The prevalence of infectious diseases, drug use and abuse, and mental illness, as well as the co- occurrence of these among incarcerated populations has led practitioners and researchers to view correctional institutions as necessary places to intervene with public health efforts. The period of reentry to the community from secure custody is of particular importance for disease prevention and substance abuse treatment efforts as offenders often return to previous patterns of high-risk behavior (e.g., intravenous drug use, unprotected sex with multiple partners, trading sex for drugs or money) in an attempt to make up for lost time. However, numerous barriers exist for linking offenders to appropriate treatment as part of the reentry process, such as the triple stigma of being a former offender living with HIV who has a history of substance abuse. It is known that disruption in linkage and adherence to HIV treatment once individuals living with HIV are released from custody (a primary reason for this being addiction relapse) is a challenge for public health practitioners. Such barriers to linkage-to-care during reentry are currently being explored under a NIDA funded project, the Criminal Justice Drug Abuse Treatment Studies 2 (CJDATS2). Because CJDATS2 is an implementation science project, it is necessarily focused exclusively on institutional and staff barriers and is not focusing on individual level client experiences/data. For this reason, and using CJDATS2 as a platform, the proposed project aims to explore the challenges and facilitators that HIV+ individuals experience during reentry related to linkage to treatment, and to identify barriers and drivers for treatment adherence once HIV+ individuals are linked to treatment care in the community. Because this population requires services related to a number of interrelated issues (i.e., health care, substance abuse treatment), and are thus at risk for multiple sites of stigmatizing attitudes and discrimination, the investigator is also interested in whether and how these individuals experience and cope with stigma. The study proposed here will utilize qualitative methodologies to begin to explore these issues. Participants in the study will be recruited from community HIV and substance use treatment agencies to which offenders are linked upon reentering to the community, as well as from the correctional agencies from which they are being referred. Data will be collected through interviews that address the stigma, stresses, difficulties, and concerns that former offenders living with HIV experience as barriers to care. This project will be used as a doctoral dissertation by a PhD candidate in sociology at the University of Delaware who intends to use the fellowship as a means for obtaining training and skills related to her research interests in order to pursue a career in behavioral science research in the area of public health.
The findings from this project will help scientists and practitioners understand the challenges facing former offenders with multiple needs, primarily related to health and substance use, as they return to their communities from custodial care. This project will also provide suggestions for how to improve this process from the perspective of the individuals themselves. Further, this project will help guide future projects that seek to develop interventions for reducing the spread of HIV and other infectious diseases, improving the public health impact of reentering offenders with HIV and substance abuse problems, improving the lives of HIV+ individuals and those around them once they are released into the community, reducing recidivism rates, and reducing the amount of stigma aimed toward reentering offenders with multiple disadvantages.