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. 2023 Aug;27(8):2791-2802. doi: 10.1007/s10461-023-04003-5. Epub 2023 Feb 6.


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.

Keywords: Black sexual minority men; Black transgender women; Incarceration; Mediation; Selling sex.

MeSH terms

  • Acquired Immunodeficiency Syndrome*
  • Black or African American
  • Female
  • HIV Infections* / epidemiology
  • HIV Infections* / prevention & control
  • Humans
  • Male
  • Prisoners*
  • Sex Work*
  • Sexual Behavior
  • Sexual and Gender Minorities*
  • Transgender Persons*
  • United States / epidemiology