Multilevel challenges to engagement in HIV care after prison release: a theory-informed qualitative study comparing prisoners’ perspectives before and after community reentry

Abstract

BackgroundAlthough prison provides the opportunity for HIV diagnosis and access to in-prison care, following release, many HIV-infected inmates experience clinical setbacks, including nonadherence to antiretrovirals, elevations in viral load, and HIV disease progression. HIV-infected former inmates face numerous barriers to successful community reentry and to accessing healthcare. However, little is known about the outcome expectations of HIV-infected inmates for release, how their post-release lives align with pre-release expectations, and how these processes influence engagement in HIV care following release from prison.MethodsWe conducted semi-structured interviews (24 pre- and 13 post-release) with HIV-infected inmates enrolled in a randomized controlled trial of a case management intervention to enhance post-release linkage to care. Two researchers independently coded data using a common codebook. Intercoder reliability was strong (kappa = 0.86). We analyzed data using Grounded Theory methodology and Applied Thematic Analysis. We collected and compared baseline sociodemographic and behavioral characteristics of all cohort participants who did and did not participate in the qualitative interviews using Fisher’s Exact Tests for categorical measures and Wilcoxon rank-sum tests for continuous measures.ResultsMost participants were heterosexual, middle-aged, single, African American men and women with histories of substance use. Substudy participants were more likely to anticipate living with family/friends and needing income assistance post-release. Most were taking antiretrovirals prior to release and anticipated needing help securing health benefits and medications post-release. Before release, most participants felt confident they would be able to manage their HIV. However, upon release, many experienced intermittent or prolonged periods of antiretroviral nonadherence, largely due to substance use relapse or delays in care initiation. Substance use was precipitated by stressful life experiences, including stigma, and contact with drug-using social networks. As informed by the Social Cognitive Theory and HIV Stigma Framework, findings illustrate the reciprocal relationships among substance use, experiences of stigma, pre- and post-release environments, and skills needed to engage in HIV care.ConclusionThese findings underscore the need for comprehensive evidence-based interventions to prepare inmates to transition from incarceration to freedom, particularly those that strengthen linkage to HIV care and focus on realities of reentry, including stigma, meeting basic needs, preventing substance abuse, and identifying community resources.

Correlates and Experiences of HIV Stigma in Prisoners Living With HIV in Indonesia: A Mixed-Method Analysis

“…Moreover, HIV stigma may magnify the perceived challenges of accessing HIV care and utilizing ART after release from prison (Choi et al, 2010; Haley et al, 2014). Higher stigma scores in those taking ART while incarcerated may also reflect higher ART use in those who were diagnosed before incarceration and therefore had greater exposure to stigmatizing public attitudes before incarceration.…”

“…Political-economic upheaval that slowed an initial response to the HIV epidemic, and inadequate training of health care personnel (Harapan et al, 2013), also contribute to discrimination against PLWH in health care settings (Merati, Supriyadi, & Yuliana, 2005). Incarcerated PLWH, many of whom are PWID, survive under a triple veil of HIV-, drug use-, and incarceration-related stigmas that compound other stressors of incarceration, and magnify the perceived challenges of community re-entry (Choi et al, 2010; Haley et al, 2014). Understanding how incarcerated PLWH experience stigma and how it affects their engagement in care is essential for improving health outcomes.…”

Infecções sexualmente transmissíveis e as vivências de mulheres em situação de reclusão

“…Diante do elevado quantitativo de portadoras de IST/AIDS privadas de liberdade, a admissão prisional é tida como uma importante oportunidade para o diagnóstico precoce e tratamento destas infecções 15 .…”

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

“…With the disproportionate incarceration of PLHIV, the prevalence of HIV in U.S. prisons is more than three times that of the general population (Bureau of Justice Statistics, 2015b). Thus prisons and jails are opportunities to provide HIV services including HIV-prevention education, testing, treatment, and linkage to post-release care (Haley et al, 2014; Rosen et al, 2015). However, efforts to provide these services may be undermined by HIV stigma among inmates and prison staff (Albizu-Garcia, Perez-Cardona, & Santiago-Negron, 2012; Derlega, Winstead, Gamble, Kelkar, & Khuanghlawn, 2010; Rotily et al, 2001).…”

“…HIV stigma is found among inmates and staff (Albizu-Garcia et al, 2012; Derlega, Winstead, & Brockington, 2008; Derlega et al, 2010; Rotily et al, 2001) and impedes HIV testing (Derlega et al, 2008) and status disclosure (Culbert, 2014; Derlega et al, 2010). Stigma is also an important factor limiting clinical success of HIV treatment for individuals while they are incarcerated (Meyer, Tangney, Stuewig, & Moore, 2014) and after release (Haley et al, 2014). …”