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Background:  Annually, 1 in 5 HIV⁺ persons in the United States passes through a correctional facility. While HIV care is largely available in prisons, HIV⁺ releasees may face challenges in accessing health care. Further, HIV RNA levels of former inmates have been observed to increase during periods of release.

Methods:  Two cohorts were studied:  86 HIV⁺ state prison inmates who were interviewed within 3 months prior to and 30 to 60 days post-release; and 84 HIV⁺ inmates released from prison and then re-incarcerated (recidivists) who received the same interview shortly after re-incarceration. All were asked about access to HIV care while free.

Results:  Of the 86 subjects interviewed before release (58% women, 87% non-white, 81% heterosexual, mean age = 36 years), 59% were receiving ART. More than three quarters agreed that after release they “can get medical care whenever needed” but 68% said “covering cost of medical visits will be problem”; 36% said that they “will go without care due to cost” and 26% that “it will be hard to get emergency care.” Post-release interviews were conducted in 95% of those eligible (2 subjects died and 5 were re-incarcerated shortly after release) a mean of 36 days post-release. 59% said they had seen a health care provider. All of those prescribed ART reported receiving medication to take home at release (mean 32 day supply) but 15% had gone without ART for >2 days since release. Among the 84 recidivists (32% women, 82% non-white, 73% heterosexual, mean age = 35 years, median time free = 435 days), 34% had not received HIV care while free; 46% gauged their health to be the same and 28% worse than when last released; 63% received ART since release but 41% were not on ART at re-incarceration and a third of ART-treated subjects had run out of medication a mean 159 days after release for an average of 203 days. Half had a case manager; 54% thought that covering medical costs between incarcerations was a problem; 39% said that they went without care due to cost and 26% responded that it was hard to get medical care when needed. 

Conclusions:  Following release, HIV⁺ former prison inmates experience difficulty maintaining HIV care, continuing medical therapy and affording health care. Coupled with data from the same cohorts indicating high rates of post-release HIV transmission risk behaviors, these results support efforts to strengthen the continuity of HIV care following prison release for the benefit of individual and public health.

Keywords: Access to care; Prisoners