Correlates of partner-specific condom use intentions among incarcerated women in Rhode Island.

Unintended pregnancies and sexually transmitted diseases (STDs) are important and costly public health problems in the United States and are highly prevalent among incarcerated women. Nationally, 6–10% of incarcerated women are pregnant; 1,400 U.S. women gave birth while incarcerated in 1998.1 Pregnancies in this population usually are unplanned and high-risk, and they typically result in poor outcomes.2 Rates of STDs are substantially higher in the prison population than in the general population;3 for example, compared with the general female population, incarcerated women had a significantly higher prevalence of chlamydia (27% vs. 0.5%) and gonorrhea (8% vs. 0.1%) in 2001.4 In addition, many STDs increase the risk of HIV transmission at least threefold to fivefold.5 Most incarcerated women have had multiple sexual risk exposures. Hogben and colleagues found that incarcerated women had a relatively high lifetime number of sexual partners, and a large proportion had not used a condom at last sex; more than half reported a history of coerced sex.6 A history of physical or sexual abuse, in childhood or adulthood, is also common among incarcerated women,7 and such abuse may be linked to sexual and drug use behaviors that increase HIV risk.8 Additional sexual risk behaviors reported by incarcerated women are having exchanged sex for drugs or money, having engaged in sexual intercourse with injection drug users or HIV-positive partners, and having used alcohol or drugs before or during sex.9 Like many sexually active populations, incarcerated women typically have had sexual intercourse in relationships involving various levels of commitment, familiarity with partners and duration. Adults’ and adolescents’ use of condoms is more likely with casual partners than with main or steady partners.10 To date, few studies of incarcerated women’s sexual risk behaviors have considered these relationship context factors, and few have measured behavioral outcomes with reference to partner type to identify targets for risk reduction messages. A study that applied the theory of planned behavior to incarcerated women’s intentions to use condoms with main partners demonstrated that beliefs and attitudes about condoms, as well as social norms and perceived self-efficacy, all influence (directly or indirectly) behavioral intentions.11 However, that study focused on women with long prison sentences (three years or more) and did not assess behavioral intentions regarding nonprimary sexual partners. Further information on factors that influence incarcerated women’s decision-making regarding condom use with future primary and casual partners could help improve interventions to reduce these women’s risks of STD exposure and unplanned pregnancy after they are released. We report results of a study that we undertook to examine the following research question: What demographic, psychosocial, personal risk and behavioral variables are associated with incarcerated women’s intentions of future condom use with main and casual partners?