Relationship dependencies and autonomy as mediation pathways of incarceration and HIV risk outcomes among low income drug involved adults.

摘要

HIV/AIDS prevalence within correctional settings and among populations with criminal justice histories are several times that of the general population. Despite prior investigations that have empirically identified associations between criminal justice system involvement and HIV risk behavior, few studies have investigated mechanisms of autonomy and relationship dependencies as mediating mechanisms between incarceration history and HIV risk behavioral outcomes. The purpose of this dissertation is to examine the role of relationship dependencies (reliance on a partner for drug and non-drug related expenses) and autonomy (personal access to resources including housing, employment and educational opportunities, relationship dependency) as a pathway linking prior incarceration and HIV risk behavior. An integrated theory combining General Strain Theory and the Theory of Gender and Power informed the hypothesis for this dissertation. It was hypothesized that incarceration history would be associated with HIV risk behaviors among drug involved adults. Relationship dependencies and autonomy was also hypothesized to be associated with HIV risk behaviors among drug involved adults, relationship dependencies and autonomy were hypothesized to mediate any observed positive relationships between incarceration history and HIV risk behavior. This investigation represented a cross-sectional design using a baseline dataset of street recruited heterosexual couples participating in a NIDA funded randomized HIV prevention intervention trial (343 men, 346 women). Findings showed that incarceration had significant associations with HIV risk behaviors including sex exchange, injection drug use and sharing injection equipment among women but not among men. It was also found that autonomy had significant negative relationships with HIV risk indicators among women, with no significant associations being found among men. Multivariate results also suggested that relationship dependencies regarding expenses for drugs were associated with HIV risk indicators including sex exchange and injection drug use for women, and sex exchange for men. Although incarceration history was significantly associated with relationship dependencies for drug expenses among women, there was not sufficient evidence to suggest that relationship dependencies or autonomy were mediating mechanisms of HIV risk outcomes. Results of this study have important implications for the development of practice and policy level harm reduction and HIV prevention interventions for drug involved adults.