The Impact of Incarceration Upon Adherence to HIV Treatment Among HIV-Positive Injection Drug Users: A Qualitative Study

"HIV-positive injection drug users (IDU) often do not derive the full benefits of highly active antiretroviral therapy (HAART). Among IDU, recent incarceration has been associated with discontinuation of HAART for non-clinical reasons," explained the study authors. In order to identify factors influencing treatment adherence, they sought to qualitatively evaluate experiences with HAART among recently incarcerated HIV-positive IDU in British Columbia.

Twelve in-depth qualitative interviews were performed with males recruited from a cohort study involving more than 450 HIV-positive IDU. All participants had initiated HAART prior to incarceration. Audio-recorded interviews were conducted on participants' experiences taking HAART in prison, with particular focus on adherence and experiences of treatment discontinuation.

The men's accounts described situations where HAART adherence was compromised in custody. A small number of participants reported treatment interruptions in which they were unable to obtain HIV medications through institutional health care for more than one week. Short-term treatment interruptions were said to be common during intake into prison and at the point of release from custody. High levels of HIV discrimination motivate prisoners to hide their serostatus by making efforts to take medications discreetly, possibly resulting in missed doses.

"The current study identified contextual factors within correctional environments that hinder individuals' ability to adhere to HAART," the researchers concluded. "These findings also indicated that improved health services and coordination with community care providers are needed to enhance the quality of HIV treatment within correctional environments."