Rozanova Julia, Brown Shan-Estelle, Bhushan Ambika, Marcus Ruthanne, Altice Frederick L
Department of Internal Medicine, Section of Infectious Diseases, AIDS Program, Yale University School of Medicine, 135 College Street, Suite 323, New Haven, CT 06510-2283 USA.
Harvard Medical School, Boston, MA USA.
Health Justice. 2015 Dec 18;3:18. doi: 10.1186/s40352-015-0030-6. eCollection 2015.
This paper examines how family and social relations facilitate and inhibit adherence to antiretroviraltherapy (ART) for people living with HIV (PLH) who have underlying substance use disorders and are transitioningto the community post-incarceration.
Combining the methods of inductive close reading and constantcomparison, we analyzed the data from 30 semi-structured interviews of PLH who had recently transitioned to thecommunity within the previous 90 days.
Three central themes were anticipated as important socialrelationships post-release: self-reported family, friends and clinicians. Among these, four sub-themes (social isolation, 'double jeopardy', search for belonging, and trust and respect) emerged, highlighting how they impacted ART adherence. Post-release, participants returned to resource-poor communities where they experienced socialisolation. ART adherence was enabled by having a purpose in life, which correlated with having robust family support structures. Many former prisoners felt that a chasm between them and their families existed, both because of HIV stigma and their addiction problems. In this context, relationships with untrustworthy friends from their druguse networks led to relapse of drug use and risky behaviors, jeopardizing participants' ART adherence and persistence. To avoid the double jeopardy, defined as seeking friends for support but who were also the ones who contributed to drug relapse, participants searched for new social anchors, which often included their healthcare providers who represented trusted and respected persons in their life.
While some former prisonersperceived doctors as uncaring and their relationships asymmetrical, positive relationships with these providers,when respect and trust was mutual, reinforced the participants' sense of belonging to what they called 'the world that don't do drugs' and motivated them to adhere to ART.
本文探讨了家庭和社会关系如何促进及阻碍感染艾滋病毒（HIV）且有潜在物质使用障碍的人在出狱后过渡到社区时对抗逆转录病毒疗法（ART）的坚持。
结合归纳性仔细阅读和持续比较的方法，我们分析了对30名在过去90天内刚过渡到社区的HIV感染者进行的半结构化访谈数据。
预计有三个核心主题是出狱后重要的社会关系：自我报告的家庭、朋友和临床医生。其中出现了四个子主题（社会孤立、“双重危险”、寻求归属感以及信任和尊重），突出了它们如何影响抗逆转录病毒疗法的坚持。出狱后，参与者回到资源匮乏的社区，在那里他们经历了社会孤立。有生活目标能促进对抗逆转录病毒疗法的坚持，而这与强大的家庭支持结构相关。许多曾经入狱的人觉得他们和家人之间存在鸿沟，这既是因为HIV污名，也是因为他们的成瘾问题。在这种情况下，与来自吸毒网络中不可信赖的朋友的关系导致吸毒复发和危险行为，危及参与者对抗逆转录病毒疗法的坚持和持续治疗。为了避免被定义为寻求朋友支持但这些朋友也是导致吸毒复发的人的“双重危险”，参与者寻找新的社会支柱，这通常包括他们的医疗保健提供者，这些提供者在他们的生活中代表着值得信任和尊重的人。
虽然一些曾经入狱的人认为医生冷漠，他们之间的关系不对称，但当相互尊重和信任时，与这些提供者的积极关系增强了参与者对他们所称的“不吸毒的世界”的归属感，并激励他们坚持接受抗逆转录病毒疗法。
