Self-Justifications for Unsafe Sex Among Incarcerated Young Men Who Have Sex with Men and Are Living with HIV: Results from a New York City Jail-Based Pilot Intervention

  • Janet J. WiersemaEmail author
  • Anthony J. Santella
  • Press Canady
  • Alison O. Jordan
Original Paper


Young men who have sex with men (YMSM), especially African American and Latinx YMSM, accounted for the highest proportion of new HIV diagnoses in 2016. Minorities and persons living with HIV are over-represented in correctional settings. To influence risk behaviors of incarcerated YMSM who are living with HIV, New York City Health + Hospitals adapted, implemented, and evaluated an evidence-based intervention (EBI)—Personalized Cognitive Counseling—as a pilot program for YMSM, aged 20–29 in New York City jails from May 2015 to July 2016. Thirty-four participants recalled a memorable episode of unprotected anal intercourse (UAI), discussed the episode and resulting thoughts and feelings, identified the self-justifications that facilitated the episode, and discussed possible behavior modifications when presented with similar situations in the future. The top endorsed self-justifications for UAI included that they already had UAI with this person, condomless sex feels more natural, not wanting to lose the opportunity for sex, that substance use influenced their thinking, and not wanting to think about HIV transmission. HIV knowledge improved slightly, as measured by the 18 item HIV-KQ-18 HIV Knowledge Questionnaire, from a pre-intervention average of 15.17 (SD = 3.05) to post-intervention average of 16.48 (SD = 1.64) (p < 0.05). Learning the self-justifications that justice-involved MSM have for having UAI is beneficial for targeting future health promotion interventions. Despite challenges inherent in the jail setting, HIV behavioral EBIs are feasible and they can improve HIV knowledge and encourage exploration of self-justifications for risky behavior.


Health education and risk reduction Incarcerated persons Young minority men who have sex with men Adapted evidence-based intervention Correctional health 



Implementation and evaluation of this project was made possible by an HIV/AIDS Initiative for Minority Men (AIMM) from the U.S. Department of Health and Human Services Office of Minority Health, grant number CPIMP161118 (formerly CPIMP141083). We would like to thank the following people and agencies for their participation and support: U.S. Department of Health and Human Services Office of Minority Health including Sonsiere Cobb-Souza; The Fortune Society; and NYC CHS staff and consultants including Michael Bishop, Darcel Borno, Tahkyia Brady, Jacqueline Cruzado Quiñones, Allison Dansby, Earl Drayton, Monica Katyal, Jean Larece, Ross MacDonald, Rupert Malcolm, Damita Owens, Luis Quiñones, Neha Qureshi, Jannileici Reyes, Marie Ross, and Luisa Terrero.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Centers for Disease Control and Prevention National Center for HIV/AIDS, Viral Hepatitis, Sexual Transmitted Diseases and Tuberculosis. (2014). HIV and young men who have sex with men: CDC Division of Adolescent and School Health.
  2. 2.
    Hess, K. L., Hu, X., Lansky, A., Mermin, J., & Hall, H. I. (2017). Lifetime risk of a diagnosis of HIV infection in the United States. Annals of Epidemiology, 27(4), 238–243.CrossRefGoogle Scholar
  3. 3.
    Spaulding, A. C., Seals, R. M., Page, M. J., Brzozowski, A. K., Rhodes, W., & Hammett, T. M. (2009). HIV/AIDS among inmates of and releasees from US correctional facilities, 2006: Declining share of epidemic but persistent public health opportunity. PLoS ONE, 4(11), e7558.CrossRefGoogle Scholar
  4. 4.
    Centers for Disease Control and Prevention. (2017). HIV among incarcerated populations: National Center for HIV/AIDS, Viral Hepatitis, STD and TB Prevention [updated September 25, 2017].
  5. 5.
    Subramanian, R. D., Delaney, R., Roberts, S., Fishman, N., McGarry, P. (2015). Incarceration’s front door: The misuse of jails in America. In: Vera Institute of Justice Center on Sentencing and Corrections, editor.
  6. 6.
    Pettit, B., & Western, B. (2004). Mass imprisonment and the life course: Race and class inequality in US incarceration. American Sociological Review, 69(2), 151–169.CrossRefGoogle Scholar
  7. 7.
    Braithwaite, R. L., & Arriola, K. R. (2008). Male prisoners and HIV prevention: a call for action ignored. American Journal of Public Health, 98(9 Suppl), S145–S149.CrossRefGoogle Scholar
  8. 8.
    Eaton, L. A., Driffin, D. D., Kegler, C., Smith, H., Conway-Washington, C., White, D., et al. (2015). The role of stigma and medical mistrust in the routine health care engagement of black men who have sex with men. American Journal of Public Health, 105(2), e75–e82.CrossRefGoogle Scholar
  9. 9.
    Centers for Disease Control and Prevention. (2018). Compendium of evidence-based interventions and best practices for HIV prevention: Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention; [Updated October 30, 2018].
  10. 10.
    NYC Health + Hospitals. (2016). Correctional Health Services Progress Report.
  11. 11.
    New York City Health + Hospitals Correctional Health Services. Unpublished Patient Data for 2016. [Analyzed 2018].Google Scholar
  12. 12.
    New York City Health + Hospitals Correctional Health Services. (2016). Program data: Ryan White Services Annual Report, Individual-Level Services Data [unpublished]. Correctional Health Services Reentry and Continuity Services.Google Scholar
  13. 13.
    Herbst, J. H., Raiford, J. L., Carry, M. G., Wilkes, A. L., Ellington, R. D., & Whittier, D. K. (2016). Adaptation and national dissemination of a brief, evidence-based, HIV prevention intervention for high-risk men who have sex with men. MMWR Supplements, 65(1), 42–50.CrossRefGoogle Scholar
  14. 14.
    Centers for Disease Control and Prevention National Center for HIV/AIDS, Viral Hepatitis, Sexual Transmitted Diseases and Tuberculosis. (2018). Personalized Cognitive Counseling Fact Sheet.
  15. 15.
    Dilley, J. W., Woods, W. J., Sabatino, J., Lihatsh, T., Adler, B., Casey, S., et al. (2002). Changing sexual behavior among gay male repeat testers for HIV: A randomized, controlled trial of a single-session intervention. Journal of Acquired Immune Deficiency Syndromes, 30(2), 177–186.CrossRefGoogle Scholar
  16. 16.
    Dilley, J. W., Woods, W. J., Loeb, L., Nelson, K., Sheon, N., Mullan, J., et al. (2007). Brief cognitive counseling with HIV testing to reduce sexual risk among men who have sex with men: Results from a randomized controlled trial using paraprofessional counselors. Journal of Acquired Immune Deficiency Syndromes, 44(5), 569–577.CrossRefGoogle Scholar
  17. 17.
    Carey, M. P., & Schroder, K. E. (2002). Development and psychometric evaluation of the brief HIV Knowledge Questionnaire. AIDS Education and Prevention, 14(2), 172–182.CrossRefGoogle Scholar
  18. 18.
    Ware, J., Jr., Kosinski, M., & Keller, S. D. (1996). A 12-Item Short-Form Health Survey: Construction of scales and preliminary tests of reliability and validity. Medical Care, 34(3), 220–233.CrossRefGoogle Scholar
  19. 19.
    Gandek, B., Ware, J. E., Aaronson, N. K., Apolone, G., Bjorner, J. B., Brazier, J. E., et al. (1998). Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA [International Quality of Life Assessment] Project. Journal of Clinical Epidemiology, 51(11), 1171–1178.CrossRefGoogle Scholar
  20. 20.
    Coffin, P. O., Santos, G.-M., Colfax, G., Das, M., Matheson, T., DeMicco, E., et al. (2014). Adapted personalized cognitive counseling for episodic substance-using men who have sex with men: A randomized controlled trial. AIDS and Behavior, 18(7), 1390–1400.CrossRefGoogle Scholar
  21. 21.
    Springer, S. A., Spaulding, A. C., Meyer, J. P., & Altice, F. L. (2011). Public health implications for adequate transitional care for HIV-infected prisoners: Five essential components. Clinical Infectious Diseases, 53(5), 469–479.CrossRefGoogle Scholar
  22. 22.
    Solomon, A. L., Osborne, J. W., LoBuglio, S. F., Mellow, J., & Mukamal, D. (2008). Life after lockup: Improving reentry from jail to the community. Washington, DC: The Urban Institute.Google Scholar
  23. 23.
    US Department of Justice Bureau of Justice Statistics. (2017). Drug Use, dependence, and abuse among state prisoners and jail inmates, 2007–2009.
  24. 24.
    Jordan, A. O., Cohen, L. R., Harriman, G., Teixeira, P. A., Cruzado-Quinones, J., & Venters, H. (2013). Transitional care coordination in New York City jails: Facilitating linkages to care for people with HIV returning home from Rikers Island. AIDS and Behavior, 17(2), 212–219.CrossRefGoogle Scholar
  25. 25.
    Knight, K. R., Das, M., DeMicco, E., Raiford, J. L., Matheson, T., Shook, A., et al. (2014). A roadmap for adapting an evidence-based HIV prevention intervention: Personal cognitive counseling (PCC) for episodic substance-using men who have sex with men. Prevention Science, 15(3), 364–375.CrossRefGoogle Scholar
  26. 26.
    Gold, R. S., & Skinner, M. J. (1994). Unprotected anal intercourse in HIV-infected and non-HIV-infected gay men. Journal of Sex Research, 31(1), 59–77.CrossRefGoogle Scholar
  27. 27.
    Skinta, M. D., Murphy, J. L., Paul, J. P., Schwarcz, S. K., & Dilley, J. W. (2012). Thoughts, attitudes, and feelings of HIV-positive MSM associated with high transmission-risk sex. Health Education & Behavior, 39(3), 315–323.CrossRefGoogle Scholar
  28. 28.
    Mimiaga, M. J., Reisner, S. L., Tinsley, J. P., Mayer, K. H., & Safren, S. A. (2009). Street workers and internet escorts: Contextual and psychosocial factors surrounding HIV risk behavior among men who engage in sex work with other men. Journal of Urban Health, 86(1), 54–66.CrossRefGoogle Scholar
  29. 29.
    Gold, R. S., & Skinner, M. J. (1992). Situational factors and thought processes associated with unprotected intercourse in young gay men. AIDS, 6(9), 1021–1030.CrossRefGoogle Scholar
  30. 30.
    Schwarcz, S. K., Chen, Y. H., Murphy, J. L., Paul, J. P., Skinta, M. D., Scheer, S., et al. (2013). A randomized control trial of personalized cognitive counseling to reduce sexual risk among HIV-infected men who have sex with men. AIDS Care, 25(1), 1–10.CrossRefGoogle Scholar
  31. 31.
    Robinson, R. K. (2011). Masculinity as prison: Sexual identity, race, and incarceration. Cal L. Rev., 99, 1309.Google Scholar
  32. 32.
    University of California San Francisco Center of Excellence for Transgender Health and Center for AIDS Prevention Studies. (2017). Personalized Cognitive Counseling: An adaptation for working with transwomen.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.NYC Health + Hospitals Correctional Health ServicesNew YorkUSA
  2. 2.Department of Health ProfessionsHofstra UniversityHempsteadUSA
  3. 3.NYC Health + Hospitals Correctional Health ServicesEast ElmhurstUSA

Personalised recommendations