标题：Highly Active Antiretroviral Therapy Use and HIV Transmission Risk Behaviors Among Individuals Who Are HIV Infected and Were Recently Released From Jail
摘要：We evaluated highly active anti-retroviral therapy (HAART) use and risk behaviors among 177 inmates who were HIV infected and were released and reincarcerated in San Francisco, Calif, jails over a 12-month period. During the month preceding reincarceration, HIV transmission risk behaviors were common among respondents, and 59% of those with a history of antiretroviral use were not taking HAART. HAART discontinuation was independently associated with homelessness, marijuana use, injection drug use, and not receiving community medical care. Postrelease interventions for inmates who are HIV infected are needed. A quarter of the adults who are HIV infected in the United States pass through correctional facilities annually. 1 Incarceration represents an opportunity to provide critical HIV prevention and health services, including highly active antiretroviral therapy (HAART). 2 – 6 The structured environment of jail and prison promote high rates of medication adherence, 7 – 9 leading to favorable virological and immunologic outcomes. 8 , 10 – 12 However, 2 recent studies documented rising viral loads and falling CD4 cell counts among prisoners who were released and then rein-carcerated. 11 , 12 These results suggest that ex-offenders may have difficulty transitioning from a situation in which antiretroviral therapy is taken in a structured and often directly observed setting to one in which medications must be self-managed while facing the challenges of community reentry. 12 Homelessness, joblessness, drug use, mental illness, and inconsistent health care among recently released inmates who are HIV infected likely contribute to discontinuation of or low adherence to treatment. 5 , 11 , 12 To our knowledge, no studies to date have directly assessed HAART use and adherence or factors associated with HAART use among recently released inmates. Furthermore, few studies have described the postrelease sexual and drug-related behaviors in this population. 13 , 14 To better understand antiretroviral use and HIV transmission behaviors of recently released inmates, we studied 177 inmates who were HIV infected and were released and then reincarcerated in the San Francisco, Calif, jail system in a 12-month period.
