title: The impact of incarceration upon adherence to HIV treatment among HIV-positive injection drug users: a qualitative study.
abstract: BACKGROUND
  HIV-positive injection drug users (IDU) often do not derive the full benefits of highly active antiretroviral therapy (HAART). Among IDU, recent incarceration has been associated with discontinuation of HAART for non-clinical reasons. We sought to qualitatively evaluate experiences with HAART among HIV-positive IDU who had been recently incarcerated within provincial prisons in British Columbia in order to identify factors influencing adherence to treatment.
  
  
  METHODS
  Twelve in-depth qualitative interviews were conducted with males recruited from a cohort study (ACCESS) involving over 450 HIV-positive IDU. All participants had been incarcerated after initiating HAART. Audio-recorded interviews were conducted to examine experiences of taking HAART in prison, with particular attention to adherence and experiences of treatment discontinuation.
  
  
  RESULTS
  Participant accounts described situations where adherence to HIV treatment was compromised in custody. A small number of participants reported treatment interruptions that lasted over a week when they were unable to obtain HIV medications through institutional healthcare. Short-term interruptions in treatment were said to be common during intake into the correctional system and at the point of release from custody. High levels of HIV discrimination motivate prisoners to hide the fact that they are HIV-positive by making efforts to take medications discreetly, which may result in missed doses.
  
  
  CONCLUSIONS
  The current study identified contextual factors within correctional environments that hinder individuals' ability to adhere to HAART. These findings also indicate that improved health services and coordination with community care providers are needed to enhance the quality of HIV treatment within correctional environments.
authors.affiliation: British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, Canada.
authors.forename: Will
authors.initials: W
authors.lastname: Small
authors.forename: Evan
authors.initials: E
authors.lastname: Wood
authors.forename: Glenn
authors.initials: G
authors.lastname: Betteridge
authors.forename: Julio
authors.initials: J
authors.lastname: Montaner
authors.forename: Thomas
authors.initials: T
authors.lastname: Kerr
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active / Q000523:psychology*; D015331:Cohort Studies; D003142:Communication; D015658:HIV Infections / Q000188:drug therapy* / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010344:Patient Advocacy; D010349:Patient Compliance / Q000523:psychology*; D011287:Prejudice; D011329:Prisoners; D015819:Substance Abuse, Intravenous / Q000523:psychology