In a recent commentary published in the American Journal of Public Health, authors at the Emory Rollins School of Public Health urged public health researchers to consider the lifetime likelihood of incarceration (in both jails and prisons) when developing interventions surrounding HIV, substance abuse and sexually transmitted infections for black men who have sex with men (BMSM).

Anne C. Spaulding, MD, MPH, associate professor of epidemiology, was lead author of the article, which accompanied a systematic review of health interventions in jails and prisons for BMSM by Nina Harawa, PhD, MPH, and colleagues at UCLA, published in the same issue.

The editorial builds upon Harawa’s paper, and includes a 28-page supplement detailing how Spaulding and co-authors Tiffany L. Lemon, MSPH, and Marvin So, MPH, derived their estimates.

“Other estimates have solely considered people who are in prison,” says Spaulding. “What’s different about ours is that we’ve added up the people who have been in either jail or prison at some point over the course of their lives.”

“What we’ve come up with is a statistic more comprehensive than previous calculations,” says Lemon. “We demonstrated that if someone is a black man with less than a high school education and was born between 1965 and 1974 (i.e., Generation X), the likelihood that they would have been in jail or in prison at least once over their lifetime is 81 percent.” For reference, this rate represents a higher likelihood than that of a man of any race getting married.

This study’s findings on the frequency of incarceration support the conclusion of Harawa’s paper: the necessity of delivering high quality, tailored, and effective health interventions in jails and prisons. So adds, “The high lifetime frequency of incarceration raises not only public health concerns, but should also make us question what we have lost as a society by incarcerating such a large portion of a generation.”