Provider Perspectives Regarding the Health Care Needs of a Key Population: HIV-infected Prisoners After Incarceration

Abstract

During incarceration, many HIV-infected prisoners receive care and are adherent to medication. However, following release, many have difficulty engaging in HIV care and remaining on antiretroviral therapy (ART). Community-based service providers for HIV-infected releasees have a deep understanding of the health needs and challenges these individuals face on community re-entry. We conducted in-depth qualitative interviews with 38 health care and service professionals in 2 U.S. southern states regarding the barriers releasees faced in meeting their health needs, including HIV care and treatment post-release. Individual, community, and organization-level barriers to HIV care and treatment adherence post-release were identified and offered unique insight into the ways that these multi-level obstacles affect HIV-infected former prisoners’ abilities to engage in care and access necessary social services. Provider perspectives should be considered when designing interventions to support HIV care after release.

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:…”

Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review

“…There were several individual‐level factors that affected linkage to HIV care following release. Unstable housing or homelessness were the most common barriers to HIV care post‐release . Conversely, Booker et al found that inmates with stable housing 30 days post‐release were over four times more likely to be linked to HIV care .…”

“…In addition, several studies identified social support and the presence of children or other dependents as important facilitators to linkage to HIV care among released inmates. Other individual‐level barriers to linkage to HIV care following release included re‐incarceration, HIV‐related stigma, having less than a high school education, and a lack of trust or previous negative experiences with healthcare providers . Conversely, engagement in HIV care and adherence to antiretroviral therapy prior to incarceration, as well as having a dedicated off‐site HIV care provider were all associated with increased linkage to HIV care post‐release.…”

“…The main facilitators to linkage included the provision of case management, discharge planning, transportation assistance, housing support and peer navigation. The chief barriers to linkage to HIV care were the lack of either transportation assistance or post‐release reintegration assistance with housing, employment, addiction and other services, health insurance, etc, as well as prison transfers …”

Influences of Economic, Social and Cultural Marginalization on the Association Between Alcohol Use and Sexual Risk Among Formerly Incarcerated Latino Men

“…Exposure to long and short-term imprisonment dramatically increases an individual’s vulnerability towards HIV, STIs, and potentially aggravate the severity of pre-existing (or onset of) drug use, alcohol use, and mental health disorders. 33,34 High levels of HIV/AIDS and alcohol abuse are well-documented among formerly incarcerated populations and have been attributed to issues of re-entry: difficulty re-entering the workforce, adapting to new cultural environments, stigma, and isolation. 35,36 These high levels of risk behaviors among FILM can be attributed to unemployment.…”