Intersectional social control: The roles of incarceration and police discrimination in psychological and HIV-related outcomes for Black sexual minority men.

Abstract Rationale Although Black gay, bisexual, and other sexual minority men (SMM) face disproportionately high levels of incarceration and police discrimination, little research examines how these stressors may drive psychological and HIV inequities among these men. Objective In this study we examined associations between incarceration history, police and law enforcement discrimination, and recent arrest with psychological distress, Pre-Exposure Prophylaxis (PrEP) willingness, and sexual HIV risk among Black SMM. Method Participants were a U.S. national sample of 1,172 Black SMM who responded in 2017-2018 to self-report measures of incarceration history, past year police and law enforcement discrimination, recent arrests, psychological distress, PrEP willingness, and sexual HIV risk. We used structural equation modeling to examine direct and indirect pathways from incarceration, police and law enforcement discrimination, and arrests to psychological distress, PrEP willingness, and sexual HIV risk. Results Past-year police and law enforcement discrimination prevalence was 43%. Incarceration history was positively associated with later police and law enforcement discrimination, which, in turn, was positively associated with recent arrest. Incarceration and police and law enforcement discrimination were negatively associated with PrEP willingness; incarceration and recent arrest and were positively associated with sexual HIV risk; and police and law enforcement discrimination was positively associated with psychological distress. Mediation analyses showed that the effects of incarceration were partially mediated by police and law enforcement discrimination. Conclusion Findings suggest police discrimination may be a mechanism of mass incarceration and fundamental driver of health inequities among Black