The effectiveness of antiretroviral drugs is closely linked to the degree of adherence. The prison environment has specific characteristics that may affect adherence in HIV-positive patients, so that it may not be possible to extrapolate factors associated with nonadherence in HIV+ patients outside prison. The objective was to analyze the prevalence of nonadherence to antiretroviral treatment in three Spanish prisons, and to examine the relation between a large group of factors and nonadherence to the medication. A cross-sectional study of all patients receiving antiretroviral treatment was done. Adherence was evaluated using a validated questionnaire (SMAQ). The prevalence of nonadherence was 54.8%, and the factors independently associated with nonadherence were having difficulties in taking the medication, feeling completely or largely unable to follow the medication, classifying the food as "bad", mentioning not having anyone concerned for them outside prison, suffering anxiety or depression in the last week, and having the flexibility of the prison staff opening their cell in the event of them forgetting their medication.

Quality of life (QoL) is one of the most commonly used self-assessment outcome measures in chronic disease. The prison environment has specific characteristics that may affect antiretroviral treatment and adherence in HIV-positive patients. The objective of this cross-sectional study was to analyse the association between several factors and QoL in inmates on antiretroviral treatment in three Andalusian prisons. A total of 160 patients on antiretroviral treatment was enrolled. QoL was measured by means of the MOS-HIV. Of the sample, 88% were men and, of these, 53.8% were considered adherent to treatment. In the multivariate analysis, inmates who were considered adherent, who had a higher educational level, who did not receive food supplements and who were prescribed a greater number of pills were found to have a better physical and mental QoL. Likewise, those who felt unable or scarcely able to continue the treatment and who had been drug abusers for a longer time presented a lower physical QoL. Regarding mental QoL, those without a fixed abode, with difficulties in treatment or chronic disease had lower scores.

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There is a group of prisoners with specific characteristics that refuse HAART. Specific interventions should be performed in these prisoners to make them aware of the effects of their decision on the course of their disease.

RESUMENIntroducción: En los estudios existentes sobre pacientes VIH+ la población a estudio ha sido tomada de manera homogénea, sin diferenciar aquella que cumple los requerimientos terapéuticos de la que no lo hace. Quizás por la dificultad en el acceso al grupo de pacientes que rehúsan el tratamiento antirretroviral. El medio penitenciario nos permite acceder a esta población, hasta hoy no estudiada. El objetivo de este estudio es describir el estado clínico y psicosocial de los reclusos seropositivos que rehúsan el TARV, comparándolo con el de aquellos que sí están en TARV o no se les indica tomarlo.Métodos: Estudio transversal con 585 reclusos VIH positivos ingresados en tres prisiones andaluzas entre mayo-julio de 2004. Como variable de agrupación se empleó rehusar el TARV, tomarlo o no hacerlo por no estar indicado. Como independientes se incluyeron sociodemográficas, psicosociales, clínicas y relacionadas con el medio penitenciario.Resultados: El 16,8% de los reclusos rehusaban el TARV, mientras el 56,3% estaban en tratamiento y al 26,8% no le estaba indicado. Entre los reclusos que rehusaban el TARV aparece una mayor prevalencia de coinfección por VHC, mayor consumo intrapenitenciario de opiáceos y tratamiento con metadona, más juicios pendientes y más entradas en prisión.Conclusiones: Estos resultados ponen de relieve la existencia de un grupo poblacional, accesible gracias al medio penitenciario, con características propias que no sigue las indicaciones terapéuticas y que representa un riesgo no sólo para su salud, sino para la de la comunidad.Palabras clave: VIH, Impacto Psicosocial, Terapia Antirretroviral, Prisiones, Negativa al Tratamiento, Prisiones. PATIENTS WHO REFUSE ANTIRETROVIRAL TREATMENT IN PRISON ABSTRACTIntroduction: Current studies of HIV+ patients in the prison population have been carried out without considering differences that might exist between patients who accept retroviral treatment and those who do not. One possible reason for this may be the difficulty in gaining access to patients who refuse antiretroviral treatment. However, the prison environment makes it possible to locate and study this type of patient, who up till now has not been the subject of study. The aim of this article is to describe the clinical and psychosocial state of HIV+ inmates who refuse ARVT and compare this data with patients receiving treatment and others for whom treatment has not been indicated.Methods: Cross-sectional study using 585 HIV+ inmates in three prisons in Andalusia from May to June 2004. Refusal, acceptance and non-indication of ARVT treatment was the grouping variable used. The independent variables were socio-demographic, psychosocial, clinical and other variables relating to the prison environment.Results: 16.8% of patients refused ARVT, while 56.3% were receiving treatment and another 26.8 were not indicated