HIV Risk-Related Behaviors and Willingness to Use Pre-Exposure Prophylaxis Among Black Americans with an Arrest History



Black individuals in the USA are arrested and incarcerated at a significantly higher rate than White individuals, and incarceration is associated with increased HIV vulnerability. Pre-exposure prophylaxis (PrEP) reduces the risk for HIV transmission, but little is known about the relationship between HIV risk behavior and willingness to use PrEP among Black individuals with an arrest history.


A total of 868 individuals completed a nationally representative survey and provided baseline data on sexual risk. Participants were grouped as those with a history of arrest (N = 226) and those with no history of arrest (N=619) based on self-reported arrest history. Our study examined HIV risk behaviors associated with willingness to use PrEP between those with arrest history and those without arrest history.


Participants with an arrest history were more likely to have a lifetime history of anal sex (p<0.0001) and sexually transmitted diseases (p=0.0007). A history of multiple sexual partners in the past 3 months was associated with PrEP willingness in individuals with an arrest history [aPR 2.61 (1.77, 3.85), p<0.0001], adjusting for other covariates in the model.


Differences in risk behavior and willingness to use PrEP exist by arrest history. Understanding these risk behaviors are necessary to increase access to PrEP. PrEP uptake and adherence interventions, when recommended and made available for individuals at substantive risk of HIV infection at the time of arrest and during incarceration, are essential to reducing the spread of HIV in correctional facilities and in communities to which they return.

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We want to thank the National Advisory Committee who created the survey. This publication was made possible with help from the Harvard University Center for AIDS Research (CFAR), an NIH funded program (P30 AI060354).

Data, Materials, and/or Code Availability

All data and materials as well as SAS version 9.4 support our findings and comply with field standards.


This study was supported by grants from Harvard University Center for AIDS Research (HU CFAR NIH/NAIDS P30-AI 060354). Dr. Bogart was also supported by P30MH058107.

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All authors contributed to the study conception, design, and analysis. Ugochukwu Uzoeghelu wrote the first draft of the manuscript and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Ugochukwu Uzoeghelu.

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Ethical approval was obtained from the Boston Children’s Hospital Institutional Review Board.

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Uzoeghelu, U., Bogart, L.M., Mahoney, T. et al. HIV Risk-Related Behaviors and Willingness to Use Pre-Exposure Prophylaxis Among Black Americans with an Arrest History. J. Racial and Ethnic Health Disparities (2021).

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  • HIV risk
  • PrEP
  • Willingness
  • Arrest history
  • Correctional facilities