The Path to Implementation of HIV Pre-exposure Prophylaxis for People Involved in Criminal Justice Systems

Excerpt

The criminal justice (CJ)-involved population in the United States (US) is among the most vulnerable to and heavily impacted by HIV [1]. HIV prevalence is three to five times higher among incarcerated populations than in the general population [2] and one in seven people living with HIV (PLH) pass through CJ systems each year [3]. Among racial and ethnic minorities, HIV and incarceration are even more closely intertwined: one of every five HIV-infected black or Hispanic/Latino adults passes through CJ systems annually [4]. Individuals involved in CJ systems experience a confluence of factors at the individual (e.g., substance abuse, mental health issues, childhood abuse), interpersonal (e.g., inconsistent condom use, intimate partner violence exposure), and community level (e.g., housing instability, unemployment, poverty, disengagement from medical services, stigma) that increase their risk of HIV [5‐15]. HIV risk is exceptionally high immediately following release from prisons or jails, termed “community re-entry,” when relapse to substance use, discontinuous healthcare engagement, homelessness and under-insurance compounds, and other health disparities [16] Additionally, individuals from populations with an elevated risk of HIV acquisition (i.e., Black men who have sex with men [MSM], people who inject drugs [PWID], commercial sex workers [CSWs]) frequently come into contact with CJ systems [14, 17‐21]. These subpopulations that experience intersecting risk, exacerbated by CJ involvement, need to be engaged in HIV prevention interventions. However, traditional HIV prevention approaches alone, such as risk reduction counseling and condom distribution programs, have had limited success with currently and recently incarcerated populations [22, 23]. …