Abstract
BackgroundEarly initiation of antiretroviral therapy (ART) reduces the development of acquired immunodeficiency syndrome (AIDS), non-AIDS related comorbidities and mortality, and prevents transmission. However, the prevalence of delayed ART initiation amongst prisoners in sub-Saharan African countries is high and the contributing factors to this are relatively unknown.MethodsQualitative interviewing was employed to understand the prisoners’ lived world with regard to initiating ART and associated barriers and facilitators in the South Ethiopian prison system. We interviewed seven (five male and two female) inmates living with HIV (ILWH) and eleven stakeholders who had a role in human immunodeficiency virus (HIV) care provision for incarcerated people. A phenomenological approach was used to analyse the interview data in which meaning attributed to the lived experiences of the participants was abstracted.ResultsIn this study, participants discussed both barriers to, and facilitators of, early ART initiation during incarceration. The barriers included a lack of access to voluntary counselling and testing (VCT) services, poor linkage to care due to insufficient health staff training, uncooperative prison security systems and loss of privacy regarding disclosure of HIV status. Insufficient health staff training and uncooperative prison security systems both contributed to a loss of patient privacy, ultimately resulting in treatment refusal. Although most participants described the importance of peer education and support for enhancing HIV testing and treatment programs amongst prisoners, there had been a decline in such interventions in the correctional facilities. Service providers suggested opportunities that a prison environment offers for identification and treatment of HIV infected individuals and implementation of peer education programs.ConclusionsOur study identified crucial barriers to and facilitators of early ART initiation amongst prisoners, a key HIV priority population group. Interventions that address the barriers while strengthening the facilitators may enhance a greater utilisation of ART.
Highlights
Initiation of antiretroviral therapy (ART) reduces the development of acquired immunodeficiency syndrome (AIDS), non-AIDS related comorbidities and mortality, and prevents transmission
Of prisoner participants who reported their likely mode of infection, the majority reported engaging in unprotected heterosexual intercourse prior to their imprisonment
The service providers related the prison health staff’s inability to declare test results with an insufficiency of skills related to provision of appropriate counselling and referral services: “I have experienced something like this: He [a prisoner] was diagnosed there [at prison clinic] and we found him positive here and he said, ‘I was diagnosed there but I have not been told this!’ We just thought that it might be due to a counselling problem by the health staff and we counselled him and let him start the treatment.” (Male ART service provider, age: 40’s-50’s; Health Facility ‘B’)
Summary
Initiation of antiretroviral therapy (ART) reduces the development of acquired immunodeficiency syndrome (AIDS), non-AIDS related comorbidities and mortality, and prevents transmission. Incarceration rates have been increasing rapidly in subSaharan African (SSA) countries including Ethiopia [1, 2]. The prevalence of human immunodeficiency virus (HIV) in prison populations of SSA countries is much higher than in the general population [5,6,7], with prevalences up to 13 times higher reported in some countries [5]. While there have been reports of unprotected homosexual practices, including rape and sex bartering in the SSA prisons [9,10,11,12,13], pre-incarceration unprotected heterosexual intercourse is the main risk factor for HIV infection in prisoners [9, 11, 14, 15]
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