COMMUNITY DISRUPTION AND HIV/AIDS IN THE DISTRICT OF COLUMBIA
September 13-14, 2012
Suggested Bibliography
The speakers at the Community Disruption and HIV/AIDS in the District of Columbia conference
provided a list of the articles they thought were most relevant to the themes of the conference
and important for their research. Conference speakers are in bold.
Bingenheimer, Jeffrey B. 2007. “Wealth, Wealth Indices, and HIV Risk in East Africa.”
International Family Planning Perspectives 33(2): 83-84.
Bingenheimer, Jeffrey B. and Arline T. Geronimus. 2009. “Behavioral Mechanisms in HIV
Epidemiology and Prevention: Past, Present, and Future Roles.” Studies in Family
Planning 40(3): 287-204.
Abstract: In the 1980s, behavioral variations across geographically and socially defined
populations were the central focus of AIDS research, and behavior change was seen as
the primary means of controlling HIV epidemics. Today, biological mechanisms-especially other sexually transmitted infections, antiretroviral therapy, and male
circumcision--predominate in HIV epidemiology and prevention. We describe several
reasons for this shift in emphasis. Although the shift is understandable, we argue for a
sustained focus on behavioral mechanisms in HIV research in order to realize the
theoretical promise of interventions targeting the biological aspects of HIV risk. We also
provide evidence to suggest that large reductions in HIV prevalence may be
accomplished by small changes in behavior. Moreover, we contend that behavioral
mechanisms will find their proper place in HIV epidemiology and prevention only when
investigators adopt a conceptual model that treats prevalence as a determinant as well
as an outcome of behavior and that explicitly recognizes the dynamic interdependence
between behavior and other epidemiological and demographic parameters.
Bound, John, Waidmann, Timothy, Schoenbaum, Michael, and Jeffrey B. Bingenheimer. 2003.
“Labor Market Consequences of Race Differences in Health.” Milbank Quarterly 81(3):
441-474.
Abstract: Differences in health status across different race and ethnic groups in the
United States, particularly between black and white Americans, have been the subject
of considerable medical and social science research. For instance, numerous studies
using a variety of health measures have shown the health of black men and women to
be worse than that of whites (e.g., Manton, Patrick, and Johnson 1987). The health
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disadvantage of Native Americans, relative to that of whites, has also been documented
extensively. Patterns for other major ethnic groups (e.g., Hispanics and Asians) have
been somewhat more variable, depending on the measure, the age of the study sample,
and other factors such as place of birth and acculturation (Hayward and Heron 1999 ;
Shalala et al. 1999 ). Systematic health disparities are likely to have profound—and
self‐reinforcing—consequences for the relative well‐being of different population
groups. In this article, we focus on one dimension of such consequences: the association
between race differences in health status and race differences in labor market
outcomes.
Clear, Todd R. 2007. Imprisoning Communities: How Mass incarceration Makes Disadvantaged
Neighborhoods Worse. Oxford University Press. New York. Especially Chapter 5: “Death
by a Thousand Little Cuts.”
Dickson-Gomez, Julia. 2010. “Structural Factors Influencing Patterns of Drug Selling and Use
and HIV Risk in the San Salvador Metropolitan Area.” Medical Anthropology Quarterly
24(2): 157-181.
Abstract: This article explores differences in the social context in which crack sales and
use and HIV risk take place in seven low-income communities in San Salvador, and
structural factors that may influence these differences. The organization of drug selling
varied among the communities on a number of dimensions including: whether drug
sales were open or closed systems; the type of drug-selling site; and the participation of
drug users in drug-distribution roles. Drug-use sites also varied according to whether
crack was used in private, semiprivate, or public spaces, and whether individuals used
drugs alone or with other drug users. Three patterns of drug use and selling were
identified based on the dimensions outlined above. Structural factors that influenced
these patterns included the geographic location of the communities, their physical
layout, gang involvement in drug sales, and police surveillance. Implications for HIV risk
and prevention are explored for each pattern.
Dickson-Gomez, Julia, Corbett, A. Michelle, Bodnar, Gloria, Rodriguez, Karla, and Carmen E.
Guevara. 2010. “Resources and Obstacles to Developing and Implementing a Structural
Intervention to Prevent HIV in San Salvador, El Salvador.” Social Science and Medicine
70(3): 351-9.
Abstract: HIV prevention researchers have increasingly advocated structural
interventions that address factors in the social, political and economic context to reduce
disparities of HIV/AIDS among disadvantaged populations. This paper draws on data
collected in three different types of low-income communities (n=6) in the San Salvador
metropolitan area in El Salvador. Nine focus group discussions were conducted between
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January 2006 and July 2007, 6 with community leaders, and 3 with crack cocaine users,
as well as in-depth interviews with 20 crack users and crack dealers. We explore
opportunities and barriers to the implementation of a community-level, structural
intervention. We first analyze the different forms of leadership, and other community
resources including existing HIV prevention activities that could potentially be used to
address the related problems of crack use and HIV in the communities, and the
structural factors that may act as barriers to capitalizing on communities' strengths in
interventions. Each of the communities studied demonstrated different resources that
stem from each community's unique history and geographic location. HIV testing and
prevention resources varied widely among the communities, with resources
concentrated in one Older Central community despite a strong need in all communities.
In many communities, fear of gang violence and non-responsiveness by government
agencies to communities' needs have discouraged community organizing. In the
discussion, we offer concrete suggestions for developing and implementing structural
interventions to reduce HIV risks that use communities' different but complementary
resources.
Johnson, Rucker C. and Steven Raphael. 2009. “The Effects of Male Incarceration Dynamics on
Acquired Immune Deficiency Syndrome Infection Rates among African American
Women and Men.” Journal of Law and Economics 53(2): 251-293.
Abstract: This paper investigates the connection between incarceration dynamics and
acquired immune deficiency syndrome (AIDS) infection rates, with particular emphasis
on the black-white AIDS rate disparity. Using case-level U.S. data spanning 1982–96, we
model the dynamic relationship between AIDS infection rates and the proportion of
men in the age-, state-, and race-matched cohort that are incarcerated. We find strong
effects of male incarceration rates on male and female AIDS rates. The dynamic
structure of this relationship parallels the incubation time between human
immunodeficiency virus infection and the onset of full-blown AIDS. These results persist
after controlling for year fixed effects; a fully interacted set of age, race, and state fixed
effects; crack cocaine prevalence; and flow rates in and out of prison. The results reveal
that higher incarceration rates among black males over this period explain the lion’s
share of the racial disparity in AIDS infection among women.
Dickson-Gomez, Julia, Bodnar, Gloria, Guevara, Carmen E., Rodriguez, Karla, and Lorena Rivas
de Mendoza. 2011. “With God’s Help I Can Do It: Crack Users’ Formal and Informal
Recovery Experiences in El Salvador.” Substance Use and Misuse 46(4): 426-39.
Abstract: Crack use has increased dramatically in El Salvador in the last few decades. As
with other developing countries with sudden onsets of drug problems, El Salvador has
few medical staff trained in addictions treatment. Little research has examined drug
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users? attempts to reduce or abstain from drug use in countries where governmentregulated formal medical treatment for drug addiction is scarce. This paper uses
qualitative and quantitative data gathered from active crack users to explore their
formal and informal strategies to reduce or abstain from drugs, and compares these
with components of informal and formal treatment in developed countries.
Khan, Maria R., Wohl, David A., Weir, Sharon S., Adimora, Adaora A., Moseley, Caroline,
Norcott, Kathy, Duncan, Jesse, Kaufman, Jay S., and William C. Miller. 2008.
“Incarceration and Risky Sexual Partnerships in a Southern US City.” Journal of Urban
Health 85(1): 100-113.
Abstract: Incarceration is strongly associated with HIV infection and may contribute to
viral transmission by disrupting stable partnerships and promoting high-risk
partnerships. We investigated incarceration and STI/HIV-related partnerships among a
community-based sample recruited for a sexual behavior interview while frequenting
venues where people meet sexual partners in a North Carolina city (N = 373). Men
reporting incarceration in the past 12 months were more likely than men without recent
incarceration to experience multiple new sexual partnerships (unadjusted prevalence
ratio [PR] 1.8, 95% confidence interval [CI]: 1.1-3.1) and transactional sex defined as
trading sex for money, goods, or services (unadjusted PR: 4.0, 95% CI: 2.3-7.1) in the
past 4 weeks. Likewise, women who were ever incarcerated were more likely than
never-incarcerated women to experience recent multiple new partnerships (unadjusted
PR: 3.1, 95% CI: 1.8-5.4) and transactional sex (unadjusted PR: 5.3, 95% CI: 2.6-10.9).
Sexual partnership in the past 12 months with someone who had ever been
incarcerated versus with partners with no known incarceration history was associated
with recent multiple new partnerships (men: unadjusted PR 2.0, 95% CI 1.4-2.9, women:
unadjusted PR 4.8, 95% CI 2.3-10.1) and transactional sex (men: unadjusted PR 3.3, 95%
CI 1.7-6.6, women: unadjusted PR 6.1, 95% CI 2.4-15.4). Adjustment for demographic
and socioeconomic variables had minimal effect on estimates. However, the strong
overlap between incarceration, partner incarceration, and substance abuse had
substantial effects in multivariable models. Correctional-facility and community-based
HIV prevention, with substance abuse treatment, should reach currently and formerly
incarcerated individuals and their sexual partners.
Khan, Maria R., Miller, William C., Schoenbach, Victor J., Weir, Sharon S., Kaufman, Jay S.,
Wohl, David A., and Adaora A. Adimora. 2008. “Timing and Duration of Incarceration
and High-Risk Sexual Partnerships among African Americans in North Carolina.” Annals
of Epidemiology 18(5): 403-410.
Abstract: Incarceration may contribute to HIV transmission by disrupting stable
partnerships and promoting high-risk partnerships. We investigated incarceration and
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high-risk partnerships among African Americans in North Carolina. We conducted a
weighted analysis using the North Carolina Rural Health Project (N = 320), a populationbased case-control study of HIV among African Americans. We measured associations
between timing and duration of incarceration and high-risk partnerships (multiple
partnerships or sex trade for money or drugs). Duration of incarceration appeared to be
more important than how long ago incarceration occurred. After adjustment for
sociodemographic indicators, high-risk partnerships were associated with short-term (<1
month) incarceration of the respondent versus no respondent incarceration (men:
adjusted prevalence ratio (aPR) 1.9, 95% confidence interval (95% CI) 1.2-2.8; women:
aPR 3.1, 95% CI 1.2-8.3). High-risk partnerships also were associated with incarceration
of a partner versus no partner incarceration (men: aPR 1.8, 95% CI 1.1-3.0; women: aPR
2.0, 95% CI 1.1-3.8). Among men, associations remained when adjusting for substance
use. Among women, adjustment for substance use weakened estimates due to the
strong correlation between substance use and incarceration. HIV-prevention programs
targeting currently and formerly incarcerated individuals and their partners may
decrease HIV in African American communities with high incarceration rates.
Khan, Maria R., Behrend, Lindy, Adimora, Adaora A., Weir, Sharon S., White, Becky L., and
David A. Wohl. 2011. “Dissolution of Primary Intimate Relationships During
Incarceration and Implications for Post-release HIV Transmission.” Journal of Urban
Health 88(2): 365-375.
Abstract: Incarceration is associated with sexually transmitted infections (STIs) including
human immunodeficiency virus (HIV). Incarceration may contribute to STI/HIV by
disrupting primary intimate relationships that protect against high-risk relationships.
Research on sexual network disruption during incarceration and implications for postrelease sexual risk behavior is limited. We interviewed a sample of HIV-positive men
incarcerated in North Carolina to assess how commonly inmates leave partners behind
in the community; characteristics of the relationships; and the prevalence of
relationship dissolution during incarceration. Among prison inmates, 52% reported
having a primary intimate partner at the time of incarceration. In the period prior to
incarceration, 85% of men in relationships lived with and 52% shared finances with their
partners. In adjusted analyses, men who did not have a primary cohabiting partner at
the time of incarceration, versus those did, appeared to have higher levels of multiple
partnerships (adjusted prevalence ratio (PR), 1.5; 95% confidence interval (CI) 0.9–2.6;
p = 0.11) and sex trade, defined as giving or receiving sex for money, goods, or services
(adjusted PR, 2.1; 95% CI 0.9–4.8; p = 0.08) in the 6 months prior to incarceration.
Involvement in financially interdependent partnerships appeared to be associated with
further reductions in risk behaviors. Of men in primary partnerships at the time of
prison entry, 55% reported their relationship had ended during the incarceration. The
findings suggest that involvement in primary partnerships may contribute to reductions
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in sexual risk-taking among men involved in the criminal justice system but that many
partnerships end during incarceration. These findings point to the need for longitudinal
research into the effects of incarceration-related sexual network disruption on postrelease HIV transmission risk.
Khan, Maria R., Behrend, Lindy, Adimora, Adaora A., Weir, Sharon S., Tisdale, Caroline, and
David A. Wohl. 2011. “Dissolution of Primary Intimate Relationships During
Incarceration and Associations with Post-release STI/HIV risk Behavior in a Southeastern
City.” Sexually Transmitted Diseases 38(1): 43-47.
Abstract: Incarceration is associated with sexually transmitted infections (STIs) including
human immunodeficiency virus (HIV). It may contribute to STI/HIV by disrupting primary
intimate relationships that protect against high-risk partnerships. In an urban sample of
men (N = 229) and women (N = 144) in North Carolina, we assessed how often
respondents experienced the dissolution of a primary intimate relationship at the time
of their own (among men) or their partner's (among women) incarceration. We then
measured the association between dissolution of relationships during incarceration and
STI/HIV-related risk behaviors. Among men who had ever been incarcerated for 1 month
or longer (N = 72), 43% (N = 31) had a marital or nonmarital primary partner at the time
of the longest prior sentence. Among women, 22% (N = 31) had ever had a primary
partner who had been incarcerated for 1 month or longer. Of men and women who
were in a relationship at the time of a prior incarceration of 1 month or longer (N = 62),
more than 40% of men and 30% of women reported that the relationship ended during
the incarceration. In analyses adjusting for sociodemographic characteristics and
crack/cocaine use, loss of a partner during incarceration was associated with nearly 3
times the prevalence of having 2 or more new partners in the 4 weeks before the survey
(prevalence ratio: 2.80, 95% confidence interval: 1.13-6.96). In this sample,
incarceration disrupted substantial proportions of primary relationships and dissolution
of those relationships was associated with subsequent STI/HIV risk. The results highlight
the need for further research to investigate the effects of incarceration on relationships
and health.
Khan, Maria R., Epperson, Matthew W., Mateu-Gelabert, Pedro, Bolyard, Melissa, Sandoval,
Milagros, and Samuel R. Friedman. 2011. “Incarceration, Sex with an STI- or HIVinfected Partner, and Infection with an STI or HIV in Bushwick, Brooklyn, NY: A Social
Network Perspective.” American Journal of Public Health 101(6): 1110-1117.
Abstract: We examined the link between incarceration and sexually transmitted
infection (STI), including HIV, from a social network perspective. We used data collected
during a social network study conducted in Brooklyn, NY (n = 343), to measure
associations between incarceration and infection with herpes simplex virus-2,
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chlamydia, gonorrhea, and syphilis or HIV and sex with an infected partner, adjusting for
characteristics of respondents and their sex partners. Infection with an STI or HIV was
associated with incarceration of less than 1 year (adjusted prevalence ratio [PR] = 1.33;
95% confidence interval [CI] = 1.01, 1.76) and 1 year or longer (adjusted PR = 1.37; 95%
CI = 1.08, 1.74). Sex in the past 3 months with an infected partner was associated with
sex in the past 3 months with 1 partner (adjusted PR = 1.42; 95% CI = 1.12, 1.79) and
with 2 or more partners (adjusted PR = 1.85; 95% CI = 1.43, 2.38) who had ever been
incarcerated. The results highlight the need for STI and HIV treatment and prevention
for current and former prisoners and provide preliminary evidence to suggest that
incarceration may influence STI and HIV, possibly because incarceration increases the
risk of sex with infected partners.
Keene, Danya, and Arline T. Geronimus. 2011. "’Weathering’ HOPE VI: The Importance of
Evaluating the Population Health Impact of Public Housing Demolition and
Displacement." Journal of Urban Health 88(3): 417-435.
Abstract: HOPE VI has funded the demolition of public housing developments across the
United States and created in their place mixed-income communities that are often
inaccessible to the majority of former tenants. This recent uprooting of low-income,
urban, and predominantly African American communities raises concern about the
health impacts of the HOPE VI program for a population that already shoulders an
enormous burden of excess morbidity and mortality. In this paper, we rely on existing
literature about HOPE VI relocation to evaluate the program from the perspective of
weathering—a biosocial process hypothesized by Geronimus to underlie early health
deterioration and excess mortality observed among African Americans. Relying on the
weathering framework, we consider the effects of HOPE VI relocation on the material
context of urban poverty, autonomous institutions that are health protective, and on
the broader discourse surrounding urban poverty. We conclude that relocated HOPE VI
residents have experienced few improvements to the living conditions and economic
realities that are likely sources of stress and illness among this population. Additionally,
we find that relocated residents must contend with these material realities, without the
health-protective, community-based social resources that they often rely on in public
housing. Finally, we conclude that by disregarding the significance of health-protective
autonomous institutions and by obscuring the structural context that gave rise to
racially segregated public housing projects, the discourse surrounding HOPE VI is likely
to reinforce health-demoting stereotypes of low-income urban African American
communities. Given the potential for urban and housing policies to negatively affect the
health of an already vulnerable population, we argue that a health-equity perspective is
a critical component of future policy conversations.
Ojeda, Victoria D., Robertson, Angela M., Hiller, Sarah P., Lozada, Remedios, Cornelius, Wayne,
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Palinkas, Lawrence A., Magis-Rodriguez, Carlos, and Steffanie A. Strathdee. 2011.”A
Qualitative View of Drug Use Behaviors of Mexican Male Injection Drug Users Deported
from the United States.” Journal of Urban Health 88(1): 104-117.
Abstract: Deportees are a hidden yet highly vulnerable and numerous population.
Significantly, little data exists about the substance use and deportation experiences of
Mexicans deported from the United States. This pilot qualitative study describes illicit
drug use behaviors among 24 Mexico-born male injection drug users (IDUs), ≥ 18 years
old, residing in Tijuana, Mexico who self-identified as deportees from the United States.
In-person interviews were conducted in Tijuana, Mexico in 2008. Content analysis of
interview transcripts identified major themes in participants' experiences. Few
participants had personal or family exposures to illicit drugs prior to their first U.S.
migration. Participants reported numerous deportations. Social (i.e., friends/family,
post-migration stressors) and environmental factors (e.g., drug availability) were
perceived to contribute to substance use initiation in the U.S. Drugs consumed in the
United States included marijuana, heroin, cocaine, methamphetamine, and crack. More
than half of men were IDUs prior to deportation. Addiction and justice system
experiences reportedly contributed to deportation. After deportation, several men
injected new drugs, primarily heroin or methamphetamine, or a combination of both
drugs. Many men perceived an increase in their substance use after deportation and
reported shame and loss of familial social and economic support. Early intervention is
needed to stem illicit drug use in Mexican migrant youths. Binational cooperation
around migrant health issues is warranted. Migrant-oriented programs may expand
components that address mental health and drug use behaviors in an effort to reduce
transmission of blood-borne infections. Special considerations are merited for substance
users in correctional systems in the United States and Mexico, as well as substance users
in United States immigration detention centers. The health status and health behaviors
of deportees are likely to impact receiving Mexican communities. Programs that address
health, social, and economic issues may aid deportees in resettling in Mexico.
Ojeda, Victoria D., Burgos, José Luis, Hiller, Sarah P., Lozada, Remedios, Rangel, Gudelia, Vera,
Alicia, Artamonova, Irina, and Carlos Magis-Rodriguez. 2012. “Circular Migration by
Mexican Female Sex Workers Who are Injection Drug Users: implications for HIV in
Mexican Sending Communities.” Journal of Immigrant and Minority Health / Center for
Minority Public Health 14(1): 107–115.
Abstract: Circular migration and injection drug use increase the risk of HIV transmission
in sending communities. We describe female sex workers who are injection drug users'
(FSW-IDUs) circular migration and drug use behaviors. Between 2008-2010, 258 migrant
FSW-IDUs residing in Tijuana and Ciudad Juarez, Mexico responded to questionnaires.
24% of FSW-IDUs were circular migrants. HIV prevalence was 3.2% in circular migrants
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and 6.1% in non-circular migrants; 50% of circular and 75% of non-circular migrants
were unaware of their HIV infection. Among circular migrants, 44% (n = 27) consumed
illicit drugs in their birthplace; 74% of these (n = 20) injected drugs and one-half of
injectors shared injection equipment in their birthplace. Women reporting active social
relationships were significantly more likely to return home. Circular migrant FSW-IDUs
exhibit multiple HIV risks and opportunities for bridging populations. Regular HIV testing
and treatment and access to substance use services is critical for FSW-IDUs and their
sexual/drug-using contacts.
Robertson, Angela M., Rangel, M. Gudelia, Lozada, Remedios, Vera, Alicia, and Victoria D.
Ojeda. 2012. “Male Injection Drug Users Try New Drugs Following U.S. Deportation to
Tijuana, Mexico.” Drug and Alcohol Dependence 120(1-3): 142–148.
Abstract: Background: Among male injection drug users (IDUs) in Tijuana, Mexico, U.S.
deportation is associated with HIV transmission. Changing drug use behaviors following
deportation, including the use of new drugs, may increase HIV risk but are understudied.
We identify correlates of trying new drugs following male IDUs' most recent U.S.
deportation to Mexico. Methods: In 2010, we recruited 328 deported male IDUs in
Tijuana, Mexico. Questionnaires collected retrospective data on drug use and other HIV
risk behaviors throughout migratory events. Logistic regression identified correlates of
trying new drugs/combinations following their most recent deportations. Informed
consent was obtained from all participants. Results: Nearly one in six men (n = 52, 16%)
tried new drugs following their most recent deportation, including heroin (n = 31),
methamphetamine (n = 5), and heroin/methamphetamine combined (n = 17). Trying
new drugs following deportation was independently associated with U.S. incarceration
(adjusted odds ratio [AOR] = 3.96; 95% confidence interval [Cl.] 1.78, 8.84), increasing
numbers of U.S. deportations (AOR=1.11 per deportation; C.I. 1.03, 1.20), feeling sad
following deportation (AOR 2.69; C.I. 1.41, 5.14), and perceiving that one's current
lifestyle increases HIV/AIDS risk (AOR 3.91; C.I. 2.05, 7.44). Conclusions: Trying new
drugs following U.S. deportation may be related to the unique contexts and stressors
experienced by drug-abusing migrants as they attempt to reestablish their lives in
Mexico. Findings imply an unmet need for health and social programs to alleviate preand post-deportation stressors faced by undocumented and return migrants in the U.S.Mexico context.
Robertson, Angela M., Lozada, Remedios, Vera, Alicia, Palinkas, Lawrence A., Burgos, José Luis,
Magis-Rodriguez, Carlos, Rangel, Gudelia; and Victoria D Ojeda. 2012. “Deportation
Experiences of Women Who Inject Drugs in Tijuana, Mexico.” Qualitative Health
Research 22(4): 499-510.
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Abstract: Deportation from the United States for drug offenses is common, yet the
consequences of deportation for women drug users are poorly documented. In 2008, in
Tijuana, Mexico, we conducted an exploratory qualitative study of migration,
deportation, and drug abuse by interviewing 12 Mexican injection-drug-using women
reporting U.S. deportation. Women reported heavy drug use before and after
deportation, but greater financial instability and physical danger following deportation
than when in the United States. We identified an unmet need for health and social
services among deported drug-using women, including HIV prevention, drug treatment,
physical and mental health services, and vocational training. Binational coordination is
needed to help deported women resettle in Mexico.
Robertson, Angela M., Lozada, Remedios, Pollini, Robin A., Rangel, Gudelia, and Victoria D.
Ojeda. 2012. “Correlates and Contexts of US Injection Drug Initiation Among
Undocumented Mexican Migrant Men Who Were Deported from the United States.”
AIDS and Behavior 16(6): 1670-1680.
Abstract: Preventing the onset of injection drug use is important in controlling the
spread of HIV and other blood borne infections. Undocumented migrants in the United
States face social, economic, and legal stressors that may contribute to substance
abuse. Little is known about undocumented migrants' drug abuse trajectories including
injection initiation. To examine the correlates and contexts of US injection initiation
among undocumented migrants, we administered quantitative surveys (N = 309) and
qualitative interviews (N = 23) on migration and drug abuse experiences to deported
male injection drug users in Tijuana, Mexico. US injection initiation was independently
associated with ever using drugs in Mexico pre-migration, younger age at first US
migration, and US incarceration. Participants' qualitative interviews contextualized
quantitative findings and demonstrated the significance of social contexts surrounding
US injection initiation experiences. HIV prevention programs may prevent/delay US
injection initiation by addressing socio-economic and migration-related stressors
experienced by undocumented migrants.
Rogers, Susan M., Khan, Maria R., Tan, Sylvia, Turner, Charles F., Miller, William C., and Emily
Erbelding. 2012. “Incarceration, High-risk Sexual Partnerships and Sexually Transmitted
Infections in an Urban Population.” Sexually Transmitted Infections 88(1): 63-68.
Abstract: Objectives The authors examined the associations between personal and
partner incarceration, high-risk sexual partnerships and biologically confirmed sexually
transmitted infection (STI) in a US urban population. Methods Data from a probability
survey of young adults 15-35 years of age in Baltimore, Maryland, USA, were analysed
to assess the prevalence of personal and partner incarceration and its association with
several measures of high-risk sexual partnerships including multiple partners, partner
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concurrency and current STI. Results A history of incarceration was common (24.1%
among men and 11.3% among women). Among women with an incarcerated partner in
the past year (15.3%), the risk of current STI was significantly increased (adjusted
prevalence ratio=2.3, 95% CI 1.5 to 3.5). Multiple partners (5+) in the past year and
partner concurrency were disproportionately high among men and women who had
been incarcerated or who had sexual partner(s) or who had recently been incarcerated.
These associations remained robust independent of personal socio-demographic factors
and illicit drug use. Conclusions Incarceration may contribute to STI risk by influencing
engagement in high-risk behaviours and by influencing contact with partners who
engage in risky behaviours and who hence have elevated risk of infection.
Strathdee, Steffanie A., Patterson, Thomas L., Lozada, Remedios, Ojeda, Victoria D., Pollini
Robin A., Brouwer, Kimberly C., Vera, Alicia, Cornelius, Wayne, Nguyen, Lucie, MagisRodriguez, Carlos, and Proyecto El Cuete, for Proyecto El Cuete. 2008. “Differential
Effects of Migration and Deportation on HIV Infection among Male and Female Injection
Drug Users in Tijuana, Mexico.” PloS one 3(7): e2690.
Abstract: HIV prevalence is rising, especially among high risk females in Tijuana, Baja
California, a Mexico-US border city situated on major migration and drug trafficking
routes. We compared factors associated with HIV infection among male and female
injection drug users (IDUs) in Tijuana in an effort to inform HIV prevention and
treatment programs. IDUs aged > or = 18 years were recruited using respondent-driven
sampling and underwent testing for HIV, syphilis and structured interviews. Logistic
regression identified correlates of HIV infection, stratified by gender. Among 1056 IDUs,
most were Mexican-born but 67% were born outside Tijuana. Reasons for moving to
Tijuana included deportation from the US (56% for males, 29% for females), and looking
for work/better life (34% for females, 15% for males). HIV prevalence was higher in
females versus males (10.2% vs. 3.5%, p = 0.001). Among females (N = 158), factors
independently associated with higher HIV prevalence included younger age, lifetime
syphilis infection and living in Tijuana for longer durations. Among males (N = 898),
factors independently associated with higher HIV prevalence were syphilis titers
consistent with active infection, being arrested for having 'track-marks', having larger
numbers of recent injection partners and living in Tijuana for shorter durations. An
interaction between gender and number of years lived in Tijuana regressed on HIV
infection was significant (p = 0.03). Upon further analysis, deportation from the U.S.
explained the association between shorter duration lived in Tijuana and HIV infection
among males; odds of HIV infection were four-fold higher among male injectors
deported from the US, compared to other males, adjusting for all other significant
correlates (p = 0.002). Geographic mobility has a profound influence on Tijuana's
evolving HIV epidemic, and its impact is significantly modified by gender. Future studies
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are needed to elucidate the context of mobility and HIV acquisition in this region, and
whether US immigration policies adversely affect HIV risk.
Tach, Laura. 2009. “More than Bricks and Mortar: Neighborhood Frames, Social Processes, and
the Mixed-Income Redevelopment of a Public Housing Project.” City & Community 8(3):
273-303.
Abstract: Policy initiatives to deconcentrate poverty through mixed-income
redevelopment were motivated in part by the desire to reduce social isolation and social
disorganization in high-poverty neighborhoods. This article examines whether the
presence of higher-income neighbors decreased social isolation or improved social
organization in a Boston public housing project that was redeveloped into a HOPE VI
mixed-income community. Based on in-depth interviews and neighborhood
observation, I find that it was the lower-income former public housing residents who
were primarily involved in creating neighborhood-based social ties, providing and
receiving social support, and enforcing social control within the neighborhood, rather
than the higher-income newcomers. This variation in neighborhood engagement
stemmed from the different ways that long-term and newer residents perceived and
interpreted their neighborhood surroundings. These differences were generated by
residents' comparisons of current and past neighborhood environments and by
neighborhood reputations. Residents' perceptions of place may thus influence whether
mixed-income redevelopment can reduce social isolation and improve social
organization in high-poverty neighborhoods and, more generally, whether changes in
neighborhood structural characteristics translate into changes in social dynamics.
Thomas, James C., and Lynne A. Sampson. 2005. “Incarceration as a Social Force Affecting STD
Rates.” Journal of Infectious Diseases 191(Suppl 1): S55-S60.
Abstract: The United States has the highest rate of incarceration in the world. Some
populations experience both high rates of incarceration and high rates of sexually
transmitted infections (STIs). To estimate the strength of this correlation, we calculated
age-adjusted Pearson correlation coefficients between rates of incarceration and of
reportable STIs in the 100 counties of North Carolina in 1999. Moderately strong
correlations were found for chlamydia (r=0.577) and gonorrhea (r=0.521). The
correlations between rates of incarceration and reported cases of acquired
immunodeficiency syndrome and syphilis were weak (r=0.205 and 0.004, respectively).
Hypothetical causes of the stronger associations included incarceration increasing the
number of infected prisoners or the infectiousness of released prisoners; an imbalance
in the community sex ratio; and the negative influences of high rates of incarceration on
social disorganization and collective efficacy. The magnitude of incarceration as a major
force in American society, its association with some STIs, and our lack of empirical data
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on the potential causal connections argue for a new direction in STI research.
Thomas, James C. 2006. “From Slavery to Incarceration: Social Forces Affecting the
Epidemiology of STDs in the Rural South.” Sexually Transmitted Diseases 33(7 Suppl): S610. Abstract: The high rates of sexually transmitted diseases (STDs) in the southeastern
United States have been shaped by historic and contemporary social forces. More than
other regions of the country, the South was defined by slavery, an extremely
hierarchical relationship between whites and blacks. Emancipation left much of the
racial hierarchy intact with whites as farm owners and blacks as hired workers or
sharecroppers. Agricultural policies that favored mechanization caused blacks to leave
farm work and move into segregated towns, leading to the advent of the rural ghetto.
Post-World War II mass migration, mostly by young men, to the industrial north altered
the sex ratio and social capital of the southern towns left behind. The cocaine epidemic
of the 1990s, followed by the high incarceration rates of the "War on Drugs,"
disproportionately affected low-income blacks. Each of these forces led to sexual and
care-seeking behaviors that favor transmission of STDs.
Thomas, James C. and Elizabeth Torrone. 2006. “Incarceration as Forced Migration: Selected
Community Health Effects.” American Journal of Public Health 96(10): 1762-5.
Abstract: We estimated the effects of high incarceration rates on rates of sexually
transmitted infections and teenage pregnancies. We calculated correlations between
rates of incarceration in state prisons and county jails and rates of sexually transmitted
infections and teenage pregnancies for each of the 100 counties in North Carolina
during 1995 to 2002. We also estimated increases in negative health outcomes
associated with increases in incarceration rates using negative binomial regression
analyses. Rates of sexually transmitted infections and teenage pregnancies, adjusted for
age, race, and poverty distributions by county, consistently increased with increasing
incarceration rates. In the most extreme case, teenage pregnancies exhibited an
increase of 71.61 per 100000 population (95% confidence interval [CI]=41.88, 101.35) in
1996 after an increase in the prison population rate from 223.31 to 468.58 per 100000
population in 1995. High rates of incarceration can have the unintended consequence of
destabilizing communities and contributing to adverse health outcomes.
Thomas, James C., Levandowski, Brooke A., Isler, Malika Roman, Torrone, Elizabeth, and
George Wilson. 2008. “Incarceration and Sexually Transmitted Infections: A
Neighborhood Perspective.” Journal of Urban Health 85(1): 90-99.
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Abstract: The social dynamics of some communities are affected by the loss of
significant numbers of people to prison and by the release of others who encounter the
challenge of coping with the negative effects of the incarceration experience. The
effects on communities are evident, in part, in the high rates of sexually transmitted
infections (STIs) in North Carolina (NC) counties that have a high rate of incarceration. In
the present study, we examined whether the same associations can be observed at the
census tract level in one urban city of NC. To identify the mechanisms by which
incarceration can affect the transmission of STIs, we conducted ethnographic interviews
with ex-offenders and people who lost a sexual partner to prison. We found that census
tract rates of incarceration were consistently associated with gonorrhea rates in the
subsequent year. An increase of the percentage of census tract person-time spent in
prison from 2.0% to 2.5% corresponded to a gonorrhea rate increase of 7.1 cases per
100,000 person-years. The people interviewed spoke of sexual partnership changes
including those left behind finding new partners, in part for help in making financial
ends meet; men having sex with men for the first time in prison; and having multiple
new partners upon reentry to the community. The statistical associations and stories of
the effects of incarceration on sexual relationships provide additional evidence of
unintended community health consequences of high rates of incarceration.
Wildeman, Christopher. 2010. “Invited Commentary: (Mass) Imprisonment and (Inequities in)
Health.” American Journal of Epidemiology 173(5): 488-491.
Abstract: The US imprisonment rate has increased dramatically since the mid-1970s,
precipitating tremendous interest in the consequences of having ever been imprisoned
for the marginal men for whom contact with prisons and jails has become
commonplace. The article by Spaulding et al. in this issue of the Journal (Am J Epidemiol.
2011;173(5):479–487) makes a substantial contribution to research in this area by
demonstrating for the first time that the small short-term benefits of imprisonment with
regard to mortality risk are far outweighed by the much larger long-term mortality costs
of having ever been imprisoned. Yet it remains unclear whether contact with the penal
system causes the associations therein. In this commentary, the author addresses some
of the obstacles to causal inference that exist in this research area and highlights one
way to overcome them. He then suggests that future research might focus on 1) the
consequences of mass imprisonment for health inequities among adult men and 2) the
spillover effects of mass imprisonment for persons who are also affected by the penal
system—the families, friends, and communities prisoners leave behind.
Zayas, Luis H. 2010. “Protecting Citizen-Children Safeguards Our Common Future.” Journal of
Health Care for the Poor and Underserved 21(3): 809-814.
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Abstract: For every two adult undocumented immigrants that are deported from the
U.S., one citizen-child is affected. With roughly 1.3 million adults deported in the past
decade, the number of citizen-children is staggering. Deportation forces parents to
make crucial decisions about their U.S.-born children: to take them or leave them
behind. Our deportation policies and practices fall hardest on citizen-children in mixedstatus families. In this commentary, I review the conditions facing citizen-children, and
consider the consequences to the children and to the U.S. To remedy the effects of
deportation policies and practices, federal immigration enforcement must follow sound
child welfare models. Solid health and educational research helps immigration courts in
decision-making by documenting the effects of parental deportation on citizen-children.
Promoting legislation such as the Child-Citizen Protection and The Dream Act insures the
principled and humane treatment of citizen-children. International treaties and
programs that protect citizen-children will also safeguard our nation’s future.
Zimmerman, Marc A., Bingenheimer, Jeffrey B., and Paul C. Notaro. 2002. “Natural Mentors
and Adolescent Resiliency: A Study with Urban Youth.” American Journal of Community
Psychology 30(2): 221-243.
Abstract: Natural mentors may play an important role in the lives of adolescents. We
interviewed 770 adolescents from a large Midwestern city. Fifty-two percent reported
having a natural mentor. Those with natural mentors were less likely to smoke
marijuana or be involved in nonviolent delinquency, and had more positive attitudes
toward school. Natural mentors had no apparent effect on anxiety or depression. Using
the resiliency theory framework, natural men- tors were found to have compensatory
but not protective effects on problem behaviors, and both compensatory and protective
effects on school attitudes. Direct and indirect (mediated) effects of natural mentors are
explored for problem behaviors and school attitudes. The potential importance of
natural mentors is supported, and implications for future research are considered.
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