Violence and the perceived risks of taking antiretroviral therapy in US jails and prisons

About one in five men living with HIV in the USA passes through a correctional center annually. Jails and prisons are seen therefore as key intervention sites to promote HIV treatment as prevention. Almost no research, however, has examined inmates' perspectives on HIV treatment or their strategies for retaining access to antiretroviral therapy (ART) during incarceration. The purpose of this paper is to describe the results of an exploratory study examining men's perceptions of and experiences with HIV care and ART during incarceration.

Semi-structured, in-depth interviews were conducted with 42 HIV positive male and male-to-female transgendered persons recently released from male correctional centers in Illinois, USA.

Interpersonal violence, a lack of safety, and perceived threats to privacy were frequently cited barriers to one's willingness and ability to access and adhere to treatment. Over 60 percent of study participants reported missed doses or sustained treatment interruption (greater than two weeks) because of failure to disclose their HIV status, delayed prescribing, intermittent dosing and out-of-stock medications, confiscation of medications, and medication strikes.

Substantial improvements in ART access and adherence are likely to follow organizational changes that make incarcerated men feel safer, facilitate HIV status disclosure, and better protect the confidentiality of inmates receiving ART.

This study identified novel causes of ART non-adherence among prisoners and provides first-hand information about how violence, stigma, and the pursuit of social support influence prisoner's decisions to disclose their HIV status or accept ART during incarceration.