Health impact of incarceration among HIV positive individuals

Background: Research has demonstrated a link between HIV and incarceration and that incarceration is associated with lower levels of health service utilization, higher likelihood of engagement in risky behavior and lower levels of adherence to ART. However, there is a lack of research that measures the direct impact of incarceration on health and the indirect impact of incarceration on social conditions after release that may also affect health status.
Methods: This study measures the impact of incarceration on health and social conditions after release among HIV positive individuals. The study sample includes 75 HIV positive individuals who have never been incarcerated and 75 who have spent at least three months in jail or prison in the last six months. The survey used was created in collaboration with HIV positive individuals who had recently been released from jail who also helped with survey administration. The survey measured: health, incarceration quality of care, social support, incarceration environment, post-release social conditions (e.g. living conditions, employment, voting rights).
Results: Demographics mirrored the demographic breakdown for HIV positive, incarcerated individuals in Nashville, TN. 75% were Black, 75% were male and the median age was 41. The mean for self-reported health was significantly different between the incarcerated and non-incarcerated individuals (good vs. very good). Linear regression demonstrated that a recent incarceration explained 23% of the variance in self-reported health and that having a recent incarceration lowers a self-rated health score by .132. Preliminary analysis also indicated that incarceration has an impact on homelessness, voting, employment status and presence of social support post-release. Those who were recently incarcerated rated their quality of care while incarcerated as poor, their health status as fair and a majority reported overcrowding in their correctional facility.
Conclusions: The results of this study highlight 1) that incarceration has an impact on health and also the social conditions that one experiences post release; and 2) that quality of care and health status while incarcerated is generally subpar. Efforts must be made to stem the impact of incarceration on health both while incarcerated (by delivering better and more timely care, improving prison or jail conditions) and after release.