Gender disparities in HIV treatment outcomes following release from jail: results from a multicenter study

Abstract

Objectives: We assessed gender differences in longitudinal HIV treatment outcomes among HIV-infected jail detainees transitioning to the community.

Methods: Data were from the largest multisite prospective cohort study of HIV-infected released jail detainees (n = 1270)-the Enhancing Linkages to HIV Primary Care and Services in Jail Setting Initiative, January 2008 and March 2011, which had 10 sites in 9 states. We assessed baseline and 6-month HIV treatment outcomes, stratifying by gender.

Results: Of 867 evaluable participants, 277 (31.9%) were women. Compared with men, women were more likely to be younger, non-Hispanic White, married, homeless, and depressed, but were similar in recent alcohol and heroin use. By 6 months postrelease, women were significantly less likely than men to experience optimal HIV treatment outcomes, including (1) retention in care (50% vs 63%), (2) antiretroviral therapy prescription (39% vs 58%) or optimal antiretroviral therapy adherence (28% vs 44%), and (3) viral suppression (18% vs 30%). In multiple logistic regression models, women were half as likely as men to achieve viral suppression.

Conclusions: HIV-infected women transitioning from jail experience greater comorbidity and worse HIV treatment outcomes than men. Future interventions that transition people from jail to community-based HIV clinical care should be gender-specific.

FIGURE 1—

Disposition of study participants enrolled in EnhanceLink: January 2008–March 2011. Note. EnhanceLink = Enhancing Linkages to HIV Primary Care and Services in Jail Setting Initiative.

FIGURE 2—

HIV treatment cascade of participants enrolled in EnhanceLink, stratified by gender, at (a) baseline and (b) 6 months: January 2008–March 2011. Note. EnhanceLink = Enhancing Linkages to HIV Primary Care and Services in Jail Setting Initiative.