This research describes high-risk sexual and drug-using behaviors in and out of incarceration and evaluates the contribution of these behaviors to HIV risk for African-American men receiving HIV care at 3 public medical centers in Los Angeles County, California.

A case-control study was conducted in which 305 neighborhood controls, ages 20-49, were frequency-matched by age.

Thirty-one percent of HIV-infected men who self-identified as heterosexual reported anal sex with a man while not incarcerated. Of those with a history of incarceration(n=332), 23% of the cases and 9% of the controls reported anal sex while incarcerated(adjusted OR=1.1; 95% CI:0.6, 2.2). Most(90%) of the anal sex during incarceration occurred without condoms. The percentage reporting anal sex with men decreased for all sexual orientations during incarceration. Sexual and drug using behaviors during incarceration were not associated with HIV infection.

The high proportion of heterosexually identified men reporting anal sex with men supports enhanced behavioral change interventions for heterosexual African-American men. Although not associated with HIV in this study group, the substantial percentage of men with a history of incarceration reporting unprotected anal sex with men while incarcerated underscores the importance of HIV prevention in the incarcerated setting.

Are condoms supplied in prisons? If not they should be.

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HIV surveillance reveals increasing heterosexual transmission among African Americans (AAs) in the Southern US, but little is known about the distribution of sexual risk behaviors in this population.

A standardized interview concerning sexual and drug using behavior was administered to 188 consecutive AAs who: were reported to the State Health Department within the past six months as having heterosexually-acquired HIV; lived in selected North Carolina counties; and consented to release their names to the study.

Although some respondents reported very high numbers of sexual partners, 52% of the 116 women (17% of the 69 men) reported fewer than 10 lifetime sexual partners, and 46% of women (46% of men) reported no more than 1 partner during the past year. 42% (26) of the women (25% of the men) with fewer than 10 lifetime partners denied "high profile" risk behavior (respondent or sex partner use of injection drugs, crack, or inhaled cocaine or heroin; exchange of sex for money, drugs, or housing by respondent or sex partner). 26% of the 62 women with fewer than 10 lifetime partners and denying high profile risk behavior reported that one of their last three sex partners had been incarcerated for more than 24 hours, as did 48% of all men and 81% of all women. 24% of women (65% of men) had themselves been incarcerated during the past 10 years.

In this southern, largely rural state, most AAs with heterosexually-acquired HIV infection report a history of incarceration for themselves or a sex partner. A substantial proportion of infected women who deny high profile risk behaviors and large numbers of partners report having had a sex partner who has been incarcerated. The relationship between incarceration and the HIV epidemic among Blacks in the US deserves further exploration.