Attitudes and Experiences of Health Care Service Delivery among HIV Positive Puerto Ricans in New York City Jails

Background

The New York City (NYC) Department of Health and Mental Hygiene’s Transitional Health Care Coordination (THCC) provides transitional care services to persons with chronic health conditions returning to the community after incarceration. Among HIV positive Latinos: 67% are linked and 33% are retained in care, 37% begin antiretroviral therapy (ART), and 26% are virally suppressed. Little data exists specific to Puerto Ricans.

Methods

THCC interviewed 14 HIV Puerto Rican patients to examine their attitudes and experiences of health care service delivery. Researchers asked about patient diagnosis, engagement in healthcare, ART adherence, social support, and stigma. Interviews in English and Spanish were recorded and transcribed; themes were coded, synthesized and analyzed.

Results

Ten men and four women were interviewed. All reported alcohol/drug use and 10 reported mental health issues. Most reported better ART adherence in jail due to a structured, drug-free environment. Substance use and homelessness were barriers to medication adherence in the community, while facilitators included convenience of care and adherence counseling. Motivations for health included age, pain, family, seeing others die, and not wanting to die in jail. Some experienced stigma from healthcare providers related to HIV status and/or incarceration.

Conclusions

HIV patients of Puerto Rican origin in NYC jails have substantial barriers to community healthcare access and medication adherence. Primary needs at release include substance abuse treatment, mental health care, case management, and benefits reactivation. Training of healthcare providers, case managers, and other practitioners is needed to engage patients in culturally appropriate care and to reduce stigma.