Self-Justifications for Unsafe Sex Among Incarcerated Young Men Who Have Sex with Men and Are Living with HIV: Results from a New York City Jail-Based Pilot Intervention
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Young men who have sex with men (YMSM), especially African American and Latinx YMSM, accounted for the highest proportion of new HIV diagnoses in 2016. Minorities and persons living with HIV are over-represented in correctional settings. To influence risk behaviors of incarcerated YMSM who are living with HIV, New York City Health + Hospitals adapted, implemented, and evaluated an evidence-based intervention (EBI)—Personalized Cognitive Counseling—as a pilot program for YMSM, aged 20–29 in New York City jails from May 2015 to July 2016. Thirty-four participants recalled a memorable episode of unprotected anal intercourse (UAI), discussed the episode and resulting thoughts and feelings, identified the self-justifications that facilitated the episode, and discussed possible behavior modifications when presented with similar situations in the future. The top endorsed self-justifications for UAI included that they already had UAI with this person, condomless sex feels more natural, not wanting to lose the opportunity for sex, that substance use influenced their thinking, and not wanting to think about HIV transmission. HIV knowledge improved slightly, as measured by the 18 item HIV-KQ-18 HIV Knowledge Questionnaire, from a pre-intervention average of 15.17 (SD = 3.05) to post-intervention average of 16.48 (SD = 1.64) (p < 0.05). Learning the self-justifications that justice-involved MSM have for having UAI is beneficial for targeting future health promotion interventions. Despite challenges inherent in the jail setting, HIV behavioral EBIs are feasible and they can improve HIV knowledge and encourage exploration of self-justifications for risky behavior.
KeywordsHealth education and risk reduction Incarcerated persons Young minority men who have sex with men Adapted evidence-based intervention Correctional health
Implementation and evaluation of this project was made possible by an HIV/AIDS Initiative for Minority Men (AIMM) from the U.S. Department of Health and Human Services Office of Minority Health, grant number CPIMP161118 (formerly CPIMP141083). We would like to thank the following people and agencies for their participation and support: U.S. Department of Health and Human Services Office of Minority Health including Sonsiere Cobb-Souza; The Fortune Society; and NYC CHS staff and consultants including Michael Bishop, Darcel Borno, Tahkyia Brady, Jacqueline Cruzado Quiñones, Allison Dansby, Earl Drayton, Monica Katyal, Jean Larece, Ross MacDonald, Rupert Malcolm, Damita Owens, Luis Quiñones, Neha Qureshi, Jannileici Reyes, Marie Ross, and Luisa Terrero.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
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