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Borderline Personality Disorder strongly associated with risk of STI/HIV transmission for straight black men in jail

Sexually transmitted infections (STI), including HIV, disproportionately affect incarcerated populations. In 2010, over 90% of the inmates living with HIV in U.S. prisons were men and the prevalence of STIs such as chlamydia, gonorrhea, and syphilis, continues to be much higher among male inmates as compared to the U.S. population at large.

“This presents a significant public health problem in the U.S. which disproportionately affects African American males who, compared with whites, face eight to 18 times the incidence of common STIs,” said Joy Scheidell, MPH, a research coordinator at the New York University Langone (NYULMC) Department of Population Health.

Compounding the already high-rate of STIs in the U.S. African American male population is the fact they are incarcerated at nearly six-times the rate of white males. These statistics outline a clear need to identify and address modifiable risk factors that drive high infection rates among men involved in the criminal justice system.

Prior research suggests that Borderline Personality Disorder (BPD) lends itself to increased sexual risk-taking, and may therefore be a significant factor in STI/HIV transmission. BPD, which is characterized by a persistent pattern of instability in interpersonal relationships, self-image and impulse control, is prevalent among 1.8% of the general population.

However, most studies on BPD in incarcerated populations have focused on women and have found up to 55% of incarcerated women have the disorder. Studies on the prevalence of BPD among incarcerated men are limited, but suggest the prevalence is near 20%.

A study from the Department of Population Health at NYULMC and New York University’s Center for Drug Use and HIV Research (CDUHR), led by Scheidell, is the first to examine the association between borderline personality disorder (BPD) and the risk for HIV and other STIs in an adult male criminal justice population.

The study used a modified version of the Borderline Evaluation of Severity over Time (BEST) assessment to measure the presence or absence of five BPD indicators that address emotional lability and relationship dysfunction, namely the fear of abandonment, major shifts in opinions about others, severe mood swings, going to extremes to keep someone from leaving and temper outbursts.