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Massaroni V, Iannone V, Donne VD, D'Angelillo A, Baldin G, Passerotto R, Sangiorgi F, Steiner RJ, Ciccullo A, Borghetti A, Visconti E, Giambenedetto SD. HIV and vicarious stigma in a cohort of people living with HIV in Italy: What happens when the stigma is fueled by healthcare providers? AIDS Care 2024; 36:1441-1451. [PMID: 38833545 DOI: 10.1080/09540121.2024.2361820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 05/24/2024] [Indexed: 06/06/2024]
Abstract
Vicarious stigma shows how indirect stigmatizing experiences can lead people living with HIV (PLWH) to feel discriminated against. We enrolled 350 PLWH, who were administered a 17-item questionnaire to investigate a subjective experience of stigma experienced in the hospital care setting. We found that at least once 215 PLWH (61.4%) did not want the HIV exemption indicated on the prescription for a specialist medical visit, 232 PLWH (66.3%) never used their HIV-related exemption to make a specialist medical visit, 230 PLWH (65.7%) avoided undergoing a medical assessment outside the infectious disease clinics and 241 patients (68.9%) felt unwelcome during a specialist medical visit. Moreover, 241 patients (61.1%) had heard at least once stories of health workers who did not want to touch PLWH, 213 patients (60.9%) had heard stories at least once of PLWH who had been mistreated by hospital staff, 180 patients (51.4%) had at least once heard stories about PLWH being refused treatment and services and 257 patients (73.4%) had at least once heard stories about health workers talking publicly about PLWH. This is a little explored area, especially regarding the vicarious stigma faced by PLWH. Our findings indicate the importance of combating HIV-related stigma for the wellbeing of PLWH.
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Affiliation(s)
- Valentina Massaroni
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Valentina Iannone
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Valentina Delle Donne
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna D'Angelillo
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Gianmaria Baldin
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rosanna Passerotto
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Flavio Sangiorgi
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Rebecca Jo Steiner
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Arturo Ciccullo
- UOC Infectious Diseases, Ospedale S. Salvatore, Aquila, Italy
| | - Alberto Borghetti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Elena Visconti
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Simona Di Giambenedetto
- Infectious Diseases Institute, Department of Safety and Bioethics, Catholic University of the Sacred Heart, Rome, Italy
- UOC Infectious Diseases, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
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Abraham SA, Cudjoe O, Nartey YA, Agyare E, Annor F, Tawiah BO, Nyampong M, Owusu KK, Abdulai M, Addo SA, Obiri-Yeboah D. Unravelling the experiences of incarcerated individuals living with HIV on ART: a qualitative study in Ghanaian prisons. INTERNATIONAL JOURNAL OF PRISON HEALTH 2024; 20:186-199. [PMID: 38984601 PMCID: PMC11342671 DOI: 10.1108/ijoph-06-2023-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
PURPOSE The Joint United Nations Programme on HIV/AIDS (UNAIDS) goal to end the acquired immunodeficiency syndrome (AIDS) epidemic as a public health threat by 2030 emphasises the importance of leaving no one behind. To determine progress towards the elimination goal in Ghana, an in-depth understanding of human immunodeficiency virus (HIV) care from the perspective of vulnerable populations such as persons living with HIV in incarceration is necessary. This study aims to explore the experiences of incarcerated individuals living with HIV (ILHIV) and on antiretroviral therapy (ART) in selected Ghanaian prisons to help inform policy. DESIGN/METHODOLOGY/APPROACH The study adopted a qualitative approach involving in-depth interviews with 16 purposively selected ILHIV on ART from purposively selected prisons. Interviews were conducted between October and December 2022. Thematic analysis was performed using the ATLAS.Ti software. FINDINGS Three themes were generated from the analysis: waking up to a positive HIV status; living with HIV a day at a time; and being my brother's keeper: preventing HIV transmission. All participants underwent HIV screening at the various prisons. ILHIV also had access to ART although those on remand had challenges with refills. Stigma perpetuated by incarcerated individuals against those with HIV existed, and experiences of inadequate nutrition among incarcerated individuals on ART were reported. Opportunities to improve the experiences of the ILHIV are required to improve care and reduce morbidity and mortality. ORIGINALITY/VALUE Through first-hand experiences from ILHIV in prisons, this study provides the perception of incarcerated individuals on HIV care in prisons. The insights gained from this study can contribute to the development of targeted interventions and strategies to improve HIV care and support for incarcerated individuals.
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Affiliation(s)
- Susanna Aba Abraham
- Department of Adult Health, School of Nursing and Midwifery, University of Cape Coast, Cape Coast, Ghana
| | - Obed Cudjoe
- Department of Medical Laboratory Science, University of Cape Coast College of Health and Allied Sciences, Cape Coast, Ghana
| | - Yvonne Ayerki Nartey
- Department of Internal Medicine, Cape Coast Teaching Hospital, Cape Coast, Ghana
| | - Elizabeth Agyare
- Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana and National HIV/AIDS Control Programme, Accra, Ghana
| | - Francis Annor
- Directorate of Research Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana
| | | | | | | | | | | | - Dorcas Obiri-Yeboah
- Department of Microbiology and Immunology, University of Cape Coast College of Health and Allied Sciences, Cape Coast, Ghana; Directorate of Research Innovation and Consultancy, University of Cape Coast, Cape Coast, Ghana and Clinical Microbiology/Public Health Unit, Cape Coast Teaching Hospital, Cape Coast, Ghana
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Sugarman OK, Wendell DA, Wennerstrom AB, Bachhuber MA, Robinson WT. Examining Pre-Release Interventions on HIV Outcomes 12 Months After Release from Louisiana State Corrections. AIDS Behav 2023; 27:3916-3926. [PMID: 37306846 PMCID: PMC10258759 DOI: 10.1007/s10461-023-04106-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2023] [Indexed: 06/13/2023]
Abstract
Louisiana has the highest proportion of people living with HIV (PLWH) in state prison custody. Linkage to care programs minimize odds of HIV care drop-off after release. Louisiana has two pre-release linkage to HIV care programs, one implemented through Louisiana Medicaid and another through the Office of Public Health. We conducted a retrospective cohort study of PLWH released from Louisiana corrections from January 1, 2017 to December 31, 2019. We compared HIV care continuum outcomes within 12 months after release between intervention groups (received any vs. no intervention) using two proportion z-tests and multivariable logistic regression. Of 681 people, 389 (57.1%) were not released from a state prison facility and thus not eligible to receive interventions, 252 (37%) received any intervention, and 228 (33.5%) achieved viral suppression. Linkage to care within 30 days was significantly higher in people who received any intervention (v. no intervention, p = .0142). Receiving any intervention was associated with higher odds of attaining all continuum steps, though only significantly for linkage to care (AOR = 1.592, p = .0083). We also found differences in outcomes by sex, race, age, urbanicity of the return parish (county), and Medicaid enrollment between intervention groups. Receiving any intervention increased the odds of achieving HIV care outcomes, and was significantly impactful at improving care linkage. Interventions must be improved to enhance long-term post-release HIV care continuity and eliminate disparities in care outcomes.
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Affiliation(s)
- Olivia K Sugarman
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, 21205, USA.
| | - Deborah A Wendell
- School of Public Health, LSU Health Sciences Center - New Orleans, New Orleans, LA, USA
- STD/HIV/Hepatitis Program, Louisiana Office of Public Health, New Orleans, LA, USA
| | - Ashley B Wennerstrom
- School of Public Health, LSU Health Sciences Center - New Orleans, New Orleans, LA, USA
- School of Medicine, Section of Community and Population Medicine, LSU Health Sciences Center - New Orleans, New Orleans, LA, USA
| | - Marcus A Bachhuber
- School of Medicine, Section of Community and Population Medicine, LSU Health Sciences Center - New Orleans, New Orleans, LA, USA
| | - William T Robinson
- School of Public Health, LSU Health Sciences Center - New Orleans, New Orleans, LA, USA
- STD/HIV/Hepatitis Program, Louisiana Office of Public Health, New Orleans, LA, USA
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Kerman J, Brewer R, Hotton A, Flores R, Devlin SA, Friedman EE, Schneider JA, McNulty MC. Multi-Level and Intersectional Stigma Experienced by Black Transgender Women in Chicago: a Qualitative Study to Inform Sociostructural Interventions for Reducing Stigma and Improving Health Outcomes. J Racial Ethn Health Disparities 2023:10.1007/s40615-023-01853-6. [PMID: 37957538 PMCID: PMC11089070 DOI: 10.1007/s40615-023-01853-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 10/20/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Stigma contributes to health disparities including increased HIV vulnerability among minority communities. Black transgender women experience multiple forms of stigma (e.g., anticipated, experienced), which can result in poor HIV-related outcomes. We utilized an adapted social ecological model (ASEM) to better understand the levels at which stigma is encountered and its impact on lived experience, particularly related to making healthcare decisions. METHODS Semi-structured interviews and two focus groups (n = 38) were conducted with Black transgender women and Black transfeminine individuals in Chicago from 2016 to 2017. Participants were asked about discrimination in the community, healthcare experiences, and their thoughts and decision-making process with their healthcare provider regarding HIV pre-exposure prophylaxis. We conducted thematic analysis and organized our findings based on the levels of the ASEM: individual, interpersonal, organizational, community, and structural. RESULTS Participants experienced and anticipated stigma at each ASEM level. Stigma was not experienced in isolation: stigma experienced at one level caused anticipated stigma at other levels and internalized stigma leading to negative self-image. In each case, stigma adversely impacted health outcomes (e.g., medication nonadherence, disengagement from care). Stigma within healthcare settings, medication-related stigma, and stigma directed at appearance and identity are particularly detrimental to shared decision-making with a healthcare provider. CONCLUSIONS Recognizing and valuing Black transgender women's experience with stigma are essential for developing social and structural interventions that may work collaboratively across multiple levels of lived experience to reduce stigma and healthcare disparities faced by Black transgender women.
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Affiliation(s)
- Jared Kerman
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Russell Brewer
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Anna Hotton
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Rey Flores
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Samantha A Devlin
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Eleanor E Friedman
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - John A Schneider
- Chicago Center for HIV Elimination, Chicago, IL, USA
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA
| | - Moira C McNulty
- Chicago Center for HIV Elimination, Chicago, IL, USA.
- Section of Infectious Diseases and Global Health, Department of Medicine, University of Chicago, 5841 S. Maryland Avenue, Chicago, IL, 60637, USA.
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Reyes JV, Myles RL, Luo Q, Beer L, Burton DC. Sociodemographic and Clinical Characteristics Associated With Recent Incarceration Among People With HIV, United States, 2015-2017. Public Health Rep 2023; 138:610-618. [PMID: 35848105 PMCID: PMC10291169 DOI: 10.1177/00333549221106646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES We examined sociodemographic, clinical, and behavioral factors associated with previous incarceration among people with diagnosed HIV to inform HIV care efforts for this population. METHODS We used 2015-2017 data from a cross-sectional, nationally representative sample of US adults with diagnosed HIV (N = 11 739). We computed weighted percentages and 95% CIs to compare the characteristics of people with HIV incarcerated in the past 12 months (ie, recently) with people with HIV not recently incarcerated. We used adjusted prevalence ratios (aPRs) with predicted marginal means to examine associations between selected factors and incarceration status. RESULTS Adults with HIV who were recently incarcerated, when compared with those who were not, were more likely to be aged 18-29 years (prevalence ratio [PR] = 2.51), non-Hispanic Black (PR = 1.39), less educated ( CONCLUSIONS Among people with HIV, recent incarceration was associated with increased health risks and worse health outcomes. Pre- and postrelease linkage-to-care interventions and reentry services might improve the health of recently incarcerated people with HIV.
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Affiliation(s)
- Jovanni V. Reyes
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ranell L. Myles
- Office of the Director, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Qingwei Luo
- Strategic Innovative Solutions, LLC, Clearwater, FL, USA
| | - Linda Beer
- Division of HIV Prevention, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Deron C. Burton
- Office of the Director, National Center for HIV, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Barbosa ML, Salvador PTCDO, Cogo ALP, Ferreira Junior MA, Costa GMC, Santos VEP. Penitentiary health team: the reality of the work process. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-812320222712.11702022en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Abstract This article aims to characterize the work process of the prison health team in the state of Paraíba. This is an exploratory research, with a qualitative approach, carried out with two Prison Primary Care Teams in the state of Paraíba. Individual interviews were carried out with health professionals in order to elucidate the work process developed. The corpus consisted of 10 texts and was analyzed using the software Interface de R pour les Analyzes Multidimensionnelles de Textes et de Questionnaires (Iramuteq) and exposed through the Descending Hierarchical Classification (CHD) and the Similarity Analysis. The analysis of the corpus showed that there were 5,417 occurrences of words, spread in 1,090 forms, whose average occurrence was 5.97 words for each form. The Descending Hierarchical Classification analyzed 152 text segments, with 75% retention of the corpus, which resulted in the construction of four partitions and six classes, namely: attention to perceived needs; counseling activity; reception of PPL and family; difficulties related to the system; difficulties related to resources; and suggestion for professional training for EABP.
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Affiliation(s)
- Mayara Lima Barbosa
- Universidade Federal do Rio Grande do Norte, Brazil; Centro Universitário Unifacisa, Brasil
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Barbosa ML, Salvador PTCDO, Cogo ALP, Ferreira Junior MA, Costa GMC, Santos VEP. Equipe de saúde penitenciária: a realidade do processo de trabalho. CIENCIA & SAUDE COLETIVA 2022; 27:4397-4405. [DOI: 10.1590/1413-812320222712.11702022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 07/19/2022] [Indexed: 11/16/2022] Open
Abstract
Resumo O objetivo deste artigo é caracterizar o processo de trabalho da equipe de saúde penitenciária no estado da Paraíba. Trata-se de uma pesquisa exploratória, com abordagem qualitativa, realizada com duas Equipes de Atenção Básica Prisional do estado da Paraíba. Foram feitas entrevistas individuais com os profissionais de saúde, a fim de elucidar o processo de trabalho desenvolvido. O corpus foi composto por dez textos, analisado com auxílio do software Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires (Iramuteq) e exposto por meio da Classificação Hierárquica Descendente (CHD) e da Análise de similitude. A análise do corpus demonstrou que houve 5.417 ocorrências de palavras, difundidas em 1.090 formas, com média de ocorrência de 5,97 palavras para cada forma. A CHD analisou 152 segmentos de texto, com retenção de 75% do corpus, que resultou na construção de quatro partições e seis classes, a saber: atenção às necessidades percebidas; atividade de aconselhamento; acolhimento da PPL e da família; dificuldades relacionadas ao sistema; dificuldades relacionadas aos recursos; e sugestão para formação profissional para EABP.
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Affiliation(s)
- Mayara Lima Barbosa
- Universidade Federal do Rio Grande do Norte, Brazil; Centro Universitário Unifacisa, Brasil
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Dasgupta S, Tie Y, Beer L, Weiser J. Unmet needs for ancillary care services are associated with HIV clinical outcomes among adults with diagnosed HIV. AIDS Care 2022; 34:606-614. [PMID: 34180733 PMCID: PMC8712612 DOI: 10.1080/09540121.2021.1946001] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 06/16/2021] [Indexed: 10/21/2022]
Abstract
Ancillary care services are essential for supporting care engagement and viral suppression among persons with HIV. Estimating unmet needs for ancillary care services may help address care barriers and improve clinical outcomes, but recent, nationally representative estimates are lacking. Using CDC Medical Monitoring Project data from 2015-2018, we report representative estimates of unmet needs for ancillary care services and associations with HIV clinical outcomes among U.S. adults with HIV. Data were collected through interview and medical record abstraction. We described weighted percentages for all characteristics and associations with HIV clinical outcomes using prevalence ratios with predicted marginal means, adjusting for potential confounding. Substantial unmet needs were reported; unmet needs were higher among persons with social determinants of poor health, persons who engaged in drug use or binge drinking, and those who experienced depression or anxiety. Having unmet needs for care was associated with adverseHIV clinical outcomes, with a dose response effect between number of unmet needs and outcomes. Expanding ancillary care access based on a comprehensive care model, strengthening partnerships between providers to connect patients to essential services, and tailoring services based on need may help reduce disparities in unmet needs and improve outcomes.
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Affiliation(s)
- Sharoda Dasgupta
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Yunfeng Tie
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Linda Beer
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - John Weiser
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Ostermann J, Yelverton V, Smith HJ, Nanyangwe M, Kashela L, Chisenga P, Mai V, Mwila C, Herce ME. Preferences for transitional HIV care among people living with HIV recently released from prison in Zambia: a discrete choice experiment. J Int AIDS Soc 2021; 24:e25805. [PMID: 34648690 PMCID: PMC8516367 DOI: 10.1002/jia2.25805] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Accepted: 07/30/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction No studies from sub‐Saharan Africa have attempted to assess HIV service delivery preferences among incarcerated people living with HIV as they transition from prisons to the community (“releasees”). We conducted a discrete choice experiment (DCE) to characterize releasee preferences for transitional HIV care services in Zambia to inform the development of a differentiated service delivery model to promote HIV care continuity for releasees. Methods Between January and October 2019, we enrolled a consecutive sample of 101 releasees from a larger cohort prospectively following 296 releasees from five prisons in Zambia. We administered a DCE eliciting preferences for 12 systematically designed choice scenarios, each presenting three hypothetical transitional care options. Options combined six attributes: (1) clinic type for post‐release HIV care; (2) client focus of healthcare workers; (3) transitional care model type; (4) characteristics of transitional care provider; (5) type of transitional care support; and (6) HIV status disclosure support. We analysed DCE choice data using a mixed logit model, with coefficients describing participants’ average (“mean”) preferences for each option compared to the standard of care and their distributions describing preference variation across participants. Results Most DCE participants were male (n = 84, 83.2%) and had completed primary school (n = 54, 53.5%), with 29 (28.7%) unemployed at follow‐up. Participants had spent an average of 8.2 months in the community prior to the DCE, with 18 (17.8%) reporting an intervening episode of re‐incarceration. While we observed significant preference variation across participants (p < 0.001 for most characteristics), releasees were generally averse to clinics run by community‐based organizations versus government antiretroviral therapy clinics providing post‐release HIV care (mean preference = –0.78, p < 0.001). On average, releasees most preferred livelihood support (mean preference = 1.19, p < 0.001) and HIV care support (mean preference = 1.00, p < 0.001) delivered by support groups involving people living with HIV (mean preference = 1.24, p < 0.001). Conclusions We identified preferred characteristics of transitional HIV care that can form the basis for differentiated service delivery models for prison releasees. Such models should offer client‐centred care in trusted clinics, provide individualized HIV care support delivered by support groups and/or peer navigators, and strengthen linkages to programs providing livelihood support.
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Affiliation(s)
- Jan Ostermann
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,South Carolina SmartState Center for Healthcare Quality, University of South Carolina, Columbia, South Carolina, USA.,Center for Health Policy & Inequalities Research, Duke Global Health Institute, Duke University, Durham, North Carolina, USA
| | - Valerie Yelverton
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Helene J Smith
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.,School of Public Health & Community Medicine, University of New South Wales, Sydney, New South Wales, Australia
| | - Mirriam Nanyangwe
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Lillian Kashela
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Peter Chisenga
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Vivien Mai
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Chilambwe Mwila
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Michael E Herce
- Implementation Science Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia.,Institute for Global Health & Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
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Buchbinder MH, Blue C, Brown ME, Bradley-Bull S, Rosen DL. Jail-Based Data-to-Care to Improve Continuity of HIV Care: Perspectives and Experiences from Previously Incarcerated Individuals. AIDS Res Hum Retroviruses 2021; 37:687-693. [PMID: 33764187 PMCID: PMC8501464 DOI: 10.1089/aid.2020.0296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Incarceration can disrupt retention in HIV care and viral suppression, yet it can also present an opportunity to reengage people living with HIV (PLWH) in care. Data-to-care (D2C) is a promising new public health strategy that uses HIV surveillance data to improve continuity of care for PLWH. The goal of this study was to examine perspectives on and experiences with D2C among PLWH who had recently been incarcerated in jail. Semistructured, qualitative interviews were conducted with 24 PLWH in community and prison settings about (1) knowledge of and experiences with D2C and (2) attitudes about implementing D2C in the jail setting. Participants who had been contacted for D2C described their interactions with state public health workers favorably, although almost half were not aware that the state performs HIV surveillance and D2C. While most participants indicated they would welcome assistance from the state for reengaging in care, they also framed retention in care as an individual responsibility. Most participants supported the idea of jail-based D2C. A vocal minority expressed adamant opposition, citing concerns about the violation of privacy and the threat of violence in the jail setting. Findings from this study suggest that D2C interventions in jails could be beneficial to reengaging PLWH in care, and acceptable to PLWH if done in a way that is sensitive to the needs and concerns of incarcerated individuals. If implemented, jail-based D2C programs must be designed with care to preserve privacy, confidentiality, and the autonomy of incarcerated individuals.
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Affiliation(s)
- Mara H. Buchbinder
- Department of Social Medicine, Center for Bioethics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Colleen Blue
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Mersedes E. Brown
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Steve Bradley-Bull
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David L. Rosen
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Erickson M, Shannon K, Ranville F, Pooyak S, Howard T, McBride B, Pick N, Martin RE, Krüsi A. "They look at you like you're contaminated": how HIV-related stigma shapes access to care for incarcerated women living with HIV in a Canadian setting. Canadian Journal of Public Health 2021; 113:282-292. [PMID: 34472049 DOI: 10.17269/s41997-021-00562-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/02/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Given the gender disparities in HIV outcomes for women living with HIV (WLWH) who experience incarceration, and the impact of HIV-related stigma on HIV care, this qualitative study investigated how HIV-related stigma within prison settings shapes HIV care for WLWH. METHODS Drawing from SHAWNA (Sexual Health and HIV/AIDS: Women's Longitudinal Needs Assessment), a community-based research project with cisgender and transgender WLWH in Metro Vancouver, peer and community interviewers conducted 19 qualitative interviews (May 2017-February 2018) with recently incarcerated WLWH focused on factors that shape incarceration trajectories. Drawing on socio-ecological frameworks and using participatory analysis, this analysis sought to characterize how HIV-related stigma shapes experiences and access to care for incarcerated WLWH. RESULTS Participants' responses focused predominately on experiences in provincial correctional facilities and the ways through which HIV-related stigma within correctional settings was linked to access to HIV care. Experiences of HIV-related stigma within prisons led to isolation and discrimination for WLWH which was reinforced through institutional processes, compromised privacy, and uncertainty about confidentiality. Experiences of HIV-related stigma informed decisions for some participants to withhold HIV status from healthcare staff, compromising access to HIV treatment during incarceration. CONCLUSION Amid ongoing efforts to improve healthcare delivery within Canadian correctional facilities, these findings have important implications for the provision of HIV care for incarcerated WLWH. Culturally safe, trauma-informed programming focused on reducing HIV-related stigma, improved communication regarding medical privacy, and interventions to change processes that compromise privacy is critical to improve healthcare access in correctional facilities.
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Affiliation(s)
- Margaret Erickson
- Centre for Gender and Sexual Health Equity, 1190 Hornby St, Vancouver, BC, V6Z 2K5, Canada
| | - Kate Shannon
- Centre for Gender and Sexual Health Equity, 1190 Hornby St, Vancouver, BC, V6Z 2K5, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Flo Ranville
- Centre for Gender and Sexual Health Equity, 1190 Hornby St, Vancouver, BC, V6Z 2K5, Canada
| | - Sherri Pooyak
- Canadian Aboriginal AIDS Network, SK, Fort Qu'Appelle, Canada
| | | | - Bronwyn McBride
- Centre for Gender and Sexual Health Equity, 1190 Hornby St, Vancouver, BC, V6Z 2K5, Canada
| | - Neora Pick
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,Oak Tree Clinic, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Ruth Elwood Martin
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Andrea Krüsi
- Centre for Gender and Sexual Health Equity, 1190 Hornby St, Vancouver, BC, V6Z 2K5, Canada. .,Department of Medicine, University of British Columbia, Vancouver, BC, Canada.
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12
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Chimoyi L, Hoffmann CJ, Hausler H, Ndini P, Rabothata I, Daniels-Felix D, Olivier AJ, Fielding K, Charalambous S, Chetty-Makkan CM. HIV-related stigma and uptake of antiretroviral treatment among incarcerated individuals living with HIV/AIDS in South African correctional settings: A mixed methods analysis. PLoS One 2021; 16:e0254975. [PMID: 34329311 PMCID: PMC8323907 DOI: 10.1371/journal.pone.0254975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 07/07/2021] [Indexed: 11/26/2022] Open
Abstract
Background Stigma affects engagement with HIV healthcare services. We investigated the prevalence and experience of stigma among incarcerated people living with HIV (PLHIV) in selected South African correctional settings during roll-out of universal test and treat. Methods A cross-sectional mixed-methods study design included 219 incarcerated PLHIV and 30 in-depth interviews were conducted with four different types of PLHIV. HIV-related stigma was assessed through survey self-reporting and during the interviews. A descriptive analysis of HIV-related stigma was presented, supplemented with a thematic analysis of the interview transcripts. Results ART uptake was high (n = 198, 90.4%) and most reported HIV-related stigma (n = 192, 87.7%). The intersectional stigma occurring due to individual and structural stigma around provision of healthcare in these settings mostly contributed to perceived stigma through involuntary disclosure of HIV status. Interpersonal and intrapersonal factors led to negative coping behaviours. However, positive self-coping strategies and relationships with staff encouraged sustained engagement in care. Conclusion We encourage continuous peer support to reduce stigmatization of those infected with HIV and whose status may be disclosed inadvertently in the universal test and treat era.
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Affiliation(s)
- Lucy Chimoyi
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- * E-mail:
| | - Christopher J. Hoffmann
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States of America
| | | | - Pretty Ndini
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | - Israel Rabothata
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
| | | | | | - Katherine Fielding
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Salome Charalambous
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Candice M. Chetty-Makkan
- Implementation Research Division, The Aurum Institute, Johannesburg, South Africa
- School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
- Health Economics and Epidemiology Research Office, Johannesburg, South Africa
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13
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Woznica DM, Ntombela N, Hoffmann CJ, Mabuto T, Kaufman MR, Murray SM, Owczarzak J. Intersectional Stigma Among People Transitioning From Incarceration to Community-Based HIV Care in Gauteng Province, South Africa. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2021; 33:202-215. [PMID: 34014112 PMCID: PMC8479561 DOI: 10.1521/aeap.2021.33.3.202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
People transitioning from incarceration to community-based HIV care experience HIV stigma, incarceration stigma, and the convergence of these stigmas with social inequities. The objective of this study is to understand intersectional stigma among people returning from incarceration with HIV in Gauteng Province, South Africa. Qualitative interviews were conducted with 42 study participants. We analyzed transcript segments and memos from these interviews. Our results showed that anticipated HIV stigma increased participants' difficulty with disclosure and treatment collection. Incarceration stigma, particularly the mark of a criminal record, decreased socioeconomic stability in ways that negatively affected medication adherence. These stigmas converged with stereotypes that individuals were inherently criminal "bandits." Male participants expressed concerns that disclosing their HIV status would lead others to assume they had engaged in sexual activity with men while incarcerated. AIDS education and prevention efforts will require multilevel stigma interventions to improve HIV care outcomes.
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Affiliation(s)
- Daniel M Woznica
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Christopher J Hoffmann
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
- Aurum Institute for Health Research, Johannesburg, South Africa
- Department of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Tonderai Mabuto
- Aurum Institute for Health Research, Johannesburg, South Africa
| | - Michelle R Kaufman
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sarah M Murray
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health
| | - Jill Owczarzak
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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14
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Pettus-Davis C, Kennedy SC, Veeh CA. Incarcerated individuals' experiences of COVID-19 in the United States. Int J Prison Health 2021; 17:335-350. [PMID: 33760428 DOI: 10.1108/ijph-11-2020-0094] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
PURPOSE This study aims to examine steps taken by correctional staff to prevent COVID-19 from spreading through correctional facilities and explores strategies used by incarcerated individuals to reduce their own risk of contracting COVID-19 during confinement. DESIGN/METHODOLOGY/APPROACH Data were drawn from interviews with 327 individuals incarcerated after March 16, 2020, in Midwest1, Midwest2 and Southeast state using a questionnaire developed for this purpose. All study participants were actively involved in a randomized controlled trial of a behavioral health reentry intervention and the human subjects board approved the supplement of this study on COVID-19; interviews were conducted from April 15 to November 19, 2020. FINDINGS Overall, 9.89% of participants contracted COVID-19. Most (68.50%) individuals learned about COVID-19 from television compared to official correctional facility announcements (32.42%). Participants wore face masks (85.02%), washed hands (84.40%) and practiced physical distancing when possible (66.36%). Participants reported that facilities suspended visitation (89.60%) and volunteers (82.57%), provided face masks (83.18%), sanitized (68.20%), conducted temperature checks (55.35%) and released individuals early (7.34%). SOCIAL IMPLICATIONS Longitudinal observational study on the implementation and effectiveness of public health guidelines in prisons and jails may identify best practices for containing the infectious disease. Maximizing transparent communications, as well as COVID-19 prevention and mitigation efforts, are critical to achieving universal best practices for virus containment and amplifying public health. ORIGINALITY/VALUE Data presented indicate the early adoption of many Centers for Disease Control guidelines by individuals and correctional facilities, although broad variation existed. Data support the identification of containment strategies for feasible implementation in a range of correctional spaces.
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Affiliation(s)
| | - Stephanie C Kennedy
- Institute for Justice Research and Development, Florida State University, Tallahassee, Florida, USA
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15
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Culbert GJ, Waluyo A, Earnshaw VA. Exploring the acceptability of HIV partner notification in prisons: Findings from a survey of incarcerated people living with HIV in Indonesia. PLoS One 2020; 15:e0234697. [PMID: 32603363 PMCID: PMC7326233 DOI: 10.1371/journal.pone.0234697] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 06/01/2020] [Indexed: 01/28/2023] Open
Abstract
Assisted HIV partner notification services provide a safe and effective way for people living with HIV (PLHIV) to inform their partners about the possibility of exposure and to offer them testing, treatment, and support. This study examined whether or not PLHIV in prison might be willing to participate in assisted HIV partner notification services and their reasons for and against disclosing their HIV-positive status to their partners. PLHIV (n = 150) recruited from Jakarta's two largest all-male prisons completed an interviewer-administered questionnaire collecting demographic and risk behavior data, and attitudes toward HIV disclosure and partner services. Among those who were sexually active and/or injecting drugs before incarceration, two-thirds (66.4%, 91/137) endorsed provider referral as an acceptable way to notify their sex partners, and nearly three quarters (72.4%, 89/123) endorsed provider referral to notify their drug-injecting partners. Only a quarter (25.1%) of participants reported that their main sex partner had ever received an HIV test. Participants with anticipated stigma were less likely to endorse provider referral for sex partners (adjusted odds ratio [aOR] = 0.58, 95% CI: 0.35, 0.96) and drug-injecting partners (aOR = 0.54, 95% CI: 0.29, 1.00). Relationship closeness was associated with higher odds of endorsing provider referral for drug-injecting partners (aOR = 2.08, 95% CI: 1.25, 3.45). Protecting partners from infection and a moral duty to inform were main reasons to disclose, while stigma and privacy concerns were main reasons not to disclose. Most incarcerated PLHIV have at-risk partners in the community who they would be willing to notify if provided with assistance. Assisted partner notification for prison populations offers a promising public health approach to accelerate diagnosis, treatment, and prevention of HIV infection in the community, particularly among women.
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Affiliation(s)
- Gabriel J. Culbert
- Department of Health Systems Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States of America
- Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
- * E-mail:
| | - Agung Waluyo
- Center for HIV/AIDS Nursing Research, Faculty of Nursing, Universitas Indonesia, Depok, Indonesia
| | - Valerie A. Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, DE, United States of America
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16
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Takada S, Ettner SL, Harawa NT, Garland WH, Shoptaw SJ, Cunningham WE. Life Chaos is Associated with Reduced HIV Testing, Engagement in Care, and ART Adherence Among Cisgender Men and Transgender Women upon Entry into Jail. AIDS Behav 2020; 24:491-505. [PMID: 31396766 PMCID: PMC6994355 DOI: 10.1007/s10461-019-02570-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Life chaos, the perceived inability to plan for and anticipate the future, may be a barrier to the HIV care continuum for people living with HIV who experience incarceration. Between December 2012 and June 2015, we interviewed 356 adult cisgender men and transgender women living with HIV in Los Angeles County Jail. We assessed life chaos using the Confusion, Hubbub, and Order Scale (CHAOS) and conducted regression analyses to estimate the association between life chaos and care continuum. Forty-eight percent were diagnosed with HIV while incarcerated, 14% were engaged in care 12 months prior to incarceration, mean antiretroviral adherence was 65%, and 68% were virologically suppressed. Adjusting for sociodemographics, HIV-related stigma, and social support, higher life chaos was associated with greater likelihood of diagnosis while incarcerated, lower likelihood of engagement in care, and lower adherence. There was no statistically significant association between life chaos and virologic suppression. Identifying life chaos in criminal-justice involved populations and intervening on it may improve continuum outcomes.
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Affiliation(s)
- Sae Takada
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA.
- Veterans Affairs Health Services Research and Development Service, Center for the Study of Healthcare Innovation, Implementation, and Policy, Los Angeles, CA, USA.
| | - Susan L Ettner
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
| | - Nina T Harawa
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- College of Medicine, Charles R. Drew University, Los Angeles, CA, USA
| | - Wendy H Garland
- Los Angeles County Department of Public Health, Division of HIV and STD Programs, Los Angeles, CA, USA
| | - Steve J Shoptaw
- Department of Family Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - William E Cunningham
- Division of General Internal Medicine and Health Services Research, Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
- Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, USA
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17
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Yanes-Lane M, Dussault C, Linthwaite B, Cox J, Klein MB, Sebastiani G, Lebouché B, Kronfli N. Using the barriers and facilitators to linkage to HIV care to inform hepatitis C virus (HCV) linkage to care strategies for people released from prison: Findings from a systematic review. J Viral Hepat 2020; 27:205-220. [PMID: 31638294 DOI: 10.1111/jvh.13220] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 09/09/2019] [Accepted: 10/06/2019] [Indexed: 01/05/2023]
Abstract
Elimination of hepatitis C virus (HCV) among short-term sentenced prison populations will require improved access to HCV care and specific strategies dedicated to linkage upon release. Prison-based HCV care has lagged behind HIV care, but much can be learned from HIV studies. We performed a systematic review to identify individual-, provider- and system-level barriers and facilitators to linkage to HCV and HIV care among released inmates. We searched MEDLINE, Scopus, the Cochrane Central Register of Controlled Trials and Embase, and performed a grey literature search for English articles published up to November 2018. Two searches were conducted, one each for HCV and HIV; 323 and 684 unique articles were identified of which two and 27 studies were included, respectively. Facilitators to linkage to HCV care included social support, having an existing primary care provider, and receipt of methadone, whereas barriers included a perceived lack of healthcare information and a lack of specialized linkage to care programs. The principal facilitators to linkage to HIV care included social support, treatment for substance use and mental illness, the provision of education, case management, discharge planning and transportation assistance. Important barriers were unstable housing, age <30 years, HIV-related stigma, poor providers' attitudes and the lack of post-release reintegration assistance. While HCV care-specific studies are needed, much can be learned from linkage to HIV care studies. Ultimately, a multi-pronged approach, addressing several individual-level social determinants of health, and key provider- and system-level barriers may be an appropriate starting point for the development of HCV linkage to care strategies.
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Affiliation(s)
- Mercedes Yanes-Lane
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Camille Dussault
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Blake Linthwaite
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Joseph Cox
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Marina B Klein
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,CIHR Canadian HIV trials Network, Vancouver, British Columbia, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Giada Sebastiani
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
| | - Bertrand Lebouché
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada.,Department of Family Medicine, McGill University, Montreal, Quebec, Canada
| | - Nadine Kronfli
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada.,Department of Medicine, Division of Infectious Diseases and Chronic Viral Illness Service, McGill University, Montreal, Quebec, Canada
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18
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Brewer R, Issema R, Moore M, Chrestman S, Mukherjee S, Odlum M, Schneider JA. Correlates of Durable Viral Suppression (DVS) Among Criminal Justice-involved (CJI) Black Men Living with HIV in Louisiana. AIDS Behav 2019; 23:2980-2991. [PMID: 31250229 DOI: 10.1007/s10461-019-02578-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Durable viral suppression (DVS) is needed to reduce HIV transmission risk and prevent new HIV infections. We examined changes in viral suppression and correlates of DVS among 97 criminal justice-involved (CJI) Black men living with HIV in Louisiana enrolled in a linkage, re-engagement, and retention in care intervention. Most participants (75%) were Black men who have sex with men. Forty-four percent (44%) were virally suppressed at baseline and only 20% had achieved DVS over a 12-month period. Multinomial logistic regression analyses showed that compared with DVS participants, those with no viral suppression (NVS) and some viral suppression (SVS) were more likely to have lived with HIV for a longer period of time and were less likely to be adherent at baseline. Medication adherence was critical for DVS among this sample of CJI Black men living with HIV who represent a high priority population for HIV care and treatment interventions.
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Affiliation(s)
- Russell Brewer
- Department of Medicine, University of Chicago, Chicago, IL, USA.
- Chicago Center for HIV Elimination, Chicago, IL, USA.
| | - Rodal Issema
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
| | - Mary Moore
- Dillard University, New Orleans, LA, USA
| | | | - Snigdha Mukherjee
- Educational Commission for Foreign Graduates (ECFG), Philadelphia, PA, USA
| | | | - John A Schneider
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Chicago Center for HIV Elimination, Chicago, IL, USA
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19
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Kouyoumdjian FG, Lamarche L, McCormack D, Rowe J, Kiefer L, Kroch A, Antoniou T. 90-90-90 for everyone?: Access to HIV care and treatment for people with HIV who experience imprisonment in Ontario, Canada. AIDS Care 2019; 32:1168-1176. [PMID: 31615271 DOI: 10.1080/09540121.2019.1679710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We examined HIV care and treatment in prison and after release for people with HIV in Ontario, Canada, and compared HIV care and treatment with the general population. We used administrative data to identify people with HIV released from provincial prison in 2010 and in the general population. We calculated the proportion of people with HIV who accessed HIV care in prison. We compared HIV care use between people with HIV on prison release and in the general population. We estimated the proportion of people with HIV on antiretroviral therapy in prison as the ratio of the average numbers of people prescribed antiretroviral therapy in prison in 2009/2010 and people with HIV in prison in January 2010. We compared the proportion of people with HIV on public drug benefits that filled an antiretroviral therapy prescription within 6 months for people postrelease and in the general population. Of 344 people with HIV on prison admission, 34.0% received HIV care in prison. Over 1 year, 63.6% of 330 people with HIV on prison release and 67.7% of 15,819 people with HIV in the general population accessed HIV care (p = 0.118), and 43.3% of people with HIV on prison release and 55.2% of people with HIV in the general population had 2 or more HIV care visits (p < 0.001). In prison, 52.4% of people with HIV (39.5/75.4) were on antiretroviral therapy. Of those accessing drug benefits, 60.1% of 226 people with HIV on prison release and 79.6% of 7458 people with HIV in the general population claimed an antiretroviral therapy prescription within 6 months (p < 0.001). Access to HIV care and treatment were suboptimal in prison, and sustained HIV care and treatment were worse for people post-release compared to the general population. Interventions are needed to support HIV care for this population.
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Affiliation(s)
- Fiona G Kouyoumdjian
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada.,ICES, Toronto, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Larkin Lamarche
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | | | - Lori Kiefer
- Ministry of Community Safety and Correctional Services, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | | | - Tony Antoniou
- ICES, Toronto, ON, Canada.,Department of Family and Community Medicine, St. Michael's Hospital and University of Toronto, Toronto, ON, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
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20
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Westergaard RP, Hochstatter KR, Andrews PN, Kahn D, Schumann CL, Winzenried AE, Sethi AK, Gangnon RE, Sosman JM. Effect of Patient Navigation on Transitions of HIV Care After Release from Prison: A Retrospective Cohort Study. AIDS Behav 2019; 23:2549-2557. [PMID: 30790170 DOI: 10.1007/s10461-019-02437-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Antiretroviral therapy is successfully administered to people living with HIV while they are incarcerated in most US prison systems, but interruptions in treatment are common after people are released. We undertook an observational cohort study designed to examine the clinical and psychosocial factors that influence linkage to HIV care and viral suppression after release from a single state prison system. In this report we describe baseline characteristics and 6-month post-incarceration HIV care outcomes for 170 individuals in Wisconsin. Overall, 114 (67%) individuals were linked to outpatient HIV care within 180 days of release from prison, and of these, 90 (79%) were observed to have HIV viral suppression when evaluated in the community. The strongest predictor of linkage to care in this study was participation in a patient navigation program: Those who received patient navigation were linked to care 84% of the time, compared to 60% of the individuals who received only standard release planning (adjusted OR 3.69, 95% CI 1.24, 10.96; P < 0.01). Findings from this study demonstrate that building and maintaining intensive patient navigation programs that support individuals releasing from prison is beneficial for improving transitions in HIV care.
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21
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Making the Connection: Using Videoconferencing to Increase Linkage to Care for Incarcerated Persons Living with HIV Post-release. AIDS Behav 2019; 23:32-40. [PMID: 29680934 DOI: 10.1007/s10461-018-2115-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Incarcerated persons living with HIV (PLWH) have relatively high levels of HIV care engagement and antiretroviral therapy adherence during incarceration, but few are able to maintain these levels upon reentry into the community. In Louisiana, PLWH nearing release from prisons were offered video conferences with case managers housed in community based organizations aimed at facilitating linkage to care in the community. Of the 144 persons who received a video conference during the study period, 74.3% had linked to HIV care in the community within 90 days after release. Compared to the comparison group (n = 94), no statistically significant difference in linkage rate was detected (p > 0.05). Nonetheless, the video conference supplement was positively received by clients and case management agencies in the community and the lack of a detectable impact may be due to early difficulties in intervention delivery and study design limitations. Further study is needed to determine the value of the video conferencing supplement in other settings.
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22
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Saka B, Tchounga B, Ekouevi DK, Sehonou C, Sewu E, Dokla A, Maboudou A, Kassankogno Y, Palokinam Pitche V. [Stigma and discrimination experienced by people living with HIV in Togo, in 2013]. SANTE PUBLIQUE 2018; 29:897-907. [PMID: 29473404 DOI: 10.3917/spub.176.0897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Stigma and discrimination experienced by people living with HIV (PLWHA) prevent and delay access to prevention and treatment services. The aim of this study was to describe the patterns of stigma and discrimination experienced by PLWHA in Togo and to identify the associated factors. METHODS A cross-sectional study was conducted in 2013 among PLWHA in Togo in order to collect data on stigma or discrimination experiences. Univariate and multivariate analyses were performed to identify associated factors. RESULTS A total of 891 PLWHA were interviewed, including 848 (95.2%) receiving antiretroviral therapy. External stigma (37.9%) was the major form of stigmatization followed by internalized stigma (35.4%). The main features of external stigma were gossip (36.5%) and issues to access education (36.0%). Internalized stigma mainly consisted of a feeling of guilt (37.6%) and self-devaluation (36.0%). In univariate and multivariate analysis, female gender was significantly associated with stigma (aOR = 1.73, 95% CI [1.08-2.77]). Of the 891 PLWHA, 75 (8.4%) reported a violation of their rights. Finally 27 (4.1%) were discouraged from having children by a health professional because of their HIV status. CONCLUSION Stigma affects more than one-third of PLWHA in Togo, more particularly females. It appears necessary to design new interventions and integrate psychosocial care in the management of PLWHA, in addition to antiretroviral therapy.
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