HIV Policy, Resource Improvements Needed for Jailed Persons in North Carolina

A new study from North Carolina has investigated individuals’ experiences with and perspectives on their receipt of HIV-related care while incarcerated in 1 of 21 jails in the state.

Internal policy improvements for jails, along with additional external resources, are needed to bump up the quality of HIV care that North Carolina’s incarcerated population receives, according to study findings published last month in PLoS One.

Using semistructured interviews from March 2019 through March 2020, authors investigated outcomes among 23 persons living with HIV (PLWH) from 21 jails in North Carolina—incarcerated (n = 13) or not (n = 10)—who had 300 jail incarcerations among them after receiving their diagnosis. Their experiences and perspectives were evaluated across 4 domains:

  • Access to HIV care during incarceration
  • Impact of jail time on HIV care continuity
  • Privacy and stigma concerns
  • Satisfaction with HIV care during incarceration

“As part of a larger study to explore the ethical considerations in extending public health HIV surveillance to jail settings, we conducted semi-structured interviews with 23 PLWH,” the authors wrote. “Most incarcerations for...PLWH occur in jails, yet studies of HIV care during jail incarceration are limited.”

Participants most often were male (69.5%), Black (78.2%), and aged 45 to 54 years (43.5%); had been living with HIV for over 10 years (69.6%); had more than 5 jail stays post HIV diagnosis (47.8%); and had a high school/General Educational Development diploma as their highest level of education (69.6%).

Close to 80% of study participants reported receiving their HIV medications while serving time, with 94% adding that this occurred within a week of entering jail. However, 78% also reported that some jail stays interrupted their care, with reasons for this being delays of correct medications, short stays, jails’ financial burdens, and personal choice. Fifty percent noted relying on family to provide their medications while in jail.

Seventy-eight percent reported meeting with a nurse or physician for HIV-related care during an incarceration, with 61% of this group receiving community-based care referrals. When these visits did occur, most study participants said they were treated well and that attempts were made to improve care and connect with local resources.

Common barriers to meeting with an HIV care provider were noted to be costs, with one participant reporting that “the jail administrators would not support HIV care”; lack of access to nonmedical resources (eg, food to combat adverse effects of medications, a bathroom); and lack of care and empathy from jail staff.

HIV care disruptions occurred in 43% of the study participants, with the most common disruption being missing or not receiving HIV medications, and 38% reported no care disruptions because they could access care or jail stays were too short to affect their care. In addition, 19% reported mixed experiences in this area, clarifying that their stays allowed them to focus more on their health, facilitated access to medications, and presented opportunities to focus on sobriety—with the latter 2 not being available outside the jails.

Sixty-five percent of the study group reporting not disclosing their HIV status to jail staff, because of perceived mistreatment from jail staff and their possible interactions with common outside acquaintances, which could lead to greater stigma and mistreatment. Among those who chose to disclose their status, however, when asked about privacy and stigma, close to a third did so just to get their medications or so staff could be prepared in case of emergency medical situations. As for disclosing their status to fellow prisoners, 87% stayed mum to avoid violence and stigma.

Overall, close to half of the study participants were not happy with their jail-related care, but these responses did not have a correlation with total incarcerations or stays in a certain jail (ie, care satisfaction varied among those with stays in the same jail), whereas 30% were satisfied with their care.

When summing their findings, the study investigators noted that that not only can incarceration disrupt HIV-related care because of lack of available resources, including adherence to antiretroviral treatment, privacy and stigma concerns, and cost, but it can also introduce opportunities to both augment care and re-engage persons who have become nonadherent to their care regimen.

Still, more research is needed, they concluded, on internal jail policies that have an impact on HIV-related care and how to improve access to care while in jail; state and local health departments need to improve their external care resource offerings; and there is value in future qualitative research that does not exclude incarcerated, and marginalized, populations.

Reference

Blue C, Buchbinder M, Brown ME, Bradley-Bull S, Rosen DL. Access to HIV care in jails: perspectives from people living with HIV in North Carolina. PLoS One. Published online January 24, 2022. doi:10.1371/journal.pone.0262882.