Objectives. To examine rates of sexually transmitted infections as a function of jail and prison incarceration rates across US counties for the years 2011 to 2016.

Methods. We used data from several national databases. The outcomes were county-level chlamydia and gonorrhea incidence as reported by the Centers for Disease Control and Prevention (2012–2016). The exposures were lagged specifications of county-level jail and prison incarceration rates as reported by the Vera Institute of Justice (2011–2015). We estimated mixed models to account for the 3 sources of response variable variation occurring across repeated measures collected from counties nested within states.

Results. In the final model, jail and prison incarceration rates were associated with a rate increase of 10.13 per 100 000 and 8.22 per 100 000, respectively, of chlamydia incidence. The corresponding rate increases for gonorrhea incidence were 2.47 per 100 000 and 4.40 per 100 000.

Conclusions. These findings provide some evidence that the documented differences in chlamydia and gonorrhea incidence between counties may be partially attributable to differences in jail and prison incarceration rates.

Structural racism is a key determinant of population health in the United States,1 causing widespread suffering not only for people of color but also for society as a whole.2 One of the major institutional mechanisms that reproduces racial inequality is mass incarceration.3 According to a recent estimate,4 in 2012, a Black man born between 1965 and 1974 without a high-school diploma had a 80.9% chance of ever being incarcerated. Thomas5 argues that historic and contemporary social forces of racial subordination—from slavery to contemporary mass incarceration6—has led to sexual and care-seeking behaviors that favor the transmission of sexually transmitted infections (STIs) and, ultimately, the disproportionate documented rates of STIs across the US South where these systems of subordination have been concentrated. Thus, it is imperative to examine the contextual factors—poverty, discrimination, Black sex ratios, incarceration rates, and racial segregation—that promote patterns of sexual networks that facilitate transmission of STIs.7,8 This article focuses on the global effects of mass incarceration on incidence of STIs by asking whether the rate of persons admitted to county jails and state prisons is associated with incidence of chlamydia and gonorrhea across US counties net of poverty, racial segregation, and Black sex ratios.