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American Public Health Association
133rd Annual Meeting & Exposition
December 10-14, 2005
Philadelphia, PA
APHA 2005
 
3072.6: Monday, December 12, 2005 - Board 1

Abstract #116544

Social determinants of medication adherence and general health among HIV-positive prison inmates

Jill Kantrowitz Kunkel, MPH, CHES1, Brenda DeVellis, PhD2, Carol Golin, MD3, Andrew Kaplan, MD4, Tasseli E. McKay, MPH5, David Wohl, MD4, and Becky Stephenson, MD4. (1) Virology Department, HIV Services, Bellevue Hospital, 462 1st Ave., New York, NY 10016, (917) 671-8956, jmkunkel@email.unc.edu, (2) Dept of Health Behavior and Health Education, University of North Carolina, CB #7400, Chapel Hill, NC 27599-7400, (3) Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, (4) Division of Infectious Diseases, University of North Carolina, 705 Mary Ellen Jones, CB#7290, Chapel Hill, NC 27599, (5) Center for Infectious Diseases, University of North Carolina at Chapel Hill, 1700 MLK, CB#3368, Suite 129, Room 120, Chapel Hill, NC 27599

Prevalence of HIV in US prisons and jails is at least eight times that observed in the general population. The AIDS-related mortality rate among HIV-positive prison inmates substantially exceeds mortality among HIV-positive individuals outside of prison. Prison systems are mandated by law to provide anti-retroviral therapy (ART) to HIV-positive inmates. Studies among non-incarcerated people demonstrate that adherence to ART is a critical determinant of treatment effectiveness. It seems likely that prison poses unique challenges to adherence for HIV-positive inmates; however, practitioners lack a systematic understanding of the obstacles faced by incarcerated individuals with HIV/AIDS.

Within a randomized, controlled trial of directly-observed ART in North Carolina prisons, we 1) define the social determinants of medication adherence and general health among HIV-positive prison inmates; 2) apply post-Structuralist social theory to understand relationships among the constructs identified; and 3) propose a conceptual model for improving medication adherence. Data were collected as part of motivational interviewing sessions with 70 HIV-positive inmates in 10 correctional facilities in Central NC. Participants completed 139 interview sessions. Session notes and verbatim transcripts for these interviews were analyzed using Atlas/ti.

Prominent themes included the following barriers to optimal adherence and maintaining good general health: subordination, stigmatization, social isolation and surveillance. Consistent with Foucaultian discourse theory, these findings define specific social and organizational aspects of the prison environment that exert a powerful influence on the well-being of HIV-positive inmates. A conceptual model of such influences reveals promising loci for public health intervention.

Learning Objectives:

  • At the end of this session, participants will be able to

    Keywords: Prison, HIV/AIDS

    Presenting author's disclosure statement:

    I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

    HIV/AIDS: Across Multiple Communities and Populations

    The 133rd Annual Meeting & Exposition (December 10-14, 2005) of APHA