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The Effects of Male Incarceration Dynamics on AIDS Infection Rates among African-American Women and Men

June 2006

Rucker C. Johnson, Goldman School of Public Policy, University of California, Berkeley; Steven Raphael, Goldman School of Public Policy, University of California, Berkeley.

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In this paper, we investigate the potential connection between incarceration dynamics and AIDS infection rates, with a particular emphasis on the black-white AIDS rate disparity. Using caselevel data from the U.S. Centers for Disease Control and Prevention, we construct a panel data set of AIDS infection rates covering the period 1982 to 1996 that vary by year of onset, mode of transmission, state of residence, age, gender, and race/ethnicity. Using data from the U.S. Census, we construct a conforming panel of male and female incarceration rates. We use this panel data to model the dynamic relationship between the male and female AIDSi nfection rates and the proportion of men in the age/state/race-matched cohort that are incarcerated. We find very strong effects of male incarceration rates on both male and female AIDS infection rates. The dynamic structure of this relationship parallels the distribution of the incubation time between HIV infection and the onset of full-blown AIDS documented in the medical and epidemiological literature. These results are robust to explicit controls for (race-specific) year fixed effects and a fully interacted set of age/race/state fixed effects. Our results reveal that the higher incarceration rates among black males over this period explain the lion's share of the racial disparity in AIDS infection between black women and women of other racial and ethnic groups. The magnitude and significance of these effects persist after controlling for measures of crack cocaine prevalence and flow rates in and out of prison. In a separate analysis, we exploit the occurrence of system-wide state prison overcrowding litigation as an instrumental variable for the flow rate of prison releases. We find short-run increases in prison release rates that were induced by final court decisions on relief of prisoner overcrowding resulted in significant increases in subsequent AIDS infection rates among women and blacks, manifesting 5-10 years following the increase of prison releases.

Crime, Incarceration, and the Labor Market, Health, Health Insurance, and Health Care