Incarceration of People Living with HIV/AIDS: Implications for Treatment-as-Prevention

Abstract

Contact with the criminal justice system, including incarceration, is a common experience for many people living with HIV/AIDS. Optimism has recently been expressed that correctional facilities could be important locations for Treatment-as-Prevention (TasP)-based initiatives. We review recent findings regarding the effect of incarceration on patterns of HIV transmission, testing, treatment initiation and retention. We found that the prevalence of HIV infection among incarcerated individuals remains higher than analogous non-incarcerated populations. Recent studies have shown that voluntary HIV/AIDS testing is feasible in many correctional facilities, although the number of previously undiagnosed individuals identified has been modest. Studies have implied enhanced linkage to HIV/AIDS treatment and care in jails in the United States was associated with improvements in the HIV cascade of care. However, for many individuals living with HIV/AIDS, exposure to the correctional system remains an important barrier to retention in HIV/AIDS treatment and care. Future research should evaluate structural interventions to address these barriers and facilitate the scale-up of TasP-based efforts among individuals living in correctional settings.

Factors associated with initiation of antiretroviral therapy among HIV-positive people who use injection drugs in a Canadian setting

“…The identification of these barriers in a setting with universal healthcare and an ongoing Treatment-as-Prevention initiative testifies not only to the pervasive impacts of the criminalization of illicit drug use, but also to the need to integrate social-structural interventions into efforts to scale-up treatment. Our findings support warnings [38] that laws, policies and programmes which treat illicit drug use as a matter of public security impair public health-based objectives to address the global HIV/AIDS pandemic. Given the increasing realization of the importance of earlier HIV treatment initiation to optimize the impact of antiretroviral therapy on HIV/AIDS-associated morbidity, mortality and HIV transmission, our findings stress the importance of engagement in evidence-based addictions treatment and addressing barriers related to criminalization of illicit drug use.…”

“…Given these dynamics, correctional facilities have been suggested as a key venue to facilitate HIV testing and treatment initiation [28]. In our setting, HIV testing and antiretroviral treatment are available to incarcerated individuals in municipal, provincial and federal correctional facilities.…”

HIV Testing, HIV Positivity, and Linkage and Referral Services in Correctional Facilities in the United States, 2009–2013

“…However, previous research suggests that it is challenging to retain HIV-infected persons who receive services while incarcerated in HIV care and other prevention services postrelease. 15,27,28 They may not adhere to their HIV medications, discontinue treatment, and/or engage in high risk behavior that may increase HIV transmission. 27,28 Other factors that may contribute are poor access to health care upon release, substance use, mental health issues, unstable housing, and unemployment.…”

“…15,27,28 They may not adhere to their HIV medications, discontinue treatment, and/or engage in high risk behavior that may increase HIV transmission. 27,28 Other factors that may contribute are poor access to health care upon release, substance use, mental health issues, unstable housing, and unemployment. 11,13,27,29–31 …”

“…27,28 Other factors that may contribute are poor access to health care upon release, substance use, mental health issues, unstable housing, and unemployment. 11,13,27,29–31 …”