HIV Care After Incarceration

After HIV-positive prisoners have done their time and reentered society, their new lives often don’t include HIV care, according to a new study. And this alarming trend may be more pronounced among women.

Researchers at Yale University tracked the post-prison HIV care of nearly 900 former inmates in 10 different U.S. cities, defining “maintaining care” as keeping one medical appointment every three months in which viral load or CD4 count was measured. They found that 34% of former inmates had no HIV care in the six months after release from prison. Only 38% kept two regularly scheduled appointments, while 19% made it to their first visit but missed their second, and 8% attended their second after missing their first.

Those skipping appointments could be risking their health by allowing their regimens to lapse, and those not adhering to their meds are also putting their sex partners at risk, since regularly taking antiretrovirals drastically cuts one’s chance of infecting others.
Rather surprisingly, heroin users were nearly 50% more likely to stay in care than other former prisoners. But perhaps the most interesting finding to emerge was that men were twice as likely as women to retain care.

“There are data to support that women fare less well than men, including from a study that we are about to publish,” says lead researcher Frederick Altice. “One reason is that HIV-positive women, compared to HIV-positive men, often have more competing medical and social comorbidities—higher rates of mental illness, substance use disorders, and other medical conditions, not to mention [they] return to less stable circumstances, such as abusive relationships, are caring for children, and [are often] breadwinners for the family.”

Altice’s research shows that prisoners who kept up with their care before they went to prison were 67% more likely to retain care after their release. Apparently, even good habits die hard.