Examining inequities in rates of undiagnosed HIV and rectal STIs in a large nationwide cohort study of sexual minority men

ObjectiveSexual minority men (SMM) of colour are disproportionately impacted by HIV and bacterial STIs (bSTIs). To better understand within-group heterogeneity and differential risk factors by race and ethnicity, we sought to examine rates of undiagnosed HIV and rectal bSTI at the intersection of racial and ethnic identity with other sociodemographic factors.MethodsWe examined data from 8105 SMM conducting home-based self-testing at enrolment in a nationwide cohort study collected from November 2017 to August 2018. We conducted analyses stratified by racial and ethnic groups to examine within-group (ie, subgroup) unadjusted rates of HIV and rectal bSTI infection across a range of characteristics.ResultsRates of undiagnosed HIV were highest among Black (4.3%, n=39) and Latino (2.4%, n=38) SMM, with lower rates among those identified as multiracial (1.6%, n=15), white (1.3%, n=56) and other races (1.3%, n=6). Across the stratified analyses of HIV infection, 15 significant associations emerged showing that age, region, insurance type, sexual positioning and incarceration history had differential impacts across racial and ethnic groups. In particular, private and public insurance were protective against HIV for white but not Black and Latino SMM, and incarceration was associated with substantially higher rates of HIV infection for Black and Latino SMM relative to white SMM. We found significant co-occurrence of HIV and bSTI rates for participants who identified as Latino (OR=7.5, 95% CI 2.12 to 26.54), white (OR=3.19, 95% CI 1.14 to 8.98) and multiracial (OR=5.5, 95% CI 1.08 to 27.90), but not those who identified as Black (OR=0.82, 95% CI 0.10 to 6.56) or other races (OR=3.56 95% CI 0.31 to 40.80).ConclusionsStratified analyses showed differential rates of HIV infection at the intersection of racial and ethnic groups with other characteristics, particularly insurance status and incarceration history, pointing to structural inequities rather than individual behaviours underlying disproportionately high rates of HIV for Black and Latino SMM.

Genomic evidence for prisons as amplifiers of community tuberculosis epidemics

Prisons are high-incidence settings for tuberculosis around the world, yet the contribution of spillover from prisons in driving community epidemics has not been quantified. We whole genome sequenced 1,152 M. tuberculosis isolates from participants diagnosed with tuberculosis within prisons and in the community in Mato Grosso do Sul, Brazil from 2014 to 2019. By integrating timed phylogenies and detailed location data, we reconstructed probabilistic transmission histories. M. tuberculosis sequences from incarcerated and non-incarcerated people were closely phylogenetically related. We found that 57% of recent community-wide tuberculosis cases were attributable to transmission from individuals with an incarceration history, 2.6% of the population. Further, we find genomic evidence that the prison system disseminates M. tuberculosis genotypes through frequent transfers across the state. This population-wide genomic transmission reconstruction framework can be applied to identify key environments amplifying infectious disease transmission to prioritize public health interventions.

Risk of Overdose-Related Death for People with A History of Incarceration

IntroductionEpidemiologic studies have shown that people released from correctional facilities are at substantially increased risk of overdose-related death compared with the general population. However, the reported effect estimates are substantially heterogeneous, and the previous studies have important limitations in relative risk assessment for overdose-related death. Objectives and ApproachBritish Columbia, Canada, has experienced an unprecedented epidemic of drug overdose, this study aimed to investigate how the overdose epidemic has affected formerly incarcerated persons. A 20% random sample of residents aged 18 years or older in British Columbia was used to conduct this cohort study. During the 5-year exposure period (January 2010 to December 2014), persons with an incarceration history were identified using provincial incarceration records. During the 3-year follow-up period (January 2015 to December 2017), overdose-related deaths were identified using linked administrative health data. Risk of overdose-related death was compared between persons who did and did not have an incarceration history using a Cox regression model. ResultsOf 765,690 persons in the cohort, 5,743 had an incarceration history during the exposure period, and 634 died from drug overdose during the follow-up period. The mortality rate was 832 and 22 per 100,000 person-years for persons who did and did not have an incarceration history, respectively. Compared with persons without an incarceration history, and adjusting for individual and neighbourhood characteristics, persons who had an incarceration history were 3.67 times (95% confidence interval 2.93 - 4.59) more likely to die from drug overdose. This association was stronger for females, persons who did not have substance use disorder, and persons who were not dispensed opioids for pain or benzodiazepines. Conclusion/ImplicationsPrevious incarceration is strongly associated with risk of overdose-related death. Specific interventions are needed to better prevent drug overdose for people released from incarceration.

For Whom Does Moving Matter?

With evidence from Chapter 4 that residential relocation is associated with a lower likelihood of reincarceration, Chapter 5 examines whether the magnitude of the association is dependent upon an individual’s incarceration history, age, substance abuse problems, gender, or race. With very few exceptions, evidence reveals that most formerly incarcerated individuals reap some benefit from living in a new physical and social environment. However, some groups benefit far more than others from a fresh start in a new location. The effect of residential change on reincarceration is substantially larger for first-releases from imprisonment relative to repeat offenders. Similarly, formerly incarcerated women benefit more than men, as do Whites relative to Blacks. The only subgroup analysis that did not reveal much difference in the magnitude of the effect of residential relocation was related to substance abuse. Individuals with and without a history of substance abuse each benefitted similarly from a residential change.

Employment after incarceration: managing a socially stigmatized identity

Purpose The purpose of this paper is to explore the social stigmatization of the formerly incarcerated identity and how this affects employment post-release. The authors consider the characteristics of this identity and the identity management strategies that individuals draw from as they navigate employment. Design/methodology/approach The authors conducted semi-structured interviews with 22 men at various stages of release from federal institutions in Canada. Participants were actively searching for employment, intending to or would consider searching for employment, or had searched for employment in the past post-incarceration. Participant data were simultaneously collected, coded and analyzed using an inductive approach (Gioia et al., 2012). Findings Formerly incarcerated individuals have a unique awareness of the social stigmatization associated with their criminal record and incarceration history. They are tasked with an intentional choice to disclose or conceal that identity throughout the employment process. Six identity management strategies emerged from their accounts: conditional disclosure, deflection, identity substitution, defying expectations, withdrawal and avoidance strategies. More specifically, distinct implications of criminal record and incarceration history on disclosure decisions were evident. Based on participants’ accounts of their reintegration experiences, four aspects that may inform disclosure decisions include: opportune timing, interpersonal dynamics, criminal history and work ethic. Originality/value The authors explore the formerly incarcerated identity as a socially stigmatized identity and consider how individuals manage this identity within the employment context. The authors identify incarceration history and criminal record as having distinct impacts on experiences of stigma and identity management strategic choice, thus representing the experience of a “double stigma”.

Women Released From Custody: Investigating Risk Factors and Reoffending

This article draws on life-course and desistance theory to explore the relationship between the factors of age, ethnicity, offence type, and incarceration history for a sample of 1,035 women released from custody between January 2013 and January 2014, data gathered from the Australian Queensland Corrective Services administrative dataset. It also explores their impact on recidivism and the time between release and reoffending (known as “time to failure”) until September 2017. The data indicate substantial rates of reoffending with 70% of the sample reoffending (a return to custody/parole/probation) within the 2- to 4-year observation period. Notably, 50% of women reoffended in their first year post-release, 36% within 6 months, and 23% within the first 3 months. Regression results show that violent offenders are considerably more likely to be recidivists and older offenders are less likely to be recidivists; Aboriginal and Torres Strait Islander offenders were also more likely to reoffend. Incarceration history is significantly associated with reoffending and “time to failure”. It is clear that there needs to be increased intervention and support for female offenders during the first 2 years post-release from custody. This is particularly important for Aboriginal and Torres Strait Islander women and those with an extensive history of incarceration.