“You're in a World of Chaos”: Experiences Accessing HIV Care and Adhering to Medications After Incarceration

Abstract

Most HIV-infected inmates leave prison with a suppressed viral load; many, however, become disconnected from care and non-adherent to medications during reentry to community life. In this secondary data analysis of focus groups (N = 6) and in-depth interviews (N = 9) with 46 formerly incarcerated HIV-infected people during reentry, we used an inductive analytic approach to explore the interplay between individual, interpersonal, community, and structural factors and HIV management. Participants described barriers and facilitators to care engagement and adherence at each of these 4 levels, as well as a milieu of HIV and incarceration-related stigma and discrimination. The constellation of barriers and facilitators created competing demands and a sense of chaos in participants’ lives, which led them to address reentry-related basic needs (e.g., housing, food) before health care needs. Interventions that simultaneously address multiple levels, including augmenting employment and housing opportunities, enhancing social support, and reducing stigma, are needed.

Correlates of Durable Viral Suppression (DVS) Among Criminal Justice-involved (CJI) Black Men Living with HIV in Louisiana

“…Correctional settings constitute an important setting for HIV care and treatment interventions as the receipt of HIV-related services during most recent incarceration was associated with DVS (2,5,6,14). The observed changes in viral suppression (i.e., baseline suppression of 44% and DVS of 20%) are consistent with previous studies that have shown HIV care and treatment benefit loss upon community release (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). As expected, medication adherence was critical for DVS such that participants who had achieved DVS were more likely to be adherent at baseline compared with both NVS and SVS participants.…”

“…The post-release transition period is a vulnerable time for many CJI individuals living with HIV infection as the benefits of HIV treatment experienced during incarceration are frequently lost upon community re-entry (2)(3)(4)(5). Post-release HIV care visits and medication adherence become challenging due to a variety of co-occurring factors including limited income, high levels of unemployment, HIV stigma, mental health issues, and relapse to drug and alcohol use (2)(3)(4)(5)(6)(7)(8)(9)(10)(11)(12). Such barriers have also been noted among CJI Black men who have sex with men (BMSM) living with HIV infection (13,14).…”

Randomized Controlled Trial of an Intervention to Maintain Suppression of HIV Viremia After Prison Release: The imPACT Trial

“…The overarching objective of the intervention was to maintain viral suppression following prison release, and entry into community medical care was presumed to be the critical mediator of this outcome. The intervention was finalized following formative research conducted with prison-based and community service providers as well as former inmates living with HIV infection, as has been previously reported (26, 27). The main elements of the tested intervention included the following:…”

HIV Care Cascade among Prisoners of the Mandalay Central Prison in Myanmar: 2011–2018

“…The released prisoners face a lot of challenges when they reenter into the community which include substance abuse, stressful life experience, stigma, and discrimination in trying to fulfill the basic needs of life [26,27]. In such a situation, HIV care may get neglected.…”