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

BMC Public Health

Sharon D Parker³  David L Rosen²  Jenna J Garrett⁵  Anna M Scheyett⁴  David A Wohl²  Claire E Farel²  Carol E Golin⁶  Danielle F Haley¹ 

[1] Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA;Institute for Global Health and Infectious Diseases, University of North Carolina, 130 Mason Farm Road, Campus Box 7215, Chapel Hill, NC 27599, USA;The Miriam Hospital Division of Infectious Diseases and Brown University School of Medicine, Providence, RI 02906, USA;College of Social Work, University of South Carolina, Columbia, SC 29208, USA;Latin America Program, Planned Parenthood Global, Miami, FL 33131, USA;Cecil G. Sheps Center for Health Services Research, 725 Airport Road, Suite 305D, Campus Box 7110, Chapel Hill, NC 27599, USA

关键词: Substance misuse;    Qualitative research;    Stigma;    Social cognitive theory;    Incarceration;    HIV/AIDS;   

Others  :  1122854
DOI  :  10.1186/1471-2458-14-1253

 received in 2014-04-17, accepted in 2014-11-17,  发布年份 2014

【 摘 要 】

Background

Although 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.

Methods

We 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.

Results

Most 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.

Conclusion

These 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.

【 授权许可】

   
2014 Haley et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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