Small Will, Wood Evan, Betteridge Glenn, Montaner Julio, Kerr Thomas
British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
AIDS Care. 2009 Jun;21(6):708-14. doi: 10.1080/09540120802511869.
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. We sought to qualitatively evaluate experiences with HAART among HIV-positive IDU who had been recently incarcerated within provincial prisons in British Columbia in order to identify factors influencing adherence to treatment.
Twelve in-depth qualitative interviews were conducted with males recruited from a cohort study (ACCESS) involving over 450 HIV-positive IDU. All participants had been incarcerated after initiating HAART. Audio-recorded interviews were conducted to examine experiences of taking HAART in prison, with particular attention to adherence and experiences of treatment discontinuation.
Participant accounts described situations where adherence to HIV treatment was compromised in custody. A small number of participants reported treatment interruptions that lasted over a week when they were unable to obtain HIV medications through institutional healthcare. Short-term interruptions in treatment were said to be common during intake into the correctional system and at the point of release from custody. High levels of HIV discrimination motivate prisoners to hide the fact that they are HIV-positive by making efforts to take medications discreetly, which may result in missed doses.
The current study identified contextual factors within correctional environments that hinder individuals' ability to adhere to HAART. These findings also indicate that improved health services and coordination with community care providers are needed to enhance the quality of HIV treatment within correctional environments.
感染艾滋病毒的注射吸毒者（IDU）往往无法充分受益于高效抗逆转录病毒疗法（HAART）。在注射吸毒者中，近期入狱与因非临床原因停用HAART有关。我们试图对不列颠哥伦比亚省省级监狱中近期入狱的艾滋病毒阳性注射吸毒者使用HAART的经历进行定性评估，以确定影响治疗依从性的因素。
对从一项涉及450多名艾滋病毒阳性注射吸毒者的队列研究（ACCESS）中招募的男性进行了12次深入的定性访谈。所有参与者在开始HAART后都曾入狱。进行了录音访谈，以考察在监狱中服用HAART的经历，特别关注依从性和治疗中断的经历。
参与者的描述表明，在监禁期间，艾滋病毒治疗的依从性受到了影响。少数参与者报告说，当他们无法通过机构医疗保健获得艾滋病毒药物时，治疗中断持续了一周以上。据说，在进入惩教系统时和从监禁中获释时，短期治疗中断很常见。高度的艾滋病毒歧视促使囚犯通过谨慎服药来隐瞒自己感染艾滋病毒的事实，这可能导致漏服剂量。
当前的研究确定了惩教环境中阻碍个人坚持HAART治疗的背景因素。这些发现还表明，需要改善医疗服务并与社区护理提供者进行协调，以提高惩教环境中艾滋病毒治疗的质量。
