Exploring Experiences of Disclosing HIV-Positive Status While in Prison

描述（由申请人提供）：为了更好地了解影响惩教艾滋病毒治疗服务利用不足的因素，我们建议进行为期3年的定性研究艾滋病毒阳性的人的决定是否透露他们的艾滋病毒状况的医疗提供者在监狱。据估计，美国所有艾滋病毒阳性者中有17%每年都在某个时候被关押在教养所。监禁可以是一个“公共卫生机会”，为弱势群体，特别是物质使用者和有色人种提供艾滋病毒治疗。与监狱艾滋病毒服务机构建立联系对于避免在监禁前开始抗逆转录病毒治疗的人的治疗中断至关重要，监狱环境为未接受抗逆转录病毒治疗的人提供了开始抗逆转录病毒治疗的机会。为了在监狱中接受艾滋病毒治疗，知道自己是艾滋病毒阳性的人必须通过同意接受艾滋病毒检测或向监狱医疗提供者表明自己的身份来披露自己的状况。血清阳性率数据表明，可能有很大比例的艾滋病毒阳性囚犯决定不透露自己的状况，因此在监禁期间得不到艾滋病毒护理。截至2012年4月，据估计，52%-71%的艾滋病毒阳性加州囚犯要么不知道自己的状况，要么决定不透露。对影响艾滋病毒抗体阳性者决定是否在狱中披露其状况的因素知之甚少。在弱势群体行为模型的指导下，我们建议调查影响这些决定的诱发因素、使能因素、阻碍因素和需求因素。具体目标是目标1：确定并探索影响艾滋病毒阳性者决定不向监狱医疗提供者披露其艾滋病毒状况的诱发、促成、阻碍和需求因素;目标2：确定并探索影响艾滋病毒阳性者决定向监狱医疗提供者披露其艾滋病毒状况的诱发、促成、阻碍和需求因素;目标3：提出方案和政策建议，以便利艾滋病毒抗体阳性者向监狱中的医疗提供者披露其状况，包括决定不退出艾滋病毒检测。为了实现这些目标，我们将招募100名在过去6个月内从州立监狱释放的艾滋病毒阳性者。加利福尼亚州奥克兰的社区组织将招募研究对象参加深入的定性访谈。将使用迭代测序方法收集数据，并使用分析归纳方法进行分析。调查结果将提供重要的知识，为促进艾滋病毒阳性者披露其在监狱中的状况的建议提供信息，可能会增加与监狱中艾滋病毒治疗有关的人数。改善监狱中获得艾滋病毒治疗的机会将对主要由少数族裔群体组成的人口产生影响。这项拟议的研究旨在与国家艾滋病战略的目标密切配合，即改善艾滋病毒感染者获得护理的机会，减少健康差距。

DESCRIPTION (provided by applicant): To better understand the factors that influence under-utilization of correctional HIV treatment services, we propose to conduct a 3-year qualitative study of HIV-positive people's decisions about whether to disclose their HIV status to medical providers in prison. An estimated 17% of all HIV-positive individuals in the United States are held in a correctional facility at some point each year. Incarceration can be a "public health opportunity" to provide HIV treatment to vulnerable populations, particularly substance users and people of color. Connecting to correctional HIV services is critical to avoid treatment interruptions for people who began ART prior to incarceration, and prison settings offer opportunities to initiate ART with people who are not receiving ART. In order to receive HIV treatment in prison, individuals who know they are HIV-positive must disclose their status either by consenting to HIV testing or by identifying themselves to correctional medical providers. Seroprevalence data suggest that a potentially large proportion of HIV-positive prisoners decide to not disclose their status and thus receive no HIV care while incarcerated. As of April 2012, it is estimated that 52%-71% of HIV-positive California prisoners either did not know their status or decided not to disclose. Very little is known about factors affecting HIV-positive people's decisions about whether to disclose their status while in prison. Guided by the Behavioral Model for Vulnerable Populations, we propose to investigate the predisposing, enabling, impeding, and need factors affecting these decisions. Specific Aims are Aim 1: To identify and explore the predisposing, enabling, impeding, and need factors that affect HIV-positive people's decisions to not disclose their HIV status to medical providers in prison; Aim 2: To identify and explore the predisposing, enabling, impeding, and need factors that affect HIV-positive people's decisions to disclose their HIV status to medical providers in prison; Aim 3: To generate programmatic and policy recommendations to facilitate HIV-positive people's disclosure of their status to medical providers in prison, including the decision not to opt out of HIV testing. To achieve these aims, we will recruit 100 HIV- positive people who have been released from state prison in the past 6 months. Community-based organizations in Oakland, CA, will recruit study subjects to participate in an in-depth qualitative interview. Data will be collected using an iterative sequencing approach and analyzed using analytic induction methods. Findings will provide critical knowledge to inform recommendations for facilitating HIV-positive people's disclosure of their status in prison, potentially increasing the numbers of individuals linked to in- prison HIV treatment. Improving access to HIV treatment in prison will have an impact on a population largely comprised of minority ethnic groups. The proposed study aims align closely with the National AIDS Strategy goals of improving access to care for people living with HIV and reducing health disparities.