October 1, 2009

Many Prisoners Revert to Intermittent Treatment After Incarceration

Less than 17 percent of HIV-positive inmates on antiretroviral (ARV) therapy continue taking their treatment consistently once they are released from prison, according to a study published September 22 in the online journal PLoS One.

Though there are often still many barriers to effective HIV therapy in prison, researchers have known that some incarcerated people are better able to access and adhere to ARV treatment while in prison than after they are released. Potential reasons for this include lack of housing, employment, access to care and social support.

To determine the rate of continuous HIV treatment after release from prison, Nitika Pant Pai, MD, from the McGill University Health Center in Montreal, and her colleagues studied 512 HIV-positive individuals doing repeated stints in the San Francisco County jail system. The study was conducted during a nine-year period.

Seventy-six percent of the study participants reported taking their HIV medications only intermittently between sentences or after leaving prison. Fifteen percent reported using their ARVs continuously, and 9 percent were never on therapy at all. Of the 497 who were on treatment for at least some period during the study, 16.9 percent remained on treatment continuously.

“The optimal solution for treating patients and controlling the HIV epidemic in the USA is to ensure continuous therapy,” claimed Milton Estes, MD, medical director of Forensic AIDS Project, San Francisco, in a press release from McGill University. “To achieve this we must work on various aspects of the prisoners’ lives, such as marginalization, psychiatric problems and drug use, both before and after their departure from prison.”

Jacqueline Tulsky, MD, from the University of California at San Francisco and a coauthor of the study, concludes, “This research highlights the need to examine ARV policies inside and outside correctional settings with a view to establishing effective lifelong management of HIV in prisoners.”

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