title: Limiting options:  sex ratios, incarceration rates, and sexual risk behavior among people on probation and parole.
abstract: BACKGROUND
  To investigate how incarceration may affect risk of acquiring HIV and other sexually transmitted infections, we tested associations of ex-offenders' sexual risk behavior with the male-female sex ratio and the male incarceration rate.
  
  
  METHODS
  Longitudinal data from 1287 drug-involved persons on probation and parole as part of the Criminal Justice Drug Abuse Treatment Studies were matched by county of residence with population factors, and stratified by race/ethnicity and gender. Generalized estimating equations assessed associations of having unprotected sex with a partner who had HIV risk factors, and having >1 sex partner in the past month.
  
  
  RESULTS
  Among non-Hispanic black men and women, low sex ratios were associated with greater risk of having unprotected sex with a risky partner (adjusted relative risk [ARR] = 1.76, 95% confidence interval [CI] = 1.29, 2.42; ARR = 2.48, 95% CI = 1.31, 4.73, respectively). Among non-Hispanic black and non-Hispanic white (NHW) women, low sex ratios were associated with having >1 sex partner (ARR = 2.00, 95% CI = 1.02, 3.94; ARR = 1.71, 95% CI = 1.06, 2.75, respectively). High incarceration rates were associated with greater risk of having a risky partner for all men (non-Hispanic black: ARR = 2.14, 95% CI = 1.39, 3.30; NHW: ARR = 1.39, 95% CI: 1.05, 1.85; Hispanic: ARR = 3.99, 95% CI = 1.55, 10.26) and having >1 partner among NHW men (ARR = 1.92, 95% CI = 1.40, 2.64).
  
  
  CONCLUSIONS
  Low sex ratios and high incarceration rates may influence the number and risk characteristics of sex partners of ex-offenders. HIV-prevention policies and programs for ex-offenders could be improved by addressing structural barriers to safer sexual behavior.
authors.affiliation: Division of General Internal Medicine, Rhode Island Hospital/Brown Medical School, Providence, RI 02903, USA. traci.c.green@brown.edu
authors.forename: Traci C
authors.initials: TC
authors.lastname: Green
authors.forename: Enrique R
authors.initials: ER
authors.lastname: Pouget
authors.forename: Magdalena
authors.initials: M
authors.lastname: Harrington
authors.forename: Faye S
authors.initials: FS
authors.lastname: Taxman
authors.forename: Anne G
authors.initials: AG
authors.lastname: Rhodes
authors.forename: Daniel
authors.initials: D
authors.lastname: OʼConnell
authors.forename: Steven S
authors.initials: SS
authors.lastname: Martin
authors.forename: Michael
authors.initials: M
authors.lastname: Prendergast
authors.forename: Peter D
authors.initials: PD
authors.lastname: Friedmann
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D044383:Black People / Q000706:statistics & numerical data; D005260:Female; D006679:HIV Seropositivity / Q000453:epidemiology* / Q000208:ethnology / Q000523:psychology / Q000635:transmission; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011329:Prisoners / Q000523:psychology / Q000706:statistics & numerical data*; D012307:Risk Factors; D012747:Sexual Partners / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D019966:Substance-Related Disorders / Q000453:epidemiology* / Q000523:psychology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult