title: Sexuality, sexual practices, and HIV risk among incarcerated African-American women in North Carolina.
abstract: BACKGROUND
  Women who have been in prison carry a greater lifetime risk of HIV for reasons that are not well understood. This effect is amplified in the Southeastern United States, where HIV incidence and prevalence is especially high among African-American (AA) women. The role of consensual sexual partnerships in the context of HIV risk, especially same-sex partnerships, merits further exploration.
  
  
  METHODS
  We conducted digitally recorded qualitative interviews with 29 AA women (15 HIV positive, 14 HIV negative) within 3 months after entry into the state prison system. We explored potential pre-incarceration HIV risk factors, including personal sexual practices. Two researchers thematically coded interview transcripts and a consensus committee reviewed coding.
  
  
  RESULTS
  Women reported complex sexual risk profiles during the 6 months before incarceration, including sex with women as well as prior sexual partnerships with both men and women. Condom use with primary male partners was low and a history of transactional sex work was prevalent. These behaviors were linked with substance use, particularly among HIV-positive women.
  
  
  CONCLUSIONS
  Although women may not formally identify as bisexual or lesbian, sex with women was an important component of this cohort's sexuality. Addressing condom use, heterogeneity of sexual practices, and partner concurrency among at-risk women should be considered for reducing HIV acquisition and preventing forward transmission in women with a history of incarceration.
authors.affiliation: University of North Carolina School of Medicine, University of North Carolina Institute for Global Health and Infectious Diseases, Chapel Hill, North Carolina. Electronic address: cfarel@med.unc.edu.
authors.forename: Claire E
authors.initials: CE
authors.lastname: Farel
authors.forename: Sharon D
authors.initials: SD
authors.lastname: Parker
authors.forename: Kathryn E
authors.initials: KE
authors.lastname: Muessig
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Grodensky
authors.forename: Chaunetta
authors.initials: C
authors.lastname: Jones
authors.forename: Carol E
authors.initials: CE
authors.lastname: Golin
authors.forename: Catherine I
authors.initials: CI
authors.lastname: Fogel
authors.forename: David A
authors.initials: DA
authors.lastname: Wohl
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D017677:Age Distribution; D017280:Condoms / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control*; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D015995:Prevalence; D011329:Prisoners / Q000523:psychology* / Q000706:statistics & numerical data; D011330:Prisons; D036301:Qualitative Research; D012309:Risk-Taking; D012725:Sexual Behavior; D012747:Sexual Partners; D019529:Sexuality; D047568:Unsafe Sex / Q000706:statistics & numerical data; D055815:Young Adult