Exploring Experiences of Disclosing HIV-Positive Status While in Prison

描述(申请人提供)：为了更好地了解影响惩教艾滋病毒治疗服务未得到充分利用的因素，我们建议对艾滋病毒阳性者是否决定是否向监狱中的医务人员披露他们的艾滋病毒状况进行为期3年的定性研究。据估计，美国所有艾滋病毒阳性者中有17%每年都会被关押在惩教所里。监禁可能是向弱势群体，特别是吸毒者和有色人种提供艾滋病毒治疗的“公共卫生机会”。连接到惩教艾滋病毒服务机构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，监狱环境为没有接受抗逆转录病毒治疗的人提供了启动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艾滋病毒检测或向惩教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披露自己的状况，因此在监禁期间没有接受艾滋病毒护理。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，要么决定不披露。人们对影响艾滋病毒阳性者决定是否在狱中披露其状况的因素知之甚少。在脆弱人群行为模型的指导下，我们建议调查影响这些决定的诱因、促成、阻碍和需要因素。具体目标1：查明和探讨影响艾滋病毒阳性者不向监狱医务人员披露其艾滋病毒状况决定的诱因、促成因素、阻碍因素和需要因素；目标2：查明和探讨影响艾滋病毒阳性者向监狱医务人员披露其艾滋病毒状况决定的诱因、促成因素、阻碍因素和需要因素；目标3：提出方案和政策建议，便利艾滋病毒阳性者向监狱医务人员披露其状况，包括不选择不进行艾滋病毒检测的决定。为了实现这些目标，我们将招募过去6个月从州立监狱释放的100名艾滋病毒阳性者。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面试。数据将使用迭代排序方法收集，并使用分析归纳法进行分析。调查结果将提供关键知识，为便利艾滋病毒阳性者披露其在监狱中的状况提供建议，可能会增加与监狱内艾滋病毒治疗有关的个人数量。改善监狱中艾滋病毒治疗的机会将对主要由少数族裔组成的人口产生影响。这项拟议的研究旨在密切配合国家艾滋病战略目标，即改善艾滋病毒携带者获得护理的机会和减少健康差距。

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.