Among incarcerated populations, the prevalence of HIV infection is 5 times greater than among the non-incarcerated. Mass incarceration directly contributes to HIV transmission within communities because inmates living with HIV are often not appropriately linked to care and treatment upon release. Indirectly, mass incarceration contributes to HIV prevalence by reducing the economic opportunities of inmates who are released from prison, increasing inequality and promoting re-engagement in HIV risk-taking behavior (drug use, multiple concurrent partnerships, and transactional sex). The purpose of this study was to explore the neighborhood-level impact of mass incarceration, prison release, and economic inequality on HIV prevalence in urban cities in the US.
We used 2012 ZIP code level HIV surveillance data from 12 metropolitan jurisdictions. Regression models were estimated for HIV prevalence rates overall and stratified by gender. Independent variables included prison release rate per 1000 adult population, inequality (GINI index), %living in poverty, and %Black population.
Mean HIV prevalence ranged from 374.7 to 1426.4 per 100,000 population across all 1,002 ZIP codes in 12 jurisdictions. In multivariate analysis, overall HIV prevalence was independently associated with greater inequality [235.9 (SE 60.5) p<0.01], higher % living in poverty [27.6 (SE 2.9) p<0.01], higher prison release rate [10.0 (SE 2.2) p<0.01], and more %Black population [5.9 (SE 2.2) p<0.01]. All associations remained independently significant within gender. However, among females, HIV prevalence depended more heavily on economic inequality [1,297.0 (SE3 25.1), p<0.01] than in males [679.9 (SE 136.4), p<0.01]. Prison release rate was more strongly associated with male than female HIV prevalence [13.5 (SE 3.4), p<0.01] vs [6.4 (SE 1.6), p<0.01].
At the neighborhood level, economic inequality and prison release are significantly associated with HIV prevalence and have a differential impact by gender. HIV prevention interventions should directly address linkage to care and broadly promote expansion of economic opportunities among former inmates living with HIV.
L. Bogart, None
K. Mayer, None