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Study: Finding HIV Services After Release from Prison

The transition from incarceration back to community life is a period of vulnerability for HIV-positive people released from prison, with 95% experiencing an interruption in HIV treatment following their release. But those who have been recently released indicate that health systems navigators (e.g. case managers, bridge counselors, linkage to care specialists) are valuable resources for re-establishing HIV care outside of prison, according to a recent study.

To address the gap in HIV treatment after prison, the federal government funded an initiative in 2011 to develop health navigator programs in both prisons and communities. Researchers interviewed 24 people post-release from across the country about their experiences in these programs and identified three aspects that participants found most valuable in helping them find HIV services.

First, participants appreciated opportunities to communicate with health navigators before release – whether via video conferencing or writing letters. Following release, they valued having a designated contact outside of prison to answer questions about medical care and non-medical support services.

One participant, a 57-year-old male 4 months post-incarceration took comfort in “knowing that there’s someone that you can call to help you when you’re in need, and knowing that I don’t have to do this all by myself.”

Second, participants emphasized the importance of clinics that offered a “one-stop-shop” for medical and other social services. A 56-year-old male participant 1.5 years post-incarceration described the clinic as his “lead source for housing, clothing, and places to sleep.”

Shannon Fuller, a medical researcher at the University of California in San Francisco and lead author of the study, noted that the services offered at these clinics are critical to motivating recently incarcerated people to get back on treatment.

“For many, the ability to get basic needs met through the clinic – such as assistance with housing, food, and transportation – offered further motivation to connect to the clinic immediately after release and subsequently re-establish care for HIV,” said Fuller.

Lastly, participants in the study repeatedly emphasized how they cherished “close, trusting relationships” with their navigators. Small caseloads – less than 20 clients per navigator at a time – facilitated these relationships in many cases. According to a participant one month after being released from prison:

“Being locked up as long as I have, your family die off. You know, like my mother and my brother—my brother got killed. My mom died. My dad died. And, you know, my house was no longer there. So, I mean, I’d probably have been sleeping on the street if I didn’t know nothing about all these things that the clinic offered.”

Study findings were published in the journal AIDS and Behavior in February. Fuller pointed out that all of the interviews described in the study were conducted with people who had successfully linked to HIV care after incarceration. Future research is needed to understand how to better support those who are unable to re-establish care.

“Our interviews reveal the specific aspects of the navigator interventions that participants appreciated, which has implications for clinics and public health initiatives that aim to develop future interventions for this population,” added Fuller.

The study’s key takeaway is that access to a health navigator is helpful for re-establishing HIV care outside of prison. Based on the perspectives of those interviewed for this study, the social and practical support offered by navigators is critical for engaging clients into care when they return to their communities. This message highlights the importance of case management programs like the Ryan White HIV/AIDS Program at a time when the White House is proposing cuts to these programs.