strategy for the United States report for future studies to examine (1) how incarceration within African American communities affects HIV-risk behaviors among the sexual partners and sexual networks of those left behind and in the community at large;[8-10] (2) health care availability and sexual networks in relation to HIV and other STI health disparities.[11] The information obtained from this study could be used to inform the development of programs and policies aimed at mitigating the adverse impact of rates of male incarceration on the transmission of HIV and other STIs.
