To better understand the factors that influence under-utilization of correctional HIV treatment services, we propose to conduct a 3-year qualitative study of HIV-positive people's decisions about whether to disclose their HIV status to medical providers in prison. An estimated 17% of all HIV-positive individuals in the United States are held in a correctional facility at some point each year. Incarceration can be a "public health opportunity" to provide HIV treatment to vulnerable populations, particularly substance users and people of color. Connecting to correctional HIV services is critical to avoid treatment interruptions for people who began ART prior to incarceration, and prison settings offer opportunities to initiate ART with people who are not receiving ART. In order to receive HIV treatment in prison, individuals who know they are HIV-positive must disclose their status either by consenting to HIV testing or by identifying themselves to correctional medical providers. Seroprevalence data suggest that a potentially large proportion of HIV-positive prisoners decide to not disclose their status and thus receive no HIV care while incarcerated. As of April 2012, it is estimated that 52%-71% of HIV-positive California prisoners either did not know their status or decided not to disclose. Very little is known about factors affecting HIV-positive people's decisions about whether to disclose their status while in prison. Guided by the Behavioral Model for Vulnerable Populations, we propose to investigate the predisposing, enabling, impeding, and need factors affecting these decisions.
Specific Aims are Aim 1: To identify and explore the predisposing, enabling, impeding, and need factors that affect HIV-positive people's decisions to not disclose their HIV status to medical providers in prison;
Aim 2 : To identify and explore the predisposing, enabling, impeding, and need factors that affect HIV-positive people's decisions to disclose their HIV status to medical providers in prison;
Aim 3 : To generate programmatic and policy recommendations to facilitate HIV-positive people's disclosure of their status to medical providers in prison, including the decision not to opt out of HIV testing. To achieve these aims, we will recruit 100 HIV- positive people who have been released from state prison in the past 6 months. Community-based organizations in Oakland, CA, will recruit study subjects to participate in an in-depth qualitative interview. Data will be collected using an iterative sequencing approach and analyzed using analytic induction methods. Findings will provide critical knowledge to inform recommendations for facilitating HIV-positive people's disclosure of their status in prison, potentially increasing the numbers of individuals linked to in- prison HIV treatment. Improving access to HIV treatment in prison will have an impact on a population largely comprised of minority ethnic groups. The proposed study aims align closely with the National AIDS Strategy goals of improving access to care for people living with HIV and reducing health disparities.
We propose to conduct a 3-year qualitative study of HIV-positive people's decisions about whether to disclose their HIV status to medical providers in prison, including decisions about opting out of correctional HIV testing. Findings from the proposed study will provide critical knowledge to inform program and policy recommendations for facilitating HIV-positive people's disclosure of their status in prison, which could increase te numbers of individuals linked to in-prison HIV treatment. This could decrease instances of treatment interruption and increase opportunities to initiate ART with people living with HIV.
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