Department of Health Behavior and Health Education, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America.
Psychiatric Research Institute, University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States of America.
PLoS One. 2020 Apr 17;15(4):e0231951. doi: 10.1371/journal.pone.0231951. eCollection 2020.
Individuals involved in the criminal justice (CJ) system continue to be at disproportionate risk for HIV infection, and often have a greater prevalence of substance use and sexual related risk behaviors relative to their non-CJ involved peers. Pre-exposure prophylaxis (PrEP), a once daily antiretroviral medicine, is an evidence-based approach for reducing the risk of contracting HIV but limited data exist regarding the use of PrEP among CJ populations, especially in the U.S. South. This study was conducted at the Pulaski County Regional Detention Facility (PCRDF) in Little Rock, Arkansas (AR), the largest county jail in the state. We explored knowledge about PrEP and HIV, perceptions about PrEP feasibility in both the jail and community settings and barriers to PrEP program implementation, through in-depth qualitative interviews with 21 jail detainees. We purposively sampled individuals based on specific self-reported risk behavior, including sexual risk (both heterosexual and same-sex) and drug related risk (e.g. IDU), among all eligible individuals. We identified five primary themes from the interviews: 1) accessing healthcare during community reentry was a low priority; 2) perception of risk and interaction with people with HIV was low; 3) there are many barriers to disclosing HIV risk behaviors in jail settings; 4) knowledge of PrEP is low but willingness to use is high; and 5) multiple barriers exist to PrEP uptake post-release. Our findings are contextually unique and therefore have important implications for future implementation of PrEP access either within jail settings or linkage to PrEP post release.
参与刑事司法（CJ）系统的个人继续面临不成比例的艾滋病毒感染风险，并且与非 CJ 相关的同龄人相比，他们通常更普遍存在药物使用和与性相关的风险行为。暴露前预防（PrEP）是一种每日一次的抗逆转录病毒药物，是减少感染艾滋病毒风险的循证方法，但关于 CJ 人群中使用 PrEP 的数据有限，特别是在美国南部。这项研究是在阿肯色州小石城的普拉斯基县地区拘留所（PCRDF）进行的，这是该州最大的县监狱。我们通过对 21 名监狱被拘留者进行深入的定性访谈，探讨了他们对 PrEP 和 HIV 的认识、对监狱和社区环境中 PrEP 可行性的看法，以及实施 PrEP 计划的障碍。我们根据所有符合条件的个人的特定自我报告的风险行为（包括异性恋和同性恋性行为以及与药物相关的风险行为），有针对性地对个体进行抽样。我们从访谈中确定了五个主要主题：1）在社区重新融入期间，获得医疗保健的优先级较低；2）对风险的感知和与艾滋病毒感染者的互动较低；3）在监狱环境中披露艾滋病毒风险行为存在许多障碍；4）对 PrEP 的了解程度较低，但愿意使用的意愿很高；5）出狱后接受 PrEP 的障碍很多。我们的发现具有特定的背景，因此对未来在监狱环境中实施 PrEP 或在出狱后与 PrEP 联系方面具有重要意义。
