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Mediation of the Effect of Incarceration on Selling Sex Among Black Sexual Minority Men and Black Transgender Women in the HPTN 061 Study

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Abstract

Incarceration among Black sexual minority men and Black transgender women (BSMM/BTW) is disproportionately high in the United States. Limited research has documented the disruptive effect of incarceration on sexual networks and sexual partnership exchange among BSMM/BTW. We estimate the influence of incarceration on selling sex and mediating pathways among 1169 BSMM/BTW enrolled in the HIV Prevention Trials Network (HPTN) 061 cohort to assess this relationship. Mediators investigated were social support, violence, illicit drug use, and distress due to experienced racism and homophobia. During the 6 months following baseline, 14% of the cohort was incarcerated, including 24% of BTW. After adjustment, recent incarceration was associated with 1.57 (95% CI 1.02, 2.42) times the risk of subsequently selling sex. The hypothesized mediators together explained 25% of the relationship, with an indirect effect risk ratio of 1.09 (95% CI 0.97, 1.24). Our results document an association and call for more research investigating mechanisms.

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Data Availability

The data that support the findings of this study are available upon request from The HIV Prevention Trials Network (https://www.hptn.org/research/studies/hptn061/accesstostudydata) but restrictions apply to the availability of these data. These restrictions preclude the authors from sharing the de-identified datasets or placing them in a public database.

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Acknowledgements

We thank the following groups who made the HPTN 061 study possible: HPTN 061 study participants; HPTN 061 Protocol co-chairs, Beryl Koblin, PhD, Kenneth Mayer, MD, and Darrell Wheeler, PhD, MPH; HPTN061 Protocol team members; HPTN Black Caucus; HPTN Laboratory Center, Johns Hopkins University School of Medicine; Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center; Statistical and Data Management Center, Statistical Center for HIV/AIDS Research and Prevention; HPTN CORE Operating Center, Family Health International (FHI) 360; Black Gay Research Group; clinical research sites, staff, and Community Advisory Boards at Emory University, Fenway Institute, GWU School of Public Health and Health Services, Harlem Prevention Center, New York Blood Center, San Francisco Department of Public Health, the University of California, Los Angeles, Center for Behavioral and Addiction Medicine, and Cornelius Baker, FHI 360. We are thankful to Sam Griffith, Senior Clinical Research Manager, FHI 360, and Lynda Emel, Associate Director, HPTN Statistical and Data Management Center, Fred Hutchinson Cancer Research Center, for their considerable assistance with HPTN 061 data acquisition and documentation.

Funding

This research uses data from the HIV Prevention Trials Network 061 (HPTN 061) study. HPTN 061 Grant support was provided by the National Institute of Allergy and Infectious Disease (NIAID), National Institute on Drug Abuse (NIDA) and National Institute of Mental Health (NIMH): Cooperative Agreements UM1 AI068619, UM1 AI068617, and UM1 AI068613. Additional site funding included Fenway Institute Clinical Research Site (CRS): Harvard University CFAR (P30 AI060354) and CTU for HIV Prevention and Microbicide Research (UM1 AI069480); George Washington University CRS: District of Columbia Developmental CFAR (P30 AI087714); Harlem Prevention Center CRS and NY Blood Center/Union Square CRS: Columbia University CTU (5U01 AI069466) and ARRA funding (3U01 AI069466-03S1); Hope Clinic of the Emory Vaccine Center CRS and The Ponce de Leon Center CRS: Emory University HIV/AIDS CTU (5U01 AI069418), CFAR (P30 AI050409) and CTSA (UL1 RR025008); San Francisco Vaccine and Prevention CRS: ARRA funding (3U01 AI069496-03S1, 3U01 AI069496-03S2); UCLA Vine Street CRS: UCLA Department of Medicine, Division of Infectious Diseases CTU (U01 AI069424). This research was supported by the National Institute on Drug Abuse Grant ‘Stop-and-Frisk, Arrest, and Incarceration and STI/HIV Risk in Minority MSM’ (Principal Investigator: Maria Khan; R01DA044037). Maria Khan, Charles Cleland, and Joy Scheidell received support from the New York University Center for Drug Use and HIV Research (P30 DA011041). Maria Khan additionally was supported by the New York University-City University of New York (NYU-CUNY) Prevention Research Center (U48 DP005008). Typhanye Dyer and Rodman Turpin were supported by the University of Maryland Prevention Research Center (U48 DP006382). Russell Brewer was supported by a Grant from NIDA (P30DA027828-08S1). This manuscript is a product of authors and has not been reviewed by and does not necessarily represent the views of the HPTN or the study sponsor/funders.

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Authors and Affiliations

  1. Department of Epidemiology, University of North Carolina at Chapel Hill Gillings School of Global Public Health, CB 7435, McGavran-Greenberg Hall, Chapel Hill, NC, 27599, USA

    Molly Remch

  2. Department of Health Sciences, University of Central Florida, Orlando, FL, USA

    Joy D. Scheidell

  3. Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA

    Charles M. Cleland, Medha Mazumdar, Jonathan Feelemyer & Maria R. Khan

  4. Department of Global and Community Health, George Mason University College of Public Health, Fairfax, VA, USA

    Rodman Turpin

  5. Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA

    Dustin T. Duncan

  6. Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA

    Typhanye T. Dyer

  7. Department of Epidemiology, Biostatistics, & Occupational Health, McGill University, Montreal, QC, Canada

    Jay S. Kaufman

  8. Department of Medicine, University of Chicago, Chicago, IL, USA

    Russell Brewer

  9. Fenway Institute, Fenway Health, Boston, MA, USA

    Kenneth H. Mayer

  10. Harvard Medical School, Boston, MA, USA

    Kenneth H. Mayer

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Contributions

MR performed the data analysis and was significantly involved in the design of this study, interpretation of the results, and manuscript writing. JDS, RT, DTD, TTD, JF, and RB provided significant contribution to the interpretation and contextualization of results and manuscript writing. CMC provided biostatistical guidance, including in imputation and mediation methodology, and was involved in the writing of the methods and results. JSK provided epidemiologic guidance and edited the manuscript. MM performed data cleaning and imputation for this study. KHM helped with the design and implementation of the original HPTN 061 study and edited the manuscript. MRK designed the study, supervised all analyses, and contributed significantly to manuscript writing. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Molly Remch.

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Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical Approval

For the original HPTN 061 study, institutional review board approval was obtained from all participating institutions: Emory University IRB #2—Biomedical IRB (Committee A), Fenway Community Health IRB #1, University of California, Los Angeles—South General Campus IRB, Columbia University Medical Center IRB, New York Blood Center IRB, San Francisco General Hospital Committee IRB #2, and George Washington University Medical Center IRB. This secondary data analysis of de-identified data was exempt from review by the New York University institutional review board.

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Informed consent was obtained from all individual participants at the time of enrollment into the HPTN 061 study.

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Remch, M., Scheidell, J.D., Cleland, C.M. et al. Mediation of the Effect of Incarceration on Selling Sex Among Black Sexual Minority Men and Black Transgender Women in the HPTN 061 Study. AIDS Behav 27, 2791–2802 (2023). https://doi.org/10.1007/s10461-023-04003-5

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