title: HIV-Related Sexual Risk among African American Men Preceding Incarceration: Associations with Support from Significant Others, Family, and Friends.
abstract: We evaluated the association between social support received from significant others, family, and friends and HIV-related sexual risk behaviors among African American men involved in the criminal justice system. Project DISRUPT is a cohort study among African American men released from prison in North Carolina (N = 189). During the baseline (in-prison) survey, we assessed the amount of support men perceived they had received from significant others, family, and friends. We measured associations between low support from each source (<median value) and participants' sex risk in the 6 months before incarceration. Low levels of social support from significant others, family, or friends were associated with poverty and homelessness, mental disorders, and substance use. Adjusting for age, poverty, and other sources of support, perceiving low support from significant others was strongly associated with multiple partnerships (fully adjusted odds ratio (OR) 2.64, 95% confidence interval (CI) 1.29-5.42). Low significant other support also was strongly associated with sex trade involvement when adjusting for age and poverty status (adjusted OR 3.51, 95% CI 1.25-9.85) but further adjustment for low family and friend support weakened the association (fully adjusted OR 2.81, 95% CI 0.92-8.55). Significant other support was not associated with other sex risk outcomes including concurrent partnerships, anal sex, or sex with an STI/HIV-infected partner. Low family support was associated with multiple partnerships in analyses adjusting for age and poverty (adjusted OR 1.98, 95% CI 1.05-3.76) but the association weakened and was no longer significant after adjusting for other sources of support (fully adjusted OR 1.40, 95% CI 0.65-3.00); family support was not correlated with other risk behaviors. Friend support was not significantly associated with sex risk outcomes. Indicators of overall support from any source were not associated with sex risk outcomes. Helping inmates maintain ties may improve economic security and well-being during community re-entry, while supporting and strengthening relationships with a significant other in particular may help reduce sex risk. Studies should evaluate the protective effects of distinct support sources to avoid masking effects of support and to best understand the influence of social support on health.
authors.affiliation: Department of Epidemiology, University of Florida, Gainesville, FL, USA.
authors.forename: Ashley M
authors.initials: AM
authors.lastname: Coatsworth
authors.affiliation: Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, New York, NY, USA.
authors.forename: Joy D
authors.initials: JD
authors.lastname: Scheidell
authors.affiliation: School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: David A
authors.initials: DA
authors.lastname: Wohl
authors.affiliation: Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, USA.
authors.forename: Nicole E
authors.initials: NE
authors.lastname: Whitehead
authors.affiliation: School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Division of General Internal Medicine and Epidemiology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.|Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Carol E
authors.initials: CE
authors.lastname: Golin
authors.affiliation: School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Selena
authors.initials: S
authors.lastname: Judon-Monk
authors.affiliation: Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University School of Medicine, New York, NY, USA. maria.khan@nyumc.org.
authors.forename: Maria R
authors.initials: MR
authors.lastname: Khan
mesh_terms: D000328:Adult; D001741:Black or African American; D005190:Family; D033062:Friends; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina; D011329:Prisoners; D012944:Social Support; D011795:Surveys and Questionnaires; D047568:Unsafe Sex / Q000517:prevention & control*; D055815:Young Adult
keywords: African American; HIV; Prison release; Sexual behavior; Social support