Skip to main content
SpringerLink
Log in

Great Expectations: HIV Risk Behaviors and Misperceptions of Low HIV Risk among Incarcerated Men

  • Original Paper
  • Published:
AIDS and Behavior Aims and scope Submit manuscript

Abstract

Incarcerated populations have relatively high HIV prevalence but little has been reported about their aggregate HIV risk behaviors or perceptions of risk. A random selection of HIV-negative men (n = 855) entering a US state prison system were surveyed to assess five risk behaviors and his self-perceived HIV risk. Using multivariate logistic regression, we identified factors associated with having elevated actual but low perceived risk (EALPR). Of the 826 men with complete data, 88% were at elevated risk. While 64% of the sample had risk perceptions concordant with their actual risk, 14% had EALPR (with the remainder at low actual but high perceived risk). EALPR rates were lower in those with a pre-incarceration HIV test but higher for those with a negative prison entry HIV test. HIV testing counseling should assess for discordance between actual and perceived risk and communicate the continued risk of HIV despite a negative result.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1

Similar content being viewed by others

References

  1. Spaulding A, Seals RM, Page MJ, Brzozowski AK, Rhodes W, Hammett TM. HIV/AIDS among inmates of and releasees from US correctional facilities 2006: declining share of epidemic but persistent public health opportunity. PLoS ONE. 2009;4:e7558.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  2. Maruschak LM, Bezofsky M, Unangst J, Medical problems of state and federal prisoners and jail inmates, 2011-2012. Bur Justice Stat. 2015:1–23.

  3. Lambert EY, Normand JL, Volkow ND. Prevention and treatment of HIV/AIDS among drug-using populations: a global perspective. J Acquir Immune Defic Syndr. 2010;55:S1–4.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Rich JD, Wohl D, Beckwith CG, Spaulding AC, Lepp NE, Baillargeon J, Gardner A, Avery A, Altice FL, Springer S, On behalf of the CFAR-CHIC Working Group. HIV-related research in correctional populations: now is the time. Curr HIV/AIDS Rep. 2011;8:288–96.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Beckwith CG, Zaller ND, Fu JJ, Montague BT, Rich JD. Opportunities to diagnose, treat, and prevent HIV in the criminal justice system. J Acquir Immune Defic Syndr. 2010;55:S49–55.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Beckwith C, Bazerman L, Gillani F, Tran L, Larson B, Rivard S, Flanigan T, Rich MD. The feasibility of implementing the HIV seek, test, and treat strategy in jails. AIDS Patient Care STDs. 2014;28(4):183–7.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Rosen DL, Wohl DA, Golin CE, Rigdon J, May J, White BL, Leone PA, Hudgens MG, Bowling JM. Comparing HIV case detection in prison during opt-in vs. opt-out testing policies: a seroprevalence study. J Acquir Immune Defic Syndr. 2016;71(3):e85–8.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Rosen DL, Schoenbach VJ, Wohl DA, White BL, Stewart PW, Golin CE. An evaluation of HIV testing among inmates in the North Carolina prison system. Am J Public Health. 2009;99:S452–9 PMC2760001.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Margolis AD, MacGowan RJ, Grinstead O, Sosman J, Kashif I, Flanigan TP, The Project Start Study Group. Unprotected sex with multiple partners: implications for HIV prevention among young men with a history of incarceration. Sex Transm Dis. 2006;33(3):175–80.

    Article  PubMed  Google Scholar 

  10. Morrow K, The START Study Group. HIV, STD, and hepatitis risk behaviors of young men before and after incarceration. AIDS Care. 2009;21(2):235–43.

    Article  PubMed  Google Scholar 

  11. Epperson MW, Khan MR, Miller DP, Perron BE, El-Bassell N, Gilbert L. Assessing criminal justice involvement as an indicator of HIV risk among women in methadone treatment. J Subst Abus Treat. 2010;38(4):375–83.

    Article  Google Scholar 

  12. Begier EM, Bennani Y, Forgione F, Punsalang A, Hanna DB, Herrera J, Torian L, Gbur M, Sepkowitz KA, Parvez F. Undiagnosed HIV infection among New York City jail entrants, 2006: results of a blinded serosurvey. J Acquir Immune Defic Syndr. 2010;54:93–101.

    PubMed  Google Scholar 

  13. Khan MR, Golin CE, Friedman S, Scheidell JD, Adimora AA, Monk S, Hobbs MM, Dockery G, Brown S, Oza K, Myers D, Hu H, Wohl DA. STI/HIV Sexual risk behavior and prevalent STI among incarcerated African American men in committed partnerships: the significance of poverty, mood disorders, and substance use. AIDS Behav. 2015;19(8):1478–90 PMC4526321.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  14. Grinstead OA, Faigeles B, Comfort M, Seal D, Nealey-Moore J, Belcher L, Morrow K. HIV, STD, and hepatitis risk to primary female partners of men being released from prison. Women Health. 2005;41(2):63–80.

    Article  PubMed  Google Scholar 

  15. Gerrard M, Gibbons FX, Bushman BJ. Relation between perceived vulnerability to HIV and precautionary sexual behavior. Psychol Bull. 1996;119(3):390–409.

    Article  PubMed  CAS  Google Scholar 

  16. MacKellar DA, et al. Perceptions of lifetime risk for acquiring HIV among young men who have sex with men. AIDS Behav. 2007;11:263–70.

    Article  PubMed  Google Scholar 

  17. Akwara AP, Madise NJ, Hinde A. Perception of risk of HIV/AIDS and sexual behavior in Kenya. J Biosoc Sci. 2003;35:384–411.

    Article  Google Scholar 

  18. Ladwig KH, Baumert J, Lowel H, Doring A, Wichmann HE. Contemplating to quit current smoking status: differences in behavioural and psychosocial patterns in a population-based cohort of current smokers. Prev Med. 2005;41:134–40.

    Article  PubMed  Google Scholar 

  19. Katapodi MC, Lee KA, Facione NC, Dodd MJ. Predictors of perceived breast cancer risk and the relation between perceived risk and breast cancer screening: a meta-analytic review. Prev Med. 2004;38:388–402.

    Article  PubMed  Google Scholar 

  20. Katapodi MC, Dodd MJ, Lee KA, Facione NC. Underestimation of breast cancer risk: influence on screening behavior. Oncol Nurs Forum. 2009;36(3):306–14.

    Article  PubMed  Google Scholar 

  21. Ko Y, Boo S. Self-perceived health versus actual cardiovascular disease risks. Jpn J Nurs Sci. 2016;13:65–74.

    Article  PubMed  Google Scholar 

  22. Fontenat HB, Fantasia HC, Charyk A, Sutherland MA. Human papillomavirus (hpv) risk factors, vaccination patterns, and vaccine perceptions among a sample of male college students. J Am Coll Health. 2014;62(3):186–92.

    Article  Google Scholar 

  23. Fan W, et al. HIV risk perception among HIV negative or status-unknown, men who have sex with men in China. BioMed Res Int. 2014;2014:1–9.

    CAS  Google Scholar 

  24. Mgbere O, Monjok E, Abughosh S, Ekong E, Holstad MM, Essien EJ. Modeling covariates of self-perceived and epidemiologic notions of risk for acquiring stis/hiv among military personnel: a comparative analysis. AIDS Behav. 2013;17:1159–75.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Nunn A, et al. Low perceived risk and high HIV prevalence among a predominantly African American population participating in Philadelphia’s rapid HIV testing program. AIDS Patient Care STDs. 2011;25(4):229–35.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Jain AK, et al. Relationship between reported prior condom use and current self-perceived risk of acquiring HIV among mobile female sex workers in southern India. BMC Public Health. 2011;11(S6):S5.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Ankomah A, et al. HIV-related risk perception among female sex workers in Nigeria. HIV AIDS (Auckl). 2011;3:93–100.

    Google Scholar 

  28. Earnshaw VA, Smith LR, Chaudoir SR, Lee I-C, Copenhaver MM. Stereotypes about people living with HIV: implications for Perceptions of HIV risk and testing frequency among at-risk populations. AIDS Educ Prev. 2012;24(6):574–81.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kacanek D, et al. Young incarcerated men’s perceptions of and experiences with HIV testing. AJPH. 2007;97(7):1209–15.

    Article  Google Scholar 

  30. Sheeran P, Harris PR, Epton T. Does heightening risk appraisals change people’s intentions and behavior? A meta-analysis of experimental studies. Psychol Bull. 2014;140(2):511.

    Article  PubMed  Google Scholar 

  31. Reyna VF, Farley F. Risk and rationality in adolescent decision making implications for theory, practice, and public policy. Psychol Sci Public Interest. 2006;7(1):1–44.

    Article  PubMed  Google Scholar 

  32. Brewer N, Chapman GB, Gibbons FX, Gerrard M, McCaul KD, Weinstein ND. Meta-analysis of the relationship between risk perception and health behavior: the example of vaccination. Health Psychol. 2007;26(2):136–45.

    Article  PubMed  Google Scholar 

  33. Brewer NT, Weinstein ND, Cuite CL, Herrington J. Risk perceptions and their relation to risk behavior. Ann Behav Med. 2004;27(2):125–30.

    Article  PubMed  Google Scholar 

  34. Rosen D, Golin CE, Grodensky CA, May J, Bowling JM, DeVellis RF, White BL, Wohl D. Opt-out testing in prison: informed and voluntary? AIDS Care. 2015;27(5):545–54.

    Article  PubMed  Google Scholar 

  35. Centers for Disease Control and Prevention (CDC), Behavioral Risk Factor Survey, 2009. http://www.cdc.gov/brfss/questionnaires/pdf-ques/2009brfss.pdf.

  36. Centers for Diseaase Control and Prevention (CDC), HIV Transmission Risk. 2012. http://www.cdc.gov/hiv/law/pdf/HIVtranmsmision.pdf.

  37. Oldenberg CE, Perez-Brumer AG, Reisner SL, Mattie J, Barnighausen T, Mayer K, Mimiage MJ. Global burden of HIV among men who engage in transactional sex: a systematic review and meta-analysis. PLoS ONE. 2014;9(7):e103549.

    Article  CAS  Google Scholar 

  38. Astemborski J, Vlahov D, Warren D, Solomon L, Nelson KE. The trading of sex for drugs or money and HIV seropositivity among female intravenous-drug-users. Am J Public Health. 1994;84(3):382–7.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  39. Edwards JM, Iritani BJ, Hallfors DD. Prevalence and correlates of exchanging sex for drugs or money among adolescents in the United States. Sex Transm Infect. 2006;82(5):354–8.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  40. Fishbein M, Coutinho R, Trial NMHP. Demographic and behavioral predictors of sexual risk in the NIMH multisite HIV prevention trial. AIDS. 1997;11:S21–7.

    Article  Google Scholar 

  41. Ross MW, Hwang LY, Zack C, Bull L, Williams ML. Sexual risk behaviours and STIs in drug abuse treatment populations whose drug of choice is crack cocaine. Int J STD AIDS. 2002;13(11):769–74.

    Article  PubMed  Google Scholar 

  42. Snell WE Jr, Finney PD, Godwin L. Stereotypes about AIDS. Contemp Soc Psychol. 1991;15:18–38.

    Google Scholar 

  43. Carey MP, Schroder KE. Development and psychometric evaluation of the brief HIV knowledge questionnaire. AIDS Educ Prev. 2002;14(2):172–82.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Allison PD. Imputation of categorical variables with PROC MI. SUGI 30 Proceedings. 2005;113(30):1–4.

  45. Horton NJ, Lipsitz SR, Parzen M. A potential for bias when rounding in multiple imputation. Am Stat. 2003;57(4):229–32.

    Article  Google Scholar 

  46. Rubin DB, Schenker N. Multiple imputation for interval estimation from simple random samples with ignorable nonresponse. J Am Stat Assoc. 1986;81(394):366–74.

    Article  Google Scholar 

  47. Rubin DB. Multiple imputation for nonresponse in surveys, vol. 81. John Wiley & Sons; 2004.

  48. Schafer JL. Multiple imputation in multivariate problems when the imputation and analysis models differ. Stat Neerl. 2003;57(1):19–35.

    Article  Google Scholar 

  49. Brown EJ, Outlaw FH, Simpson EM. Theoretical antecedents to HIV risk perception. JAPNA. 2000;6(6):177–82.

    Google Scholar 

  50. van der Pligt J. Perceived risk and vulnerability as predictors of precautionary behavior. Br J Health Psychol. 1998;3:1–14.

    Article  Google Scholar 

  51. Eiser JR, Bostrom A, Burton I, Johnston DM, McClure J, Paton D, van der Pligt J, White MP. Risk interpretation and action: a conceptual framework for responses to natural hazards. Int J Disaster Risk Reduct. 2012;1:5–16.

    Article  Google Scholar 

  52. Mills B, Reyna VF, Estrada S. Explaining contradictory relations between risk perception and risk taking. Psychol Sci. 2008;19(5):429–33.

    Article  PubMed  Google Scholar 

  53. Reyna VF. How people make decisions that involve risk: a dual-processes approach. Curr Dir Psychol Sci. 2004;13(2):60–6.

    Article  Google Scholar 

  54. Bandura A. Health promotion by social cognitive means. Health Educ Behav. 2004;31(2):143–64.

    Article  PubMed  Google Scholar 

  55. Kowalewski MR, Henson KD, Longshore D. Rethinking perceived risk and health behavior: a critical review of HIV prevention research. Health Educ Behav. 1997;24(3):313–25.

    Article  PubMed  CAS  Google Scholar 

  56. Centers for Disease Control and Prevention (CDC). Estimated percentages and characteristic of men who have sex with men and use injection drugs, United States 1999-2011. MMWR Morb Mortal Wkly Rep. 2013;62(37):557–62.

    Google Scholar 

Download references

Acknowledgements

This study was supported by the National Institute of Mental Health (R01 MH079720-01A1). Dr. Golin’s salary for conducting this work was partly supported by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (K24-HD06920 K24-DA037101). Mr. Barkley was partially supported by a T32 training Grant (T32ES007018). Additional support was provided by the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR) (P30 AI-50410). We would like to acknowledge Dr. Michael Hudgens assistance with statistical analytic planning, Dr. Angela Thrasher for editorial assistance, Ms. Jennifer Lawall for data cleaning, Ms. Kelly Green for her assistance with study data collection and management and Monique Williams, Dani Strauss, Makisha Ruffin, and Catherine Grodensky for assistance with data collection. The authors thank the NCDPS, as well as the participants in the study.

Author information

Authors and Affiliations

  1. Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, 725 MLK Blvd, CB 7590, Chapel Hill, NC, 27599-7590, USA

    C. E. Golin, C. Biddell, D. A. Wohl & D. L. Rosen

  2. Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    C. E. Golin

  3. Cecil G. Sheps Center for Health Services Research, UNC-Chapel Hill, Chapel Hill, NC, USA

    C. E. Golin

  4. Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    B. G. Barkley

Authors
  1. C. E. Golin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. G. Barkley
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Biddell
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. D. A. Wohl
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. D. L. Rosen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to C. E. Golin.

Ethics declarations

Conflict of interest

The authors have no disclosures to report.

Appendix

Appendix

See Tables 6 and 7.

Table 6 Sensitivity analysis: associations between the independent variables of interest and three outcomes in unadjusted bivariate analyses
Full size table
Table 7 Sensitivity analysis: associations between participant characteristics and elevated actual/low perceived risk (EALPR) from multiply imputed multivariate logistic regression model
Full size table

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Golin, C.E., Barkley, B.G., Biddell, C. et al. Great Expectations: HIV Risk Behaviors and Misperceptions of Low HIV Risk among Incarcerated Men. AIDS Behav 22, 1835–1848 (2018). https://doi.org/10.1007/s10461-017-1748-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10461-017-1748-z

Keywords

Search

Navigation