Incarceration is strongly, and alarmingly, associated with sexually transmitted infection (STI), including the human immunodeficiency virus (HIV). This dissertation was devoted to investigating determinants of the disproportionately high levels of STI/HIV in populations with a history of and/or at risk of incarceration in the United States (US). Given incarceration is endemic in many communities, the effect of incarceration on health is a subject of great significance.

Incarceration may contribute to STI/HIV transmission by disrupting stable partnerships and promoting high-risk partnerships. We examined the relationship between incarceration and risky partnerships using the NC Rural Health Project (NCRHP) dataset (N=320), a population-based case-control study of sexual HIV transmission among African Americans living in eastern rural NC and the NC Priorities for Local AIDS Control Efforts (PLACE) study dataset (N=373), a sample recruited from venues where people meet sexual partners in an urban NC setting. Both analyses indicated that personal incarceration and partner’s history of incarceration were strongly associated with risky partnerships in multivariable analyses adjusting for demographic and socio-economic variables. We hypothesize that incarceration and substance abuse reciprocally contributed to one another and worked in concert to increase sexual risk behaviors.

Mental illness, which disproportionately affects populations with high levels of both STI/HIV and incarceration, may contribute to STI/HIV among incarcerated populations. We explored this hypothesis by measuring associations between chronic depression and STI, by arrest history, among a sub-sample of 11,594 participants of the National Longitudinal Study of Adolescent Health. Young adults with chronic major depression—detected both early in adolescence (Wave I) and six years later in young adulthood (Wave III)—were particularly vulnerable to STI acquisition in young adulthood compared to those with no prior major depression, controlling for baseline STI. We measured higher prevalences of depression and STI and stronger associations between depression and STI among young adults with a prior history of arrest compared to those with no prior arrest history. These findings suggested that greater integration of mental health and STI services for adolescents and young adults is needed, particularly among youth involved in the criminal justice system.