HIV+ women incarcerated in New York City jails

The NYC Department of Health and Mental Hygiene, which oversees the medical and mental health care provided on Rikers Island, one of the country's largest jail systems, took part in a SPNS initiative to enhance linkages for HIV+ people leaving jails. The positive women incarcerated on Rikers Island who participated in the study were significantly more likely than the males to have been homeless and staying on the streets or in a park, or in someone else's home, compared to the men who were more likely to have slept in a rented room. We looked at having children in their care as a possible explanation, thinking that children might make it more difficult for women to find suitable housing, but no differences in child care were observed between men and women. However the women were more likely to have been bothered by family problems and reported that addressing those problems through treatment or counseling was much more important to them compared to the males. Women were also less likely to have been employed in the month before their incarceration compared to the men. Women in the study were also twice as likely as the men to have visited an emergency department for care in the 6 months prior to incarceration. Regarding their HIV infection, nearly one quarter (23%) of women said they had never taken HIV medications compared with just 12 percent of the men, and those taking medications were less likely to have taken their HIV medications prior to their incarceration. When asked if they planned to take HIV medications after their release, women reported being significantly less inclined to do so and much more likely to reply that they didn't know if they would take HIV medications after their release from jail. While many HIV+ jail detainees could benefit from assistance with housing and other social services prior to being released from jail, these differences by gender highlight the family and relationship issues that seem to more acutely affect women. Comprehensive discharge plans for women should include questions on these topics and discharge planners working with women should anticipate that these other needs may be more pressing to their clients. A tailored approach to discharge planning that acknowledges competing needs and priorities is required in order to develop appropriate plans for women leaving jail.