title: The HIV Prison Paradox: Agency and HIV-Positive Women's Experiences in Jail and Prison in Alabama.
abstract: Incarcerated women face significant barriers to achieve continuous HIV care. We employed a descriptive, exploratory design using qualitative methods and the theoretical construct of agency to investigate participants' self-reported experiences accessing HIV services in jail, in prison, and post-release in two Alabama cities. During January 2014, we conducted in-depth interviews with 25 formerly incarcerated HIV-positive women. Two researchers completed independent coding, producing preliminary codes from transcripts using content analysis. Themes were developed iteratively, verified, and refined. They encompassed (a) special rules for HIV-positive women: isolation, segregation, insults, food rationing, and forced disclosure; (b) absence of counseling following initial HIV diagnosis; and (c) HIV treatment impediments: delays, interruption, and denial. Participants deployed agentic strategies of accommodation, resistance, and care-seeking to navigate the social world of prison and HIV services. Findings illuminate the "HIV prison paradox": the chief opportunities that remain unexploited to engage and re-engage justice-involved women in the HIV care continuum.
authors.affiliation: 1 University of Massachusetts Boston, Boston, Massachusetts, USA.|2 University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: Courtenay
authors.initials: C
authors.lastname: Sprague
authors.affiliation: 1 University of Massachusetts Boston, Boston, Massachusetts, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Scanlon
authors.affiliation: 1 University of Massachusetts Boston, Boston, Massachusetts, USA.
authors.forename: Bharathi
authors.initials: B
authors.lastname: Radhakrishnan
authors.affiliation: 1 University of Massachusetts Boston, Boston, Massachusetts, USA.|3 Fenway Health, Boston, Massachusetts, USA.
authors.forename: David W
authors.initials: DW
authors.lastname: Pantalone
mesh_terms: D000328:Adult; D000407:Alabama; D001294:Attitude to Health; D005260:Female; D015658:HIV Infections / Q000523:psychology* / Q000628:therapy*; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011329:Prisoners / Q000523:psychology*; D036301:Qualitative Research; D012959:Socioeconomic Factors
keywords: HIV; US South; adherence; agency; health care-seeking; interpretive research; prison; qualitative method; social construction; stigma; women’s health