Culbert Gabriel J
Researcher, based at Nursing/Health Systems Science, University of Illinois at Chicago, Chicago, Illinois, USA.
Int J Prison Health. 2014;10(2):94-110. doi: 10.1108/IJPH-05-2013-0020.
About one in five men living with HIV in the USA passes through a correctional center annually. Jails and prisons are seen therefore as key intervention sites to promote HIV treatment as prevention. Almost no research, however, has examined inmates' perspectives on HIV treatment or their strategies for retaining access to antiretroviral therapy (ART) during incarceration. The purpose of this paper is to describe the results of an exploratory study examining men's perceptions of and experiences with HIV care and ART during incarceration.
DESIGN/METHODOLOGY/APPROACH: Semi-structured, in-depth interviews were conducted with 42 HIV positive male and male-to-female transgendered persons recently released from male correctional centers in Illinois, USA.
Interpersonal violence, a lack of safety, and perceived threats to privacy were frequently cited barriers to one's willingness and ability to access and adhere to treatment. Over 60 percent of study participants reported missed doses or sustained treatment interruption (greater than two weeks) because of failure to disclose their HIV status, delayed prescribing, intermittent dosing and out-of-stock medications, confiscation of medications, and medication strikes.
RESEARCH LIMITATIONS/IMPLICATIONS: Substantial improvements in ART access and adherence are likely to follow organizational changes that make incarcerated men feel safer, facilitate HIV status disclosure, and better protect the confidentiality of inmates receiving ART.
ORIGINALITY/VALUE: This study identified novel causes of ART non-adherence among prisoners and provides first-hand information about how violence, stigma, and the pursuit of social support influence prisoner's decisions to disclose their HIV status or accept ART during incarceration.
在美国，每五名感染艾滋病毒的男性中约有一人每年会经过惩教中心。因此，监狱被视为促进将艾滋病毒治疗作为预防手段的关键干预场所。然而，几乎没有研究考察过囚犯对艾滋病毒治疗的看法或他们在监禁期间维持抗逆转录病毒疗法（ART）治疗的策略。本文的目的是描述一项探索性研究的结果，该研究考察了男性在监禁期间对艾滋病毒护理和抗逆转录病毒疗法的认知与经历。
设计/方法/途径：对42名最近从美国伊利诺伊州男性惩教中心获释的艾滋病毒呈阳性的男性和男变女跨性别者进行了半结构化的深入访谈。
人际暴力、缺乏安全感以及对隐私的感知威胁经常被提及，这些是影响人们接受和坚持治疗的意愿与能力的障碍。超过60%的研究参与者报告称，由于未披露艾滋病毒感染状况、开处方延迟、间歇性给药和药品缺货、药品被没收以及药品罢工等原因，出现了漏服剂量或治疗持续中断（超过两周）的情况。
研究局限/启示：若组织层面做出改变，让被监禁男性感到更安全、便于艾滋病毒感染状况的披露，并更好地保护接受抗逆转录病毒疗法的囚犯的隐私，那么在抗逆转录病毒疗法的可及性和依从性方面可能会有显著改善。
原创性/价值：本研究确定了囚犯中抗逆转录病毒疗法不依从的新原因，并提供了关于暴力、耻辱感以及对社会支持的追求如何影响囚犯在监禁期间披露艾滋病毒感染状况或接受抗逆转录病毒疗法的决定的第一手信息。
