Explaining poor health-seeking among HIV-infected released prisoners

Little is understood about the self-described barriers that recently released HIV-infected prisoners face when accessing healthcare and adhering to medications. The purpose of this paper is to elucidate these barriers from the perspective of released prisoners themselves.

A qualitative assessment using 30 semi-structured interviews explored individuals’ self-reported acute stressors and barriers to health-seeking during community re-integration for recidivist prisoners. Leventhal’s Self-Regulation Model of Illness (SRMI) is applied to examine both structural and psychological barriers.

The SRMI explains that individuals have both cognitive and emotional processing elements to their illness representations, which mediate coping strategies. Cognitive representations of HIV that mediated treatment discontinuation included beliefs that HIV was stigmatizing, a death sentence, or had no physiological consequences. Negative emotional states of hopelessness and anger were either acute or chronic responses that impaired individuals’ motivation to seek care post-release. Individuals expressed feelings of mistrust, fatalism and denial as coping strategies in response to their illness, which reduced likelihood to seek HIV care.

Interventions for HIV-infected individuals transitioning to the community must incorporate structural and psychological components. Structural support includes housing assistance, employment and health insurance, and linkage to mental health, substance abuse and HIV care. Psychological support includes training to enhance agency with medication self-administration and HIV education to correct false beliefs and reduce distress. Additionally, healthcare workers should be specifically trained to establish trust with these vulnerable populations.