Exploring the social context of sex and HIV/STI risk of recently released black men in Baltimore City.
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Background: Black males comprise the largest group of US adults currently incarcerated, accounting for more than 30% of all males behind bars with rates nearly 6 times greater than those of white males. With evidence suggesting that incarceration contributes to black men’s disproportionately high risk of HIV and other STIs this issue has great public health relevance. Prior research indicates that recently released men, or those leaving prison or jail within the previous 12 months, engage in high-risk sexual behavior after being released from correctional facilities. However, there is a dearth of research exploring social contextual factors that may be relevant to these behaviors and contribute to subsequent HIV/STI risk. This research explores factors which motivate recently released black men to engage in high risk sexual behaviors, the ways in which they secure opportunities for sex, and how having a recent incarceration history impacts their perceived ability to secure those opportunities. Aims: The objective of this research is addressed in three manuscripts with the following aims (1) Explore ways in which recently released men obtain sex during the immediate post-release period (2) Explore the factors that influence recently released men’s condom use in sex during the immediate post-release period (3) Examine the ways in which exposure to incarceration impacts the dynamics of sexual partnering between recently released men and their sex partners during the immediate post-release period (4) Describe what influences recently released men to engage in sex during the immediate post-release period and (5) Discuss how those influences might be shaped by gender norms. Methods: In-depth interviews were conducted with 19 recently released black men recruited from Baltimore City community-based organizations that provide services for this population, and from former study participants of HIV prevention studies at a community-based HIV prevention research center. Interviews were structured broadly around life during incarceration and after release, with specific focus on sexual behavior and masculinity. 19 black men, mean age 33, were enrolled in the present study. All participants were interviewed at least once, and three participants completed follow-up interviews. All interviews were transcribed either by a professional transcription service or the student investigator. A coding scheme was developed using a priori codes drawn from interview guide domains and supporting literature and emergent themes from the data. Data were analyzed using an inductive and deductive approaches informed by the Constant Comparative Method. External auditing and peer debriefing were used to ensure data credibility and dependability. Main Findings & Significance: Together the three manuscripts comprising this research examine the social context of sexual risk behaviors of recently released black men. Findings of this study suggest that there are sexual norms and practices specific to the immediate post-release period that promote HIV/STI risk behaviors through several mechanisms. These sexual norms and practices are shaped by participant’s recently released status and contextually defined gender norms and are perpetuated, both directly and indirectly, by members of participants’ peer groups. This work provides insight into the mechanisms behind sexual risk behaviors of recently released black men and contextualizes HIV/STI risk among a subset of men under the supervision of the criminal justice system who are at increased risk for HIV and other sexually transmitted infections.