HIV among persons incarcerated in the USA: a review of evolving concepts in testing, treatment, and linkage to community care

• Type of Material: Article
• Authors: Ryan P. Westergaard, University of Wisconsin; Anne Spaulding, Emory University; Timothy P. Flanigan, Brown University
• Language: English
• Date: 2013-02-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: Lippincott Williams & Wilkins.; © 2013 Wolters Kluwer Health
• Final Published Version (URL): http://dx.doi.org/10.1097/QCO.0b013e32835c1dd0
• Title of Journal or Parent Work: Current Opinion in Infectious Diseases
• Volume: 26
• Issue: 1
• Start Page: 10
• End Page: 16
• Grant/Funding Information: This manuscript was supported by NIH grant K23DA032306 to RPW.
• Keywords: IMMUNODEFICIENCY-VIRUS HIV; Infectious Diseases; CORRECTIONAL FACILITIES; TREATMENT OUTCOMES; INJECTION-DRUG USERS; Life Sciences & Biomedicine; transitional case management; criminal justice system; ACTIVE ANTIRETROVIRAL THERAPY; substance abuse; PUBLIC-HEALTH; FORMER INMATES; INFECTED PRISONERS; UNITED-STATES; Science & Technology; HIV testing; HIV/AIDS; PROSPECTIVE CONTROLLED-TRIAL
• Research Categories: Health Sciences, Public Health; Sociology, Criminology and Penology; Health Sciences, Medicine and Surgery

Abstract

Purpose of Review: People who are incarcerated have a disproportionately high risk of HIV infection. They also tend to have risk factors associated with underutilization of antiretroviral therapy (ART) such as substance abuse, mental illness, and poor access to care. In this review, we describe how incarceration is a marker of vulnerability for suboptimal HIV care, and also how criminal justice settings may be leveraged as a platform for promoting testing, linkage, and retention in HIV care for a high-risk, marginalized population. Recent Findings: In both prisons and jails, routine, opt-out HIV testing strategies are more appropriate for screening correctional populations than traditional, risk-based strategies. Rapid HIV testing is feasible and acceptable in busy, urban jail settings. Although ART is successfully administered in many prison settings, release to the community is strongly associated with inconsistent access to medications and other structural factors leading to loss of viral suppression. Summary: Collaborations among HIV clinicians, criminal justice personnel, and public health practitioners represent an important strategy for turning the tide on the HIV epidemic. Success will depend upon scaled-up efforts to seek individuals with undiagnosed infection and bring those who are out-of-care into long-term treatment.