Linking Women Experiencing Incarceration to Community-Based HIV Pre-Exposure Prophylaxis Care: A Qualitative Study

Abstract

Women experiencing incarceration (WEI) in the United States are disproportionately impacted by HIV, yet HIV pre-exposure prophylaxis (PrEP) is underutilized by women in the United States. In order to inform an intervention to promote PrEP initiation during incarceration and facilitate linkage to PrEP care following release from incarceration, we conducted individual, semistructured qualitative interviews with WEI (N = 21) and key stakeholders (N = 14). While WEI had little or no previous knowledge about PrEP, they viewed it as something that would benefit women involved in the criminal justice system. Participants stated that HIV-related stigma and underestimation of HIV risk might serve as barriers to PrEP initiation during incarceration. Participants reported that competing priorities, difficulty scheduling an appointment, and lack of motivation could interfere with linkage to PrEP care in the community. Further, cost, substance use, and difficulty remembering to take the medication were cited most commonly as likely barriers to adherence.

Linkage to care to reduce the gap in HIV treatment of people living with HIV/AIDS in Peru: 2016-2019 experience

“…Research indicate that women are the last to have access to health services in the community, given that they prioritize the attention to their partners and children. The link to care plays an essential role in integrating women into the health system [33,34,39,40].…”

HIV/Sexually Transmitted Infection Screening and Eligibility for HIV Preexposure Prophylaxis Among Women Incarcerated in an Urban County Jail

“…28 Ensuring linkage to PrEP services after release from corrections will also necessitate coordination with community-based PrEP programs, which could improve the likelihood that people initiate and persist on PrEP. 11,13,27 Our study design has limitations. This was a single-site, retrospective EHR review and therefore may not apply to other jail settings and does not incorporate direct input from patients, jail staff, or medical providers.…”

“…This study has prompted the Community Health Needs Assessment committee at the DCJ to implement accessible educational resources such as podcasts and expanded HIV screening with rapid fingerstick blood tests as well as syphilis screening 28 . Ensuring linkage to PrEP services after release from corrections will also necessitate coordination with community-based PrEP programs, which could improve the likelihood that people initiate and persist on PrEP 11,13,27 …”

“…2,10 Despite these barriers, these studies provide key qualitative data indicating that incarcerated women may see PrEP as beneficial for HIV prevention and are generally enthusiastic about taking PrEP. [11][12][13] Furthermore, after examining the HIV screening practices of 5 county jails in the United States, the Corrections Demonstration Project emphasized the need for collaboration between federal funders, correctional departments, public health departments, community-based organizations, and academia to identify PrEP-eligible individuals and to provide linkage to PrEP care after incarceration. 14 Although the need for more effective and equitable PrEP implementation is emphasized in the literature, minimal data exist on how to effectively assess for PrEP eligibility in incarcerated populations, particularly among women, including how to overcome barriers such as lack of PrEP awareness among potential consumers and providers.…”

“…Multiple barriers to PrEP implementation have been identified, such as cost, patients' concerns regarding medication adverse effects, underestimation of HIV risk, and perceived PrEP-related stigma 2,10 . Despite these barriers, these studies provide key qualitative data indicating that incarcerated women may see PrEP as beneficial for HIV prevention and are generally enthusiastic about taking PrEP 11–13 . Furthermore, after examining the HIV screening practices of 5 county jails in the United States, the Corrections Demonstration Project emphasized the need for collaboration between federal funders, correctional departments, public health departments, community-based organizations, and academia to identify PrEP-eligible individuals and to provide linkage to PrEP care after incarceration 14 .…”