Meeting our medical needs after prison release: Views of formerly incarcerated people living with HIV

Background: Antiretroviral therapy (ART) is critical to optimal health and prevention for people living with HIV (PLWH). Incarcerated PLWH may adhere to medical care in prison but, after release, adherence to ART and care often falters. A deeper understanding of barriers faced upon release is needed to inform programs designed to assist PLWH during community re-entry. Methods: In-depth semi-structured qualitative interviews and focus groups were conducted with 45 (9 female, 36 male) formerly incarcerated PLWH in two regions of the US South. Perceptions of health needs and experiences with accessing HIV care post-release were assessed. Interviews and focus groups were audio-recorded, and transcripts were reviewed to identify salient themes. Results: Participants identified individual-, community-, and institutional-level facilitators and barriers to HIV care and adherence post-release. Individual-level facilitators included being proactive about managing care post-release and utilizing support networks. One participant stated, “I have lots of friends and family that help me stay clean, remind me to take my medicine, and keep my focus on my life”. Several described the community-level facilitator of outreach coordinators who assisted with the transition. An institutional-level facilitator was federally funded programs providing cell phones. Participants also encountered a number of barriers, including the individual-level barrier of transitioning to life outside of prison. One explained, “I don't think there's really any preparation that you're transition. How can you be out here and they prepare you for outside when they don't really address it [HIV] on the inside?” Community-level barriers included HIV stigma and discrimination towards PLWH that impeded access to HIV care and basic services. One participant stated, “There is a stigma once you get out of prison and tell people you been incarcerated, there is an even bigger stigma when you tell people that you have HIV.” In addition, several mentioned institutional barriers such as accessing HIV care and meeting basic needs such as, job assistance, substance abuse counseling, shelter, and mental health care. Conclusions: Significant barriers, across multiple levels, were perceived as barriers by formerly incarcerated PLWH to accessing services to meeting their many medical needs after prison release including a lack of preparation for community re-entry. Once released to their communities, PLWH reported encountering HIV stigma and a paucity of basic support services. Assistance from others, particularly formal outreach coordinators, as well as social support, helped them overcome barriers, suggesting that programs to provide transitional care could be beneficial.