Stigma, Citizenship, and the Transition to Community-based HIV Care Among People Returning from Incarceration
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Background People in prisons and jails are a key population for HIV prevention and control. Despite high rates of HIV treatment initiation and retention inside places of detention, people returning from incarceration fail to link to community-based care and to adhere to medication at high rates in the period following release. Stigma underpins post-release barriers to care, as does the relegation of individuals returning from incarceration to an alternate citizenship status that denies them access to otherwise guaranteed rights. South Africa, with among the highest prevalence of HIV in incarcerated people globally, is an important site for advancing public health knowledge about how these social factors affect care engagement. Methods This study uses data collected as part of the corrections2community intervention in Gauteng Province, South Africa. Manuscript 1 was completed through a systematic review of interventions (n=27) to improve HIV care engagement among individuals released from prison or jail. Manuscript 2 was achieved through qualitative data analysis of interviews with a purposively selected sample of people returning from incarceration with HIV (n=42) in South Africa. Manuscript 3 was completed through qualitative data analysis of interviews with reentrants’ health and social service providers (n=24) in South Africa. Results Manuscript 1 indicated that intervention strategies associated with improvements in post-release HIV care include patient navigation strategies, especially those involving peer support, and substance use treatment. Manuscript 2 revealed that people returning from incarceration with HIV experience multiple stigmas, including HIV stigma and incarceration stigma, that converge with ideologies about people with criminal convictions in South Africa. Manuscript 3 revealed how providers’ accounts of post-release care in South Africa interface with discourses about citizenship, including that rehabilitation of individuals toward responsible self-conduct necessitates increased rights. Discussion The principal contribution of these manuscripts is their contextualization of the factors influencing post-incarceration HIV care. Future public health research and practice should further address eight key features of external contexts affecting reentrants’ HIV care, as exemplified by three existing intervention studies. South Africa is an opportune site for advancing public health research and practice that aims at changing the external contexts shaping health outcomes among reentrants.