Incarceration, Social Support Networks, and Health among Black Sexual Minority Men and Transgender Women: Evidence from the HPTN 061 Study
Abstract
:1. Introduction
2. Materials and Methods
2.1. Sample and Study Design
2.2. Measures
2.3. Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Characteristic at Baseline | Overall N (%) N = 1169 | N (%) with One Person or Fewer in Network Providing Each Form of Support N = 192 | OR * (95% CI) for Association between Characteristic and One Person or Fewer in Network Providing Each Form of Support | p-Value for Association between Characteristic and One Person or Fewer in Network Providing Each Form of Support | N (%) with Consistent Network Support N = 542 | OR * (95% CI) for Association between Characteristic and Consistent Network Support | p-Value for Association between Characteristic and Consistent Network Support |
---|---|---|---|---|---|---|---|
Age | |||||||
Mean (SD) | 37.7 (11.8) | 38.40 (12.24) | 1.01 [0.99, 1.02] | 0.402 | 37.1 (12.1) | 0.98 [0.97, 0.99] | 0.001 |
Education | |||||||
High School or More | 568 (48.6) | 74 (13.0) | Referent | 307 (54.0) | Referent | ||
Less than High School | 601 (51.4) | 118 (19.6) | 1.84 [1.34, 2.54] | <0.001 | 235 (39.1) | 0.61 [0.48, 0.78] | <0.001 |
Transgender | |||||||
No | 1118 (95.6) | 182 (16.3) | Referent | 522 (46.7) | Referent | ||
Yes | 49 (4.2) | 10 (20.4) | 1.32 [0.61, 2.62] | 0.455 | 20 (40.8) | 0.76 [0.41, 1.39] | 0.371 |
City | |||||||
Atlanta | 207 (17.7) | 52 (25.1) | Referent | 68 (32.9) | Referent | ||
Boston | 173 (14.8) | 31 (17.9) | 0.71 [0.42, 1.18] | 0.192 | 64 (37.0) | 1.41 [0.90, 2.21] | 0.131 |
Los Angeles | 207 (17.7) | 39 (18.8) | 0.68 [0.42, 1.10] | 0.117 | 109 (52.7) | 2.50 [1.65, 3.83] | <0.001 |
New York City | 256 (21.9) | 42 (16.4) | 0.53 [0.33, 0.85] | 0.008 | 116 (45.3) | 1.58 [1.07, 2.35] | 0.022 |
San Francisco | 149 (12.7) | 13 (8.7) | 0.27 [0.13, 0.50] | <0.001 | 86 (57.7) | 2.94 [1.86, 4.69] | <0.001 |
Washington DC | 177 (15.1) | 15 (8.5) | 0.25 [0.13, 0.45] | <0.001 | 99 (55.9) | 2.51 [1.64, 3.89] | <0.001 |
Incarcerated Ever | |||||||
No | 465 (39.8) | 72 (15.5) | Referent | 238 (51.2) | Referent | ||
Yes | 686 (58.7) | 117 (17.1) | 1.14 [0.83, 1.59] | 0.420 | 299 (43.6) | 0.73 [0.57, 0.94] | 0.013 |
Experienced Violence | |||||||
No | 284 (24.3) | 37 (13.0) | Referent | 135 (47.5) | Referent | ||
Yes | 866 (74.1) | 152 (17.6) | 1.40 [0.95, 2.09] | 0.094 | 400 (36.8) | 0.90 [0.68, 1.20] | 0.474 |
Insufficient Income | |||||||
Yes | 655 (56.0) | 132 (20.2) | Referent | 262 (40.0) | Referent | ||
No | 513 (43.9) | 60 (11.7) | 0.49 [0.35, 0.68] | <0.001 | 280 (54.6) | 1.76 [1.37, 2.25] | <0.001 |
Unstable Housing | |||||||
No | 1055 (90.2) | 171 (16.2) | Referent | 507 (48.1) | Referent | ||
Yes | 113 (9.7) | 21 (18.6) | 1.27 [0.74, 2.08] | 0.361 | 35 (31.0) | 0.50 [0.32, 0.76] | <0.001 |
Ever tested for HIV | |||||||
No | 140 (12.0) | 31 (22.1%) | Referent | 59 (42.1) | Referent | ||
Yes | 1028 (87.9) | 161 (15.7%) | 0.62 [0.40, 0.97] | 0.031 | 483 (47.0) | 1.16 [0.79, 1.70] | 0.446 |
Health Care Coverage | |||||||
No | 456 (39.0) | 90 (19.7) | Referent | 203 (44.5) | Referent | ||
Yes | 712 (60.9) | 102 (14.3) | 0.66 [0.48, 0.91] | 0.011 | 339 (47.6) | 1.12 [0.87, 1.44] | 0.363 |
Place to Go for Medical Care when Sick | |||||||
No | 247 (21.1) | 54 (21.9) | Referent | 109 (44.1) | Referent | ||
Yes | 922 (78.9) | 138 (15.0) | 0.61 [0.43, 0.88] | 0.008 | 433 (47.0) | 1.12 [0.83, 1.51] | 0.465 |
Seen a Medical Provider in Past 6 Months | |||||||
No | 462 (39.5) | 87 (18.8) | Referent | 226 (48.9) | Referent | ||
Yes | 707 (60.5) | 105 (14.9) | 0.73 [0.53, 1.00] | 0.052 | 316 (44.7) | 0.80 [0.62, 1.02] | 0.076 |
Sexual Partnership Types | |||||||
Men Only | 511 (43.7) | 109 (21.3) | Referent | <0.001 | 187 (36.6) | Referent | |
Men and Women | 657 (56.2) | 83 (12.6) | 0.48 [0.35, 0.65] | 355 (54.0) | 1.88 [1.47, 2.42] | <0.001 | |
Multiple Partnership | |||||||
No | 673 (57.6) | 97 (14.4) | Referent | 323 (48.0) | Referent | ||
Yes | 494 (42.3) | 95 (19.2) | 1.43 [1.04, 1.96] | 0.025 | 219 (44.3) | 0.85 [0.67, 1.09] | 0.205 |
Concurrency | |||||||
No | 882 (75.4) | 141 (16.0) | Referent | 399 (45.2) | Referent | ||
Yes | 287 (24.6) | 51 (17.8) | 1.07 [0.74, 1.52] | 0.709 | 143 (49.8) | 1.10 [0.83, 1.46] | 0.500 |
Lives with Primary Partner | |||||||
No | 975 (83.4) | 158 (16.2) | Referent | 446 (45.7) | Referent | ||
Yes | 177 (15.1) | 31 (17.5) | 1.04 [0.67, 1.58] | 0.857 | 90 (50.8) | 1.14 [0.81, 1.59] | 0.452 |
Any STI | |||||||
No | 1010 (86.4) | 171 (16.9) | Referent | 460 (45.5) | Referent | ||
Yes | 138 (11.8) | 19 (13.8) | 0.74 [0.43 1.21] | 0.252 | 72 (52.2) | 1.22 [0.84, 1.78] | 0.293 |
Sex Trade | |||||||
No | 872 (74.6) | 126 (14.4) | Referent | 422 (48.4) | Referent | ||
Yes | 297 (25.4) | 66 (22.2) | 1.68 [1.20, 2.35] | 0.002 | 120 (40.4) | 0.68 [0.51, 0.90] | 0.006 |
HIV Status at Baseline | |||||||
HIV+ Acute | 3 (0.3) | 1 (33.3) | Referent | 1 (33.3) | Referent | ||
Negative | 935 (80.0) | 145 (15.5) | 0.43 [0.04, 9.24] | 0.490 | 426 (45.6) | 2.15 [0.20, 46.29] | 0.533 |
Positive | 214 (18.3) | 45 (21.0) | 0.58 [0.05, 12.58] | 0.656 | 105 (49.1) | 2.19 [0.21, 47.51] | 0.525 |
Unknown | 16 (1.4) | 1 (6.2) | 0.14 [0.00, 4.56] | 0.225 | 9 (56.2) | 3.00 [0.24, 73.58] | 0.410 |
Hard Drug Use | |||||||
No | 651 (55.7) | 101 (15.5) | Referent | 309 (47.5) | Referent | ||
Yes | 471 (40.3) | 82 (17.4) | 1.15 [0.83, 1.59] | 0.390 | 213 (45.2) | 0.90 [0.70, 1.16] | 0.434 |
Marijuana Use Weekly | |||||||
No | 807 (69.0) | 124 (15.4) | Referent | 365 (45.2) | Referent | ||
Yes | 362 (31.0) | 68 (18.8) | 1.23 [0.88, 1.70] | 0.225 | 177 (48.9) | 1.09 [0.84, 1.42] | 0.506 |
AUDIT Score | |||||||
Mean (SD) | 6.84 (7.76) | 7.65 (9.00) | 1.02 [1.00, 1.04] | 0.104 | 6.56 (7.19) | ||
Median [Min, Max] | 4.00 [0, 40.0] | 4.00 [0, 36.0] | 4.00 [0, 35.0] | 0.99 [0.97, 1.01] | 0.227 | ||
Depression Scale (CES-D) | |||||||
Mean (SD) | 16.4 (11.0) | 18.4 (11.8) | 1.02 [1.01, 1.03] | 0.004 | 15.0 (10.8) | 0.98 [0.97, 0.99] | <0.001 |
Median [Min, Max] | 14.0 [0, 59.0] | 16.0 [0, 59.0] | 12.0 [0, 56.0] | ||||
Experienced Homophobia Scale | |||||||
Mean (SD) | 53.2 (31.5) | 51.0 (32.4) | 1.00 [0.99, 1.00] | 0.164 | 55.1 (30.4) | 1.00 [1.00, 1.01] | 0.194 |
Experienced Racism Scale | |||||||
Mean (SD) | 49.5 (24.0) | 46.0 (25.0) | 0.99 [0.98, 1.00] | 0.010 | 51.5 (23.8) | 1.01 [1.00, 1.01] | 0.0418 |
Internalized Homophobia Scale | |||||||
Mean (SD) | 15.6 (7.01) | 16.4 (7.49) | 1.02 [1.00, 1.05] | 0.053 | 14.8 (6.75) | 0.97 [0.96, 0.99] | 0.002 |
Network Type | % with Network Type | RR * (95% CI) | aRR ** (95% CI) | |
---|---|---|---|---|
Small Medical Support Network | <0.001 (0.035) | |||
No Recent Incarceration | 501 (49.9) | Referent | Referent | |
Recent Incarceration | 106 (64.2) | 1.26 [1.12, 1.41] | 1.16 [1.01, 1.34] | |
Small Financial Support Network | <0.001 (0.013) | |||
No Recent Incarceration | 481 (47.9) | Referent | Referent | |
Recent Incarceration | 104 (63.0) | 1.28 [1.14, 1.45] | 1.18 [1.04, 1.35] | |
Small Social Support Network | 0.151 (0.326) | |||
No Recent Incarceration | 256 (25.5) | Referent | Referent | |
Recent Incarceration | 51 (30.9) | 1.19 [0.94, 1.52] | 1.15 [0.87, 1.52] | |
Small Emotional Support Network | 0.087 (0.916) | |||
No Recent Incarceration | 379 (37.7) | Referent | Referent | |
Recent Incarceration | 74 (44.8) | 1.17 [0.98, 1.40] | 1.01 [0.81, 1.26] | |
Consistent Network Support | 0.010 (0.337) | |||
No Recent Incarceration | 483 (48.1) | Referent | Referent | |
Recent Incarceration | 59 (35.8) | 0.77 [0.63, 0.94] | 0.90 [0.73, 1.12] | |
At Least One Person in Network Providing Each Form of Support | 0.033 (0.582) | |||
No Recent Incarceration | 666 (66.3) | Referent | Referent | |
Recent Incarceration | 94 (57.0) | 0.87 [0.77, 0.99] | 0.97 [0.86, 1.09] | |
One Person or Fewer in Network Providing Each Form of Support | 0.094 (0.271) | |||
No Recent Incarceration | 157 (15.6%) | Referent | Referent | |
Recent Incarceration | 35 (21.2%) | 1.32 [0.95, 1.81] | 1.24 [0.85, 1.81] |
Network Type | % with Health Outcome | PR * (95% CI) | aPR (95% CI) ** | Unadjusted (Adjusted) p-Value |
---|---|---|---|---|
Multiple Sexual Partnerships | ||||
Small Medical Support Network No Yes | 191 (43.8) 261 (43.0) | Referent 1.00 [0.87, 1.15] | Referent 0.92 [0.80, 1.05] | 0.978 (0.227) |
Small Financial Support Network No Yes | 197 (43.0) 255 (43.6) | Referent 1.02 [0.89, 1.17] | Referent 0.94 [0.82, 1.07] | 0.740 (0.340) |
Small Social Support Network No Yes | 342 (43.6) 110 (35.8) | Referent 0.77 [0.65, 0.91] | Referent 0.77 [0.65, 0.90] | 0.002 (0.001) |
Small Emotional Support Network No Yes | 249 (42.2) 203 (44.8) | Referent 1.03 [0.97, 1.09] | Referent 0.98 [0.86, 1.12] | 0.403 (0.792) |
Consistent Network Support No Yes | 243 (48.5) 209 (38.6) | Referent 0.90 [0.85, 0.96] | Referent 0.83 [0.72, 0.95] | <0.001 (0.008) |
At Least One Person in Network Providing Each Form of Support No Yes | 132 (46.6) 320 (42.1) | Referent 0.95 [0.89, 1.02] | Referent 0.97 [0.84, 1.13] | 0.135 (0.707) |
One Person or Fewer in Network Providing Each Form of Support No Yes | 378 (44.4) 74 (38.5) | Referent 0.94 [0.87, 1.02] | Referent 0.80 [0.67, 0.96] | 0.135 (0.018) |
Hard Drug Use | ||||
Small Medical Support Network No Yes | 124 (28.4) 203 (33.4) | Referent 1.19 [1.00, 1.42] | Referent 1.05 [0.89, 1.24] | 0.054 (0.541) |
Small Financial Support Network No Yes | 131 (28.6) 196 (33.5) | Referent 1.17 [0.98, 1.40] | Referent 1.07 [0.91, 1.26] | 0.079 (0.388) |
Small Social Support Network No Yes | 227 (30.8) 100 (32.6) | Referent 1.07 [0.89, 1.29] | Referent 0.95 [0.80, 1.12] | 0.465 (0.511) |
Small Emotional Support Network No Yes | 173 (29.3) 154 (34.0) | Referent 1.05 [0.99, 1.12] | Referent 1.03 [0.88, 1.20] | 0.083 (0.717) |
Consistent Network Support No Yes | 174 (34.7) 153 (28.2) | Referent 0.93 [0.88, 0.99] | Referent 0.87 [0.74, 1.02] | 0.021 (0.082) |
At Least One Person in Network Providing Each Form of Support No Yes | 95 (33.6) 232 (30.5) | Referent 0.97 [0.91, 1.03] | Referent 0.89 [0.75, 1.06] | 0.340 (0.181) |
One Person or Fewer in Network Providing Each Form of Support No Yes | 269 (31.6) 58 (30.2) | Referent 0.99 [0.92, 1.07] | Referent 0.92 [0.75, 1.12] | 0.837 (0.403) |
Unhealthy Alcohol Use | ||||
Small Medical Support Network No Yes | 87 (20.0) 152 (25.0) | Referent 1.25 [0.99, 1.56] | Referent 1.20 [0.96, 1.51] | 0.057 (0.108) |
Small Financial Support Network No Yes | 100 (21.8) 139 (23.8) | Referent 1.13 [0.91, 1.41] | Referent 1.15 [0.94, 1.41] | 0.266 (0.175) |
Small Social Support Network No Yes | 169 (23.0) 70 (22.8) | Referent 1.00 [0.79, 1.26] | Referent 1.02 [0.82, 1.26] | 0.974 (0.892) |
Small Emotional Support Network No Yes | 128 (21.7) 111 (24.5) | Referent 1.03 [0.98, 1.09] | Referent 1.16 [0.94, 1.42] | 0.223 (0.156) |
Consistent Network Support No Yes | 125 (25.0) 114 (21.0) | Referent 0.96 [0.91, 1.01] | Referent 0.84 [0.69, 1.02] | 0.086 (0.075) |
At Least One Person in Network Providing Each Form of Support No Yes | 72 (25.4) 167 (22.0) | Referent 0.96 [0.90, 1.02] | Referent 0.84 [0.67, 1.04] | 0.198 (0.107) |
One Person or Fewer in Network Providing Each Form of Support No Yes | 191 (22.4) 48 (25.0) | Referent 1.03 [0.96, 1.10] | Referent 1.11 [0.86, 1.44] | 0.406 (0.428) |
Visited ER in Past Six Months | ||||
Small Medical Support Network No Yes | 82 (18.8) 125 (20.6) | Referent 1.10 [0.89, 1.37] | Referent 1.05 [0.84, 1.32] | 0.376 (0.673) |
Small Financial Support Network No Yes | 81 (17.7) 126 (21.5) | Referent 1.19 [0.96, 1.47] | Referent 1.14 [0.92, 1.42] | 0.110 (0.243) |
Small Social Support Network No Yes | 145 (19.7) 62 (20.2) | Referent 1.02 [0.81, 1.28] | Referent 0.95 [0.76, 1.20] | 0.873 (0.680) |
Small Emotional Support Network No Yes | 105 (17.8) 102 (22.5) | Referent 1.08 [1.02, 1.15] | Referent 1.22 [0.99, 1.50] | 0.015 (0.063) |
Consistent Network Support No Yes | 116 (23.2) 91 (16.8) | Referent 0.94 [0.88, 1.01] | Referent 0.89 [0.71, 1.11] | 0.070 (0.305) |
At Least One Person in Network Providing Each Form of Support No Yes | 66 (23.3) 141 (18.6) | Referent 0.95 [0.89, 1.03] | Referent 0.88 [0.71, 1.10] | 0.202 (0.271) |
One Person or Fewer in Network Providing Each Form of Support No Yes | 164 (19.3) 43 (22.4) | Referent 1.05 [0.97, 1.15] | Referent 1.10 [0.85, 1.42] | 0.234 (0.457) |
Depression | ||||
Small Medical Support Network No Yes | 133 (30.5) 212 (34.9) | Referent 1.16 [0.98, 1.37] | Referent 1.04 [0.88, 1.22] | 0.086 (0.665) |
Small Financial Support Network No Yes | 132 (28.8) 213 (36.4) | Referent 1.06 [1.00, 1.13] | Referent 1.12 [0.96, 1.30] | 0.006 (0.177) |
Small Social Support Network No Yes | 229 (31.1) 116 (37.8) | Referent 1.24 [1.05, 1.46] | Referent 1.16 [0.99, 1.36] | 0.010 (0.071) |
Small Emotional Support Network No Yes | 184 (31.2) 161 (35.5) | Referent 1.27 [1.07, 1.51] | Referent 1.12 [0.95, 1.33] | 0.066 (0.163) |
Consistent Network Support No Yes | 184 (36.7) 161 (29.7) | Referent 0.90 [0.85, 0.96] | Referent 0.85 [0.73, 0.99] | 0.001 (0.035) |
At Least One Person in Network Providing Each Form of Support No Yes | 106 (37.5) 239 (31.4) | Referent 0.92 [0.86, 0.99] | Referent 0.90 [0.77, 1.06] | 0.025 (0.221) |
One Person or Fewer in Network Providing Each Form of Support No Yes | 268 (31.5) 77 (40.1) | Referent 1.11 [1.02, 1.20] | Referent 1.22 [1.02, 1.46] | 0.017 (0.031) |
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Scheidell, J.D.; Kapadia, F.; Turpin, R.E.; Mazumdar, M.; Dyer, T.V.; Feelemyer, J.; Cleland, C.M.; Brewer, R.; Parker, S.D.; Irvine, N.M.; et al. Incarceration, Social Support Networks, and Health among Black Sexual Minority Men and Transgender Women: Evidence from the HPTN 061 Study. Int. J. Environ. Res. Public Health 2022, 19, 12064. https://doi.org/10.3390/ijerph191912064
Scheidell JD, Kapadia F, Turpin RE, Mazumdar M, Dyer TV, Feelemyer J, Cleland CM, Brewer R, Parker SD, Irvine NM, et al. Incarceration, Social Support Networks, and Health among Black Sexual Minority Men and Transgender Women: Evidence from the HPTN 061 Study. International Journal of Environmental Research and Public Health. 2022; 19(19):12064. https://doi.org/10.3390/ijerph191912064
Chicago/Turabian StyleScheidell, Joy D., Farzana Kapadia, Rodman E. Turpin, Medha Mazumdar, Typhanye V. Dyer, Jonathan Feelemyer, Charles M. Cleland, Russell Brewer, Sharon D. Parker, Natalia M. Irvine, and et al. 2022. "Incarceration, Social Support Networks, and Health among Black Sexual Minority Men and Transgender Women: Evidence from the HPTN 061 Study" International Journal of Environmental Research and Public Health 19, no. 19: 12064. https://doi.org/10.3390/ijerph191912064