HIV risk after release from prison: a qualitative study of former inmates

Abstract

Background: Former prison inmates are at risk for HIV and hepatitis C (HCV) infection. This study was designed to understand how former inmates perceived their risk for HIV and HCV infection after release from prison, the behaviors and environmental factors that put patients at risk for new infection, and the barriers to accessing health care.

Methods: This was a qualitative study using individual, face-to-face, semistructured interviews exploring participants' perceptions and behaviors putting them at risk for HIV and HCV infection and barriers to engaging in regular medical care after release. Interview transcripts were coded and analyzed using a team-based general inductive approach.

Results: Participants were racially and ethnically diverse and consisted of 20 men and 9 women with an age range of 22-57 years who were interviewed within the first 2 months after their release from prison to the Denver, Colorado community. Four major themes emerged: (1) risk factors including unprotected sex, transactional sex, and drug use were prevalent in the postrelease period; (2) engagement in risky behavior occurred disproportionately in the first few days after release; (3) former inmates had educational needs about HIV and HCV infection; and (4) former inmates faced major challenges in accessing health care and medications.

Conclusions: Risk factors for HIV and HCV infection were prevalent among former inmates immediately after release. Prevention efforts should focus on education, promotion of safe sex and needle practices, substance abuse treatment, and drug-free transitional housing. Improved coordination between correctional staff, parole officers, and community health care providers may improve continuity of care.

Figure 1

Conceptual Model of Factors Impacting HIV-related Health Outcomes