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Studies reveal the impact of agency coordination and high incarceration rates on sexually transmitted disease rates

Two new studies of North Carolina counties demonstrate the importance of HIV prevention agency coordination on control of HIV and other sexually transmitted diseases (STDs) and the devastating impact of residents' prison time on a community's STD rates. The studies, supported by the Agency for Healthcare Research and Quality (HS10861), are briefly described here.

Thomas, J.C., Carter, C., Torrone, E., and Levandowski, B.A. (2008, January/February). "Pulling together: Interagency coordination and HIV/STD prevention." Journal of Public Health Management & Practice 14(1), pp. E1-E6.

In their struggle to compete for funding and clients, HIV prevention agencies often fail to work with other agencies to prevent HIV and other STDs. Yet, STD control works better when agencies work together to share information, funds, and clients, concludes this study. Through coordinated efforts among public health clinics, schools, and other sites, clients can be referred to timely and appropriate services, such as substance abuse treatment centers and HIV test counseling programs. Agencies can also coordinate by agreeing to work with different groups (for example, English speakers and Spanish speakers), or they can divide up tasks to fully address the needs of a single group, explain the researchers. They analyzed 170 HIV prevention agencies in 10 counties in North Carolina for overall density (agencies share information, funds, and clients) and centralization (only one or a few agencies act as a central hub). They examined the associations between connectedness among county agencies and syphilis and gonorrhea rates. The number of HIV prevention agencies in a county's network ranged from 5 to 32.

Syphilis rates were lower in counties with a high network density. Syphilis rates were higher and black-white rate differences were greater with centralization of services in a few agencies. Gonorrhea rates demonstrated similar but weaker patterns of association with network characteristics. Because both syphilis and gonorrhea are transmitted in the same way as HIV and each biologically facilitates HIV transmission, the authors infer that agencies working together would also improve HIV prevention.

Thomas, J.C., Levandowski, B.A., Isler, M.R., and others (2007). "Incarceration and sexually transmitted infections: A neighborhood perspective." Journal of Urban Health: Bulletin of the New York Academy of Medicine 85(1), pp. 90-99.

A community's rate of sexually transmitted infections (STIs) soars, when a significant number of its residents are sent to prison, with the rate soaring especially high during the year after imprisonment. This study reveals patterns of behavior that may explain why. It found, for example, that partners left behind (more often women with young children) find new sexual partners, often to help pay the bills. Also, men often have sex with men for the first time in prison (for protection and sexual release) and then have multiple new partners (often women, to whom they spread infection) upon reentry to the community.

To gauge the impact of incarceration on STI rates, the researchers examined the association between incarceration rates among census tracts in North Carolina counties with high incarceration rates with rates of STIs. They also interviewed ex-offenders and sexual partners of prisoners or ex-offenders. Census tract rates of incarceration were consistently associated with gonorrhea rates in the subsequent year. An increase in the percentage of census tract person-time spent in prison from 2 to 2.5 percent corresponded to a gonorrhea rate increase of 7.1 cases per 100,000 person-years. These associations and recounted experiences of those interviewed on the effects of incarceration on sexual relationships provide additional evidence of the unintended community health consequences of high incarceration rates in a community.

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