Nina T Harawa1, Bita Amani2, Jane Rohde Bowers3, Jennifer N Sayles4, William Cunningham5. 1. David Geffen School of Medicine at UCLA, Department of Medicine; 911 Broxton Avenue, 1st Floor, Los Angeles, CA 90024, United States; Charles R. Drew University, Department of Psychiatry and Human Behavior, 1731 E. 120th Street, Los Angeles, CA 90059, United States. Electronic address: ninaharawa@cdrewu.edu. 2. Charles R. Drew University, Masters of Public Health Program, 1731 E. 120th Street, Los Angeles, CA 90059, United States. 3. County of Los Angeles, Department of Health Services, Division of HIV and STD Programs, 600 S. Commonwealth Ave., 19th Floor, Los Angeles, CA 90005, United States. 4. Inland Empire Health Plan, 10801 Sixth Street, Suite 120, Rancho Cucamonga, CA 91729, United States. 5. David Geffen School of Medicine at UCLA, Department of Medicine; 911 Broxton Avenue, 1st Floor, Los Angeles, CA 90024, United States; UCLA Fielding School of Public Health, Department of Health Policy and Management, 650 Charles E. Young Dr. South, 16-035 Center for Health Sciences, Los Angeles, CA 90095-1772, United States.
Abstract
BACKGROUND: Low levels of medical care engagement have been noted for HIV-positive people leaving systems of incarceration in the United States. Substance misuse frequently co-occurs with criminal justice involvement in individuals who are living with HIV. METHODS: We analyzed data from in-depth interviews with 19 HIV-positive individuals who were currently or formerly incarcerated in order to elucidate challenges faced in accessing care and maintaining HIV treatment regimens when cycling out of (and often back into) custody. Our thematic analysis used an ecosocial framework to describe participants' shifts between substance use treatment, medical care, and criminal justice systems. RESULTS: Dominant themes included the dramatic increase in HIV-treatment-related autonomy required following release from jail because of differences in care delivery between custody-based and community-based care systems; the important, but temporary stabilization provided by residential substance use treatment programmes; and the inconsistency of substance use treatment approaches with chronic care models of disease management. CONCLUSION: Enhanced integration of criminal justice, medical care, and substance use treatment institutions in planning for reentry of HIV populations may ease the impact of the dramatic shifts in context that often dissuade linkage and retention. This integration should include coordination with custody release processes, periodic assessments for active substance misuse in HIV treatment settings, support for (re)establishing health-promoting social networks, and options for long-term, residential substance use treatment programmes.
BACKGROUND: Low levels of medical care engagement have been noted for HIV-positive people leaving systems of incarceration in the United States. Substance misuse frequently co-occurs with criminal justice involvement in individuals who are living with HIV. METHODS: We analyzed data from in-depth interviews with 19 HIV-positive individuals who were currently or formerly incarcerated in order to elucidate challenges faced in accessing care and maintaining HIV treatment regimens when cycling out of (and often back into) custody. Our thematic analysis used an ecosocial framework to describe participants' shifts between substance use treatment, medical care, and criminal justice systems. RESULTS: Dominant themes included the dramatic increase in HIV-treatment-related autonomy required following release from jail because of differences in care delivery between custody-based and community-based care systems; the important, but temporary stabilization provided by residential substance use treatment programmes; and the inconsistency of substance use treatment approaches with chronic care models of disease management. CONCLUSION: Enhanced integration of criminal justice, medical care, and substance use treatment institutions in planning for reentry of HIV populations may ease the impact of the dramatic shifts in context that often dissuade linkage and retention. This integration should include coordination with custody release processes, periodic assessments for active substance misuse in HIV treatment settings, support for (re)establishing health-promoting social networks, and options for long-term, residential substance use treatment programmes.
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