Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #116544

Jill Kantrowitz Kunkel, MPH, CHES¹, Brenda DeVellis, PhD², Carol Golin, MD³, Andrew Kaplan, MD⁴, Tasseli E. McKay, MPH⁵, David Wohl, MD⁴, and Becky Stephenson, MD⁴. (1) Virology Department, HIV Services, Bellevue Hospital, 462 1st Ave., New York, NY 10016, (917) 671-8956, jmkunkel@email.unc.edu, (2) Dept of Health Behavior and Health Education, University of North Carolina, CB #7400, Chapel Hill, NC 27599-7400, (3) Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, 725 Airport Road, CB#7590, Chapel Hill, NC 27599-7590, (4) Division of Infectious Diseases, University of North Carolina, 705 Mary Ellen Jones, CB#7290, Chapel Hill, NC 27599, (5) Center for Infectious Diseases, University of North Carolina at Chapel Hill, 1700 MLK, CB#3368, Suite 129, Room 120, Chapel Hill, NC 27599

Prevalence of HIV in US prisons and jails is at least eight times that observed in the general population. The AIDS-related mortality rate among HIV-positive prison inmates substantially exceeds mortality among HIV-positive individuals outside of prison. Prison systems are mandated by law to provide anti-retroviral therapy (ART) to HIV-positive inmates. Studies among non-incarcerated people demonstrate that adherence to ART is a critical determinant of treatment effectiveness. It seems likely that prison poses unique challenges to adherence for HIV-positive inmates; however, practitioners lack a systematic understanding of the obstacles faced by incarcerated individuals with HIV/AIDS.

Within a randomized, controlled trial of directly-observed ART in North Carolina prisons, we 1) define the social determinants of medication adherence and general health among HIV-positive prison inmates; 2) apply post-Structuralist social theory to understand relationships among the constructs identified; and 3) propose a conceptual model for improving medication adherence. Data were collected as part of motivational interviewing sessions with 70 HIV-positive inmates in 10 correctional facilities in Central NC. Participants completed 139 interview sessions. Session notes and verbatim transcripts for these interviews were analyzed using Atlas/ti.

Prominent themes included the following barriers to optimal adherence and maintaining good general health: subordination, stigmatization, social isolation and surveillance. Consistent with Foucaultian discourse theory, these findings define specific social and organizational aspects of the prison environment that exert a powerful influence on the well-being of HIV-positive inmates. A conceptual model of such influences reveals promising loci for public health intervention.

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