Understanding the Health-related Challenges Experienced by Former State Prisoners Living with HIV: A Qualitative Study

Background: Human Immunodeficiency Virus (HIV) disproportionately affects certain populations, specifically those passing through correctional facilities. It is estimated that about 1.4% of the approximately two million people residing in correctional facilities are living with HIV. Although the health services offered in correctional facilities are limited, health status may improve substantially for individuals during their placement. Often this progress is lost once a person is released back into the community. Lack of access to care and/or financial assistance inhibits the ability to make health a priority, especially when individuals are faced with the struggle to obtain basic needs such as food, shelter, housing, and employment. This population also bears an unequal burden of non-HIV health conditions. Of those individuals currently incarcerated in the state of Georgia, 1.6% are HIV positive, 26% suffer from chronic illness, 52% have mental health issues, and 25% have reported using drugs or alcohol. In an effort to provide support for this population, Georgia State University partnered with Georgia Department of Corrections Pre-Release Planning Program (PRPP) to establish the Community Connections (CC) Program in 2009. CC program was designed to connect participants with resources that assist with successful reintegration into the community. Exit interviews were conducted with individuals after their participation, and were used to gather information about postrelease challenges and outcomes associated with the CC Program. This qualitative study used these interviews to analyze the specific health-related challenges experienced by CC participants. The results from this analysis were used to provide recommendations for further improvements that address the needs of former inmates living with HIV at the policy level. Methods: This study analyzed a set of 16 in-depth, semi-structured interviews with individuals that participated in the post-release CC program during 2010 to 2012. These participants were recruited via convenience sampling, and informed consent was obtained prior to each interview. Interview questions were focused around topics pertaining to housing, employment, risk behaviors, sexual activity, social interactions, HIV care, mental health, substance abuse, and access to medication or treatment. A modified grounded theory approach was used in the analysis. Interviews were openly coded for words and phrases that pertained to health status. The results were used to determine the most pressing health-related challenges associated with this population, and to provide recommendations at the policy level for addressing such issues. Results: Commonly reported co-occurring conditions from this study were as follows: high blood pressure, epilepsy, high cholesterol, anemia, insomnia, arrhythmia, migraines, kidney disease, neuropathy, blood clots, and diabetes. Depression was the most frequently reported mental illness, followed by bipolar disorder and schizophrenia. Over half of participants reported using drugs or alcohol before, during, or following incarceration. Additional barriers to maintaining positive health outcomes included lack of medical insurance or financial assistance, the need for oral health care, and frequent hospitalization. Conclusions: Findings illustrate the need for policy-level changes that specifically address postrelease challenges for former inmates, and aim to improve health-related outcomes for this population. Linking this population to services that provide basic needs such as housing and employment would enable them to focus on maintaining their health status. Further, linking this population to insurance or other forms of financial assistance immediately following release is crucial to avoiding gaps in healthcare and treatment relapse. In the state of Georgia, expanding Medicaid to make former inmates eligible would provide a major source of relief for some of these issues. Policylevel changes will not only benefit the individual, but the community as a whole by improving overall health outcomes, reducing the spread of diseases, preventing the occurrence of relapse, and reducing the likelihood of recidivism attributable to illness.