Different Patterns of Drug Use and Barriers to Continuous HIV Care Post-Incarceration

Abstract

Individuals with a drug use history often experience drug use relapse when they are released from incarceration. This article explores the processes by which a sample of adults experienced relapse post-incarceration and consequently experienced HIV treatment interruption. Data are from in-depth interviews with 25 formerly incarcerated HIV-positive adults who have a self-reported history of drug use. Findings reveal that each participant relapsed post-incarceration. Some participants relapsed immediately after release; others remained drug free until something “triggered” a relapse. Once a participant relapsed, factors that contributed to HIV treatment interruption included re-incarceration, a lack of concern for HIV care, and the overlap of symptoms between addiction and HIV infection. The relationship between drug use and HIV treatment interruption was exacerbated when the participant reported also having a mental health disorder. Cessation of drug use facilitated HIV treatment engagement for participants. The implications of these findings for policy and practice are discussed.

Resumption of injecting drug use following release from prison in Australia

“…Release from prison has been associated with engaging in high-risk IDU behaviour, with some studies reporting a rapid return to substance use following release from prison (Shewan et al, 2001;Kinner, 2006;Evans et al, 2009;Milloy et al, 2009;Binswanger et al, 2012), unemployment (Visher et al, 2011), homelessness (Evans et al, 2009), disruption or restricted access to drug (Dolan et al, 2005;Stallwitz and Stöver, 2007;Fu et al, 2013) and other medical treatment programs (Milloy et al, 2011), and recidivism (Håkansson and Berglund, 2012;Kirwan et al, 2015). For ex-prisoners, IDU carries a high risk of fatal (Merrall et al, 2010) and non-fatal (Winter et al, 2015) overdose, infectious disease acquisition and transmission (Dolan et al, 2005), and other poor health and social outcomes (Kinner, 2006;Mallik-Kane and Visher, 2008;Swan, 2015). There is increasingly compelling evidence that improving health outcomes for ex-prisoners has considerable individual and societal benefits (Kinner and Wang, 2014).…”

Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review

“…There were several individual‐level factors that affected linkage to HIV care following release. Unstable housing or homelessness were the most common barriers to HIV care post‐release . Conversely, Booker et al found that inmates with stable housing 30 days post‐release were over four times more likely to be linked to HIV care .…”

The relationship between gastrointestinal symptom attribution, bothersomeness, and antiretroviral adherence among adults with HIV

“…This conclusion has important implications for misattribution. For example, Swan (2015) found that illicit drug users reported sometimes attributing symptoms to that drug use, rather than disease. A patient may incorrectly attribute their symptom to ARVs, rather than something else that may be causing the symptom, which could have implications for their adherence.…”

“…Several barriers to ARV medication adherence have been identified in the literature, such as drug use and mental health disorders (Aragonés, Sánchez, Campos, & Pérez, 2011; Keuroghlian et al, 2011; Malta, Strathdee, Magnanini, & Bastos, 2008; Mellins, Kang, Leu, Havens, & Chesney, 2003; Phillips, 2011; Swan, 2015), unstable housing or homelessness (Lanier & Paoline III, 2005; Meyer, Chen, & Springer, 2011; Nunn et al, 2010; Phillips, 2011; Rebholz, Drainoni, & Cabral, 2009; Rich et al, 2001), and experiencing side effects (Gay et al, 2011; Kremer et al, 2009; Lenzi, Wiens, & Pontarolo, 2013). Attributing symptoms to HIV medications (i.e., as side effects) is associated with switching ARVs, and poor retention/adherence to care (Batchelder, Gonzalez, & Berg, 2014; Kremer et al, 2009; Lenzi, et al, 2013).…”