Experiences of Justice-Involved People Transitioning to HIV Care in the Community After Prison Release in Lusaka, Zambia: A Qualitative Study

Smith, Helene J., Herce, Michael E., Mwila, Chilambwe, Chisenga, Peter, Yenga, Chisenga, Chibwe, Besa, Mai, Vivien, Kashela, Lillian, Nanyagwe, Mirriam, Hatwiinda, Sisa, Moonga, Clement N., Musheke, Maurice, Lungu, Yotam, Sikazwe, Izukanji, and Topp, Stephanie M. (2023) Experiences of Justice-Involved People Transitioning to HIV Care in the Community After Prison Release in Lusaka, Zambia: A Qualitative Study. Global Health Science and Practice, 11 (2). e2200444.

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Abstract

Introduction: In sub-Saharan Africa (SSA), incarcerated people experience a higher HIV burden than the general population. While access to HIV care and treatment for incarcerated people living with HIV (PLHIV) in SSA has improved in some cases, little is known about their transition to and post-release experience with care in the community. To address this gap, we conducted a qualitative study to describe factors that may influence post-release HIV care continuity in Zambia.

Methods: In March-December 2018, we recruited study participants from a larger prospective cohort study following incarcerated and newly released PLHIV at 5 correctional facilities in 2 provinces in Zambia. We interviewed 50 participants immediately before release; 27 (54%) participated in a second interview approximately 6 months post-release. Demographic and psychosocial data were collected through a structured survey.

Results: The pre-release setting was strongly influenced by the highly structured prison environment and assumptions about life post-release. Participants reported accessible HIV services, a destigmatizing environment, and strong informal social supports built through comradery among people facing the same trying detention conditions. Contrary to their pre-release expectations, during the immediate post-release period, participants struggled to negotiate the health system while dealing with unexpected stressors. Long-term engagement in HIV care was possible for participants with strong family support and a high level of self-efficacy.

Conclusion: Our study highlights that recently released PLHIV in Zambia face acute challenges in meeting their basic subsistence needs, as well as social isolation, which can derail linkage to and retention in community HIV care. Releasees are unprepared to face these challenges due to a lack of community support services. To improve HIV care continuity in this population, new transitional care models are needed that develop client self-efficacy, facilitate health system navigation, and pragmatically address structural and psychosocial barriers like poverty, gender inequality, and substance use.

Item ID: 78952
Item Type: Article (Research - C1)
ISSN: 2169-575X
Copyright Information: © Smith et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are properly cited. To view a copy of the license, visit https://creativecommons.org/licenses/by/4.0/. When linking to this article, please use the following permanent link: https://doi.org/10.9745/GHSP-D-22-00444
Funders: National Health and Medical Research Council (NHMRC)
Projects and Grants: NHMRC Investigator Award GNT1173004
Date Deposited: 08 Aug 2023 02:40
FoR Codes: 42 HEALTH SCIENCES > 4203 Health services and systems > 420311 Health systems @ 35%
42 HEALTH SCIENCES > 4203 Health services and systems > 420305 Health and community services @ 30%
42 HEALTH SCIENCES > 4206 Public health > 420606 Social determinants of health @ 35%
SEO Codes: 20 HEALTH > 2005 Specific population health (excl. Indigenous health) > 200599 Specific population health (excl. Indigenous health) not elsewhere classified @ 35%
20 HEALTH > 2001 Clinical health > 200105 Treatment of human diseases and conditions @ 30%
20 HEALTH > 2002 Evaluation of health and support services > 200299 Evaluation of health and support services not elsewhere classified @ 35%
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