Juengst Eric, Buchbinder Mara, Blue Colleen, Rennie Stuart, Brinkley-Rubinstein Lauren, Rosen David L
Department of Social Medicine, Center for Bioethics, UNC-Chapel Hill, Chapel Hill, North Carolina.
US Department of Veterans Affairs, Durham, North Carolina.
N C Med J. 2022 Sep-Oct;83(5):382-388. doi: 10.18043/ncm.83.5.382.
Jail detention can disrupt the continuity of care for people living with HIV/AIDS (PLWH). Using a state's "Data to Care" (D2C) program might help overcome this barrier, but raises important questions of data security, personal privacy, resource allocation, and logistics. As part of a study involving in-depth expert stakeholder interviews, a 1-day workshop was convened to identify and discuss potential ethical challenges in extending North Carolina's D2C program to jail settings. Workshop participants included public health officials, community advocates, HIV clinicians, jail administrators, privacy experts, criminal justice researchers, and a formerly incarcerated PLWH. Workshop participants discussed the results of earlier stakeholder interviews with the goal of identifying the most important points to consider in assessing the merits of extending D2C surveillance to jail settings. Although the workshop participants expressed support for improving the continuity of HIV care for jail detainees, they had mixed perspectives on whether a jail-based D2C program should include in-jail or post-release follow-up interventions. Their positions were influenced by their views on 4 sets of implementation issues: privacy/data-sharing; government assistance/overreach; HIV criminalization/exceptionalism; and community engagement. The limitations of this stakeholder engagement exercise include its purposive recruitment, relatively small number of participants, and limited duration. Improving the continuity of HIV care in particular jail settings will depend on a number of local considerations. In deciding between models featuring in-jail and post-release follow-up care, the most important of these considerations will be the possibility of establishing good partnerships between the jail, the health department, and the community. Additional research on the dynamics and impact of different models is needed.
监狱拘留可能会扰乱对艾滋病毒/艾滋病感染者（PLWH）的连续护理。利用一个州的“数据关怀”（D2C）项目或许有助于克服这一障碍，但会引发数据安全、个人隐私、资源分配和后勤等重要问题。作为一项涉及深入专家利益相关者访谈的研究的一部分，召开了一次为期一天的研讨会，以识别和讨论将北卡罗来纳州的D2C项目扩展到监狱环境中潜在的伦理挑战。研讨会参与者包括公共卫生官员、社区倡导者、艾滋病毒临床医生、监狱管理人员、隐私专家、刑事司法研究人员以及一名曾被监禁的艾滋病毒/艾滋病感染者。研讨会参与者讨论了早期利益相关者访谈的结果，目的是确定在评估将D2C监测扩展到监狱环境的优点时需要考虑的最重要要点。尽管研讨会参与者表示支持改善对监狱被拘留者的艾滋病毒护理的连续性，但他们对于基于监狱的D2C项目是否应包括狱内或释放后随访干预存在不同观点。他们的立场受到他们对四组实施问题的看法的影响：隐私/数据共享；政府援助/过度干预；艾滋病毒定罪/特殊性；以及社区参与。这次利益相关者参与活动的局限性包括其有目的的招募、相对较少的参与者数量以及有限的持续时间。改善特定监狱环境中的艾滋病毒护理连续性将取决于许多当地因素。在决定采用以狱内和释放后随访护理为特色的模式时，其中最重要的因素将是监狱、卫生部门和社区之间建立良好伙伴关系的可能性。需要对不同模式的动态和影响进行更多研究。
