RT Journal Article
SR Electronic
T1 Experiences of Justice-Involved People Transitioning to HIV Care in the Community After Prison Release in Lusaka, Zambia: A Qualitative Study
JF Global Health: Science and Practice
JO GLOB HEALTH SCI PRACT
FD Johns Hopkins University- Global Health. Bloomberg School of Public Health, Center for Communication Programs
SP e2200444
DO 10.9745/GHSP-D-22-00444
VO 11
IS 2
A1 Smith, Helene J.
A1 Herce, Michael E.
A1 Mwila, Chilambwe
A1 Chisenga, Peter
A1 Yenga, Chisenga
A1 Chibwe, Besa
A1 Mai, Vivien
A1 Kashela, Lillian
A1 Nanyagwe, Mirriam
A1 Hatwiinda, Sisa
A1 Moonga, Clement N.
A1 Musheke, Maurice
A1 Lungu, Yotam
A1 Sikazwe, Izukanji
A1 Topp, Stephanie M.
YR 2023
UL http://www.ghspjournal.org/content/11/2/e2200444.abstract
AB Key FindingsCommunity health systems can be highly intimidating, overwhelming, and unaccommodating to people living with HIV (PLHIV) involved with the criminal justice system (i.e., the “justice-involved”) and particularly challenging to navigate after prison release.Justice-involved PLHIV in Zambia are highly marginalized and face a number of psychological, socioeconomic, and structural challenges, which they are typically ill-prepared and unsupported to manage after release. Without differentiated support tailored to their unique needs, these challenges may disrupt their HIV care continuity, resulting in HIV treatment interruption.Key ImplicationDedicated and appropriately tailored interventions, which could include pre-release counseling and case management, post-release peer navigation, and/or psychosocial, socioeconomic, and gender-responsive supports, are needed to guide justice-involved PLHIV through the transition from accessing HIV care during incarceration to successfully accessing it in the community after release.Introduction:In sub-Saharan Africa (SSA), incarcerated people experience a higher HIV burden than the general population. While access to HIV care and treatment for incarcerated people living with HIV (PLHIV) in SSA has improved in some cases, little is known about their transition to and post-release experience with care in the community. To address this gap, we conducted a qualitative study to describe factors that may influence post-release HIV care continuity in Zambia.Methods:In March–December 2018, we recruited study participants from a larger prospective cohort study following incarcerated and newly released PLHIV at 5 correctional facilities in 2 provinces in Zambia. We interviewed 50 participants immediately before release; 27 (54%) participated in a second interview approximately 6 months post-release. Demographic and psychosocial data were collected through a structured survey.Results:The pre-release setting was strongly influenced by the highly structured prison environment and assumptions about life post-release. Participants reported accessible HIV services, a destigmatizing environment, and strong informal social supports built through comradery among people facing the same trying detention conditions. Contrary to their pre-release expectations, during the immediate post-release period, participants struggled to negotiate the health system while dealing with unexpected stressors. Long-term engagement in HIV care was possible for participants with strong family support and a high level of self-efficacy.Conclusion:Our study highlights that recently released PLHIV in Zambia face acute challenges in meeting their basic subsistence needs, as well as social isolation, which can derail linkage to and retention in community HIV care. Releasees are unprepared to face these challenges due to a lack of community support services. To improve HIV care continuity in this population, new transitional care models are needed that develop client self-efficacy, facilitate health system navigation, and pragmatically address structural and psychosocial barriers like poverty, gender inequality, and substance use.