WITHDRAWN: Violence Victimization Associated with Sexual Risk Behavior and Laboratory-Confirmed Sexually Transmitted Infections (STIs) Among Incarcerated Women

Introduction: Incarcerated women may have been previously exposed to multiple forms of violence, including intimate partner violence (IPV), sexual violence (SV), emotional or physical violence (PV), and adverse childhood experiences (ACEs) that can increase risk for acquiring HIV and other STIs. Associations among multiple forms of violence and sexual risk behaviors and laboratory-confirmed STIs were examined among incarcerated women. 

Methods:  521 women were recruited from two women’s prisons and enrolled in a HIV/STI risk-reduction intervention. At baseline, women were assessed on sociodemographics, ACEs prior to age 18, emotional/PV and IPV/SV at age 18 or older, partner violence (physical and non-physical) 3 months prior to incarceration, recent violence (PV or SV 3 months prior to incarceration by any person), and five measures of HIV/STI sexual risk behavior. STIs (chlamydia and gonorrhea) were measured by nucleic acid amplification testing. Separate bivariate logistic regression models examined multiple forms of violence and their associations with baseline HIV/STI-related sexual risk behaviors and STIs.

Results:  Average age was 33.8 years (SD=9.21), and the majority were white (54.0%), followed by black/African American (35.8%). An average of 3.5 out of 8 ACEs were reported prior to age 18; 77.5% reported emotional/PV, and 39.0% reported SV at or after age 18.  Over 85% reported inconsistent condom use with either main or any male partners during the past 30 days; 19.6% reported concurrent male partnerships, and 51.4% were STI-positive. Traded sex was associated with emotional/PV, partner PV, partner non-physical violence, and recent violence (p< 0.05). Inconsistent condom use with any male partner and with main male partner was associated with partner PV and partner non-physical violence (p< 0.05). Concurrent sexual partnerships were associated with ACEs, emotional/PV, IPV/SV, partner PV, partner non-physical violence, and recent violence (p < 0.05). Finally, laboratory-confirmed STIs were associated with all violence variables: ACEs (OR=1.20, 95% CI=1.11, 1.29), emotional/PV (OR=3.08, 95% CI=1.96, 4.82), IPV/SV (OR=1.97, 95% CI=1.37, 2.82), partner PV (OR=1.03, 95% CI=1.01, 1.04), partner non-physical violence (OR=1.02, 95% CI=1.01, 1.04), and recent violence (OR=1.79, 95% CI=1.08, 2.98).

Conclusions:  Women with incarceration histories are particularly vulnerable to HIV/STI risk, and experiences of violence exacerbate risk. The findings highlight that multiple forms of violence were associated with sexual behavior and laboratory-confirmed STIs. The risk profile for incarcerated women suggests that comprehensive prevention efforts addressing violence and sexual risk-reduction may be needed to meet the complex needs of this population.