“Inside These Fences Is Our Own Little World”: Prison-Based HIV Testing and HIV-Related Stigma Among Incarcerated Men and Women

Muessig, Kathryn E.; Rosen, David L.; Farel, Claire E; White, Becky L.; Filene, Eliza J.; Wohl, David A.

doi:10.1521/aeap.2016.28.2.103

Cited by 22 publications

(18 citation statements)

References 37 publications

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“…Confidentiality was a key resource for opt-out testing programmes, as the enclosed environment of prison amplifies fear of infectious disease amongst prisoners and staff [51, 57, 58]. BBVs are stigmatised within the prison context (C).…”

Section: Resultsmentioning

confidence: 99%

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Understanding how, why, for whom, and under what circumstances opt-out blood-borne virus testing programmes work to increase test engagement and uptake within prison: a rapid-realist review

Francis-Graham

Ekeke

Nelson

et al. 2019

BMC Health Serv Res

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Background Prisons represent a unique opportunity to diagnose blood-borne viruses. Opt-out testing is receiving increasing interest, as a result of mounting evidence to suggest that the manner in which a test offer is delivered, affects test uptake. Although the effectiveness of opt-out testing within the prison setting has been established, robust explanations are required for the variation in outcomes reported. Methods Rapid-realist review methodology was used to synthesise the literature on prison-based opt-out testing. The review was carried out in three phases. Phase one: An expert panel provided literature relevant to the implementation of opt-out testing within the English prison estate. Unstructured searches were also conducted to identify other social programmes where “opt-out” had been used to increase uptake. Phase two: a systematic search of six peer-review and five grey literature databases was carried out to identify empirical data on opt-out testing within the prison setting. Phase three: Additional non-exhaustive searches were carried out to identify literature that reinforced emergent concepts. The development of programme theory took place with each iteration and was validated in consultation with stakeholders. Results Programme theory was constructed for two outcomes: the proportion of intake offered a test and the proportion offered that accepted testing. The proportion of intake offered testing was influenced by the timing of the test offer, which was often delayed due to barriers to prisoner access. The decision to accept testing was influenced by concerns about confidentiality, fear of a positive diagnosis, a prisoner’s personal interpretation of risk, discomfort with invasive procedures, trust in healthcare, and the fidelity of the opt-out offer. Conclusions This review identified important implementation considerations that moderate the effectiveness of opt-out testing programmes. It also highlighted a lack of appreciation for the theoretical underpinnings of opt-out programmes and tension around how to implement testing in a manner that adheres to both default theory and informed consent. It is anticipated that results will be used to inform the design and implementation of subsequent versions of these programmes, as well as catalyse further in-depth analysis into their operation within the unique context of prison. Review registration CRD42017068342 . Electronic supplementary material The online version of this article (10.1186/s12913-019-3970-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

“…Possibly yeah?” (prison officer) [51]. Breaches in auditory and visual confidentiality can also occur when conducting testing, as a result of the confined environment, security requirements, and the increasing reliance on prisoners for the maintenance of the prison environment [39, 47, 51, 57–61].…”

Section: Resultsmentioning

confidence: 99%

Understanding how, why, for whom, and under what circumstances opt-out blood-borne virus testing programmes work to increase test engagement and uptake within prison: a rapid-realist review

Francis-Graham

Ekeke

Nelson

et al. 2019

BMC Health Serv Res

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“…Other studies failed to link HIV stigma to test acceptance, but showed a relation between test acceptance and HIV knowledge [ 13 ]. Thus enhancing the knowledge on HIV risk factors, treatment and prognosis may help to enlarge the proportion of persons willing to be tested [ 14 ]. In French facilities, health care is entrusted to the nearest public hospital.…”

Section: Discussionmentioning

confidence: 99%

Reaching the WHO target of testing persons in jails in prisons will need diverse efforts and resources

et al. 2018

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BackgroundThe Caribbean is the second most affected region in the world by human immunodeficiency virus (HIV), and HIV prevalence is significantly higher among persons in jails and prisons than in the free population. The aim of our study was to assess the screening rates of HIV, hepatitis B and C, syphilis and human T cell leukaemia virus type 1 among newly-arrived persons in 2014, at Ducos facility in Martinique and the testing process performance.MethodsThis is an observational monocentric study conducted within the prison’s health unit. The study population consisted of all individuals incarcerated between 01/01/14 and 31/12/14. At the initial medical visit, HIV and STI testing were proposed to every newcomer. The rate of acceptance was calculated, as well as the screening process performance.ResultsIn 2014 778 new persons were incarcerated, among those, 461 (59.3%) were tested. The main reasons for missing the testing opportunity were due to organization of the judiciary system (persons on electronic monitoring or day parole, transferred or quickly released before completion of the process) or to individual refusal. Finally, 75 persons did not get their results (all of them negative), 41 of them due to the medical staff work overload.ConclusionsHIV and STI testing rates among newcomers at Ducos have notable room for improvement. The future availability of combined (HIV, HBV, HCV and syphilis) rapid tests may be very useful in case of short term incarceration, if their cost is not prohibitive. Reaching higher levels of testing will also require more resources.

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“…Indeed, patients frequently describe custody as a hostile environment, with concerns about confidentiality and lack of friendly support. As elsewhere, HIV-related stigma segregation are common [34]. Furthermore, newly diagnosed persons may be reluctant to consult an unknown ambulatory unit after release.…”

Section: Factors Associated With Return To Hiv Carementioning

confidence: 97%

Returning to care after incarceration with HIV: the French Guianese experience

Huber

Vandentorren

Merceron³

et al. 2020

BMC Public Health

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Background: HIV prevalence in correctional facilities may be 2 to 10 times higher than in the general adult population. Antiretroviral therapy (ART) interruption is frequent after an incarceration. This, in combination with post-release high-risk behaviors, may have detrimental consequences on the epidemic. Although return to care after release from correctional facilities has been described in many North American settings, data from South America seemed scarce. French Guiana is the only French territory located in South America. In 2014, HIV prevalence was estimated at 1.2% among pregnant women and oscillated around 4% in the only correctional facility. Method: HIV-infected adults released from the French Guiana correctional facility between 2007 and 2013 were included in a retrospective cohort survey. The first objective was to describe the cascade of care in the 4 years following release. The secondary objectives were to describe contacts with care and to identify factors associated with return to HIV care, 1 year after release. Results: We included 147 people, mostly males (81.6%). The median time before the first ambulatory consultation was 1.8 months. Within 1 year after release, 27.9% came for unscheduled emergency consultations, 22.4% were hospitalized. Within 4 years after release, 40.0-46.5% were in care, 22.4% archieved virological success. Being on ART when incarcerated was associated with HIV care (aIRR: 2.0, CI: 1.2-3.0), whereas being HIV-diagnosed during the last incarceration was associated with poor follow-up (aIRR: 0.3, CI: 0.1-0.9). Conclusion: The risk of HIV-follow-up interruption is high, after an incarceration with HIV. ART supply should be sufficient to cover the timespan following release, several months if possible. Those not on ART at the time of incarceration may require special attention, especially those newly HIV-diagnosed while in custody. Comprehensive programs are necessary to support ex-offenders to stay on ART after incarceration.

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“Inside These Fences Is Our Own Little World”: Prison-Based HIV Testing and HIV-Related Stigma Among Incarcerated Men and Women

Cited by 22 publications

References 37 publications

Understanding how, why, for whom, and under what circumstances opt-out blood-borne virus testing programmes work to increase test engagement and uptake within prison: a rapid-realist review

Understanding how, why, for whom, and under what circumstances opt-out blood-borne virus testing programmes work to increase test engagement and uptake within prison: a rapid-realist review

Reaching the WHO target of testing persons in jails in prisons will need diverse efforts and resources

Returning to care after incarceration with HIV: the French Guianese experience

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