Facilitators of HIV Medical Care Engagement Among Former Prisoners

Abstract

Linkage to and retention in medical care is a concern for HIV-positive individuals leaving custody settings in the United States. The minimal existing research points to low rates of entry into care in the months following release and lapsed viral control among releasees who are subsequently reincarcerated. We conducted seven small focus group discussions with 27 HIVpositive individuals who were recently incarcerated in a California State prison to understand those factors that facilitated linkage to and retention in HIV care following their release. We used a consensual approach to code and analyze the focus group transcripts. Four main themes emerged from the analysis: (1) interpersonal relationships, (2) professional relationships, (3) coping strategies and resources, and (4) individual attitudes. Improving HIV-related outcomes among individuals after their release from prison requires strengthening supportive relationships, fostering the appropriate attitudes and skills, and ensuring access to resources that stabilize daily living and facilitate the process of accessing care.

Figure 1

Characteristics of in-custody and general community (out-of-custody) HIV care systems in the United States.

Figure 2

Adaptation of Springer et al 2011 representation of Maslow's hierarchy of needs as it applies to incarcerated HIV-infected patients and identified facilitators to addressing the needs underlined (Springer et al., 2011).