HIV-positive in the darkness of a correctional facility: more vulnerable and less treated

Int J STD AIDS. 2019 Apr;30(5):460-466. doi: 10.1177/0956462418816452. Epub 2019 Jan 10.

Abstract

In French Guiana, 4.5-5.0% of HIV-infected persons experienced an incarceration between 2007 and 2013. A cross-sectional survey was performed to describe the epidemiology and treatment outcomes of a population of HIV-infected inmates in French Guiana. The study population was patients released between 1/2007 and 12/2013, after >30 days of incarceration (n = 147). A secondary objective aimed to identify its main specificities, relative to both the general inmate population and the nonincarcerated HIV population. The socioeconomic situation of HIV-infected inmates was particularly precarious, relative to other detainees: 58.1% had never attended school (versus 5.5%, p < 0.01), 31.0% were homeless (versus 8.5%, p < 0.01), 63.9% were repeat offenders (versus 46.6%, p < 0.01), 33.3% were crack cocaine users (versus 9.8-12%, p < 0.01). The frequency of hypertension and chronic B hepatitis was also higher. Only 50.3% of inmates were on antiretroviral therapy (ART) versus 92.6% in the hospital HIV population (p < 0.001). Among untreated patients, 15.1% refused ART. Among those treated, 81.3% were virologically suppressed. Although comparisons were biased, HIV-positive inmates had more psychosocial vulnerabilities than the general inmate population. Despite ART availability and excellent treatment outcomes, undertreatment was a fact not completely explained by patient refusal. HIV-infected inmates should benefit from increased attention by health care and social workers.

Keywords: AIDS; antiretroviral therapy; prison; psychosocial deprivation; substance-related disorders.

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Antiretroviral Therapy, Highly Active
  • Cross-Sectional Studies
  • Female
  • French Guiana / epidemiology
  • HIV Infections / diagnosis
  • HIV Infections / drug therapy*
  • HIV Infections / epidemiology
  • Health Knowledge, Attitudes, Practice*
  • Health Services Accessibility / statistics & numerical data*
  • Healthcare Disparities*
  • Humans
  • Male
  • Prisoners / statistics & numerical data*
  • Prisons
  • Retrospective Studies
  • Socioeconomic Factors
  • Treatment Outcome

Substances

  • Anti-HIV Agents