Antiretroviral therapy adherence and serodiscordant relationships for opioid-dependent PLWHA newly released from prison

Background: Reintegration into society after prison can be chaotic for opioid-dependent PLWHA. Recently-released prisoners must develop new life routines, which sometimes involve new relationships with people who are seronegative or have unknown status. This study identified barriers and facilitators of adherence to ART medication for newly released opioid-dependent PLWHA in serodiscordant relationships.

Methods: In-depth semi-structured qualitative interviews were conducted with 30 (25 men, 5 women) formerly incarcerated opioid-dependent PLWHA within the first three months of release to three Connecticut cities. Interview topics included: difficulty adhering to ART; attempts to avoid relapse; partner notification of HIV status. Transcripts of the audio-recorded interviews were analyzed by content analysis to identify patterns in responses and salient themes.

Results: Romantic relationships encompassed three often-overlapping types: 1) a relationship with someone known for many years; 2) an ongoing relationship that continues after release; 3) a new relationship where the PLWHA has not yet explained HIV status; 4) no current relationship. Participants acknowledged the importance of adhering to an ART regimen and admitted that they missed doses. Participants worried that newer relationships would end if they divulged their HIV status; others worried that taking medication would reveal their status. One participant in a new relationship purposefully adjusted the dosage times to avoid taking ART while with his partner.

Conclusions: Newly released opioid-dependent PLWHA comprise a vulnerable population that could be better served by training on trust-building with existing and potential partners and creating successful life routines that can be put into action immediately upon release.