Research paper
Understanding interactions of formerly incarcerated HIV-positive men and transgender women with substance use treatment, medical, and criminal justice systems

https://doi.org/10.1016/j.drugpo.2017.05.013Get rights and content

Abstract

Background

Low levels of medical care engagement have been noted for HIV-positive people leaving systems of incarceration in the United States. Substance misuse frequently co-occurs with criminal justice involvement in individuals who are living with HIV.

Methods

We analyzed data from in-depth interviews with 19 HIV-positive individuals who were currently or formerly incarcerated in order to elucidate challenges faced in accessing care and maintaining HIV treatment regimens when cycling out of (and often back into) custody. Our thematic analysis used an ecosocial framework to describe participants’ shifts between substance use treatment, medical care, and criminal justice systems.

Results

Dominant themes included the dramatic increase in HIV-treatment-related autonomy required following release from jail because of differences in care delivery between custody-based and community-based care systems; the important, but temporary stabilization provided by residential substance use treatment programmes; and the inconsistency of substance use treatment approaches with chronic care models of disease management.

Conclusion

Enhanced integration of criminal justice, medical care, and substance use treatment institutions in planning for reentry of HIV populations may ease the impact of the dramatic shifts in context that often dissuade linkage and retention. This integration should include coordination with custody release processes, periodic assessments for active substance misuse in HIV treatment settings, support for (re)establishing health-promoting social networks, and options for long-term, residential substance use treatment programmes.

Section snippets

Setting

The study was carried out in Los Angeles County and involved a direct collaboration between the Division of General Internal Medicine and Health Services Research in the Department of Medicine, UCLA; the Los Angeles County Department of Public Health, Division of HIV and STD Programs (DHSP); and the Los Angeles County Sheriff’s Department (LASD). The latter oversees the LA County Jail (LACJ) system, including its medical services. Generally, jails are short-term facilities housing individuals

Results

The shifting contexts within which individuals found themselves when moving between custody and community settings featured prominently in the interviews. The themes generated describe how systems of substance use treatment, HIV medical care, and criminal justice interact to impact CJI-involved patients’ HIV care and substance use.

Discussion

The marginalized and challenging post-release experiences of CJI HIV-positive people with substance dependence reveal significant institutional deficits. Study participants’ frequent histories of both recurrent incarceration and substance misuse, despite participation in recovery programmes, highlight potentially insufficient treatment modalities and problematic criminal justice policies. Furthermore, the criminal justice system may lessen the effectiveness of substance use treatment received

Author agreement/declaration of submission

This manuscript has not been published previously, and it is not under consideration for publication elsewhere. Its publication is approved by all authors and tacitly or explicitly by the responsible authorities where the work was carried out. If accepted, it will not be published elsewhere in the same form, in English or in any other language, including electronically without the written consent of the copyright-holder. All authors warrant that the manuscript is their original work; and that

Funding source declaration

This work was supported by the National Institutes of Health (NIH)/National Institutes on Drug Abuse (NIDA) [1R01DA030781]; Drs. Amani, Harawa and Cunningham received additional support for this work through NIH/NIMHD [P20 MD000182; U54 MD007598]; NIH/NIMH [P30 MH058107]; NIH/NCRR/NCATS [UL1 TR000124]; NIH/NIDA [R01DA039934]; and the California HIV/AIDS Research Program [RP11-LA-020]. The sponsors did not have any role in the collection, analysis, data interpretation, manuscript writing, or

Acknowledgements

Special thanks to the leadership and staff of the Los Angeles Sheriff’s Department and Department of HIV and STD Programs who helped make this study possible and to those who directly served on the study team: Trista Bingham, Alexis Huynh, Saloniki James, Garrett Cox, Mark Malek, Armidia Miranda, and Nickolay Teophiluv. Additional thanks to Gerald Asare-Bempong and Hope Watkins for manuscript support. The authors accept responsibility for the contents of this manuscript.
Conflict of interest
No

References (47)

  • Centers for Disease Control and Prevention (CDC)

    National Center for HIV/AIDS, Viral Hepatitis, STD, and TB prevention

    (2017)
  • R.K. Chandler et al.

    Treating drug abuse and addiction in the criminal justice system: Improving public health and safety

    JAMA

    (2009)
  • K. Clements-Nolle et al.

    Highly active antiretroviral therapy use and HIV transmission risk behaviors among individuals who are HIV infected and were recently released from jail

    American Journal of Public Health

    (2008)
  • M.S. Cohen et al.

    Prevention of HIV-1 infection with early antiretroviral therapy

    New England Journal of Medicine

    (2011)
  • W.E. Cunningham et al.

    The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States

    Medical Care

    (1999)
  • L.G. Duncan et al.

    Buprenorphine maintenance for opioid dependence in public sector healthcare: Benefits and barriers

    Journal of Addiction Medicine and Therapeutic Science

    (2015)
  • P.D. Friedmann et al.

    Medication-assisted treatment in criminal justice agencies affiliated with the criminal justice-drug abuse treatment studies (CJ-DATS): Availability, barriers, and intentions

    Substance Abuse

    (2012)
  • A. Gonzalez et al.

    Substance use: Impact on adherence and HIV medical treatment

    Current HIV/AIDS Reports

    (2011)
  • H.B. Hansen et al.

    Variation in use of buprenorphine and methadone treatment by racial, ethnic, and income characteristics of residential social areas in New York City

    The Journal of Behavioral Health Services & Research

    (2013)
  • N.T. Harawa et al.

    Using arrest charge to screen for undiagnosed HIV infection among new arrestees: A study in Los Angeles County

    Journal of Correctional Health Care

    (2009)
  • M. Hewson

    Encyclopedia of case study research

    (2010)
  • P.A. Iroh et al.

    The hiv care cascade before, during, and after incarceration: a systematic review and data synthesis

    American Journal of Public Health

    (2015)
  • R. Jurgens et al.

    HIV and incarceration: Prisons and detention

    Journal of the International AIDS Society

    (2011)
  • Cited by (0)

    View full text