HIV-infected women experience worse treatment outcomes after release from jail

A Yale study has uncovered significant gender differences in the treatment outcomes of HIV-infected jail detainees who are transitioning to life outside jail, with women faring much worse than men. The study appears online in the American Journal of Public Health.

In the United States, the HIV epidemic is highly concentrated among those in the criminal justice system. One sixth of all people living with HIV/AIDS transition through jail or prison annually. In addition, the criminal justice population has high numbers of people who experience economic or social instability, psychiatric disorders, and substance use disorders. These conditions have an adverse impact on treatment outcomes for those infected with HIV, and also interfere with HIV prevention and treatment efforts. Unlike prisons, jails house individuals who are pre-trial or have short sentences, leading to rapid turnover that is particularly destabilizing.

The team examined gender differences in HIV treatment outcomes at the time of release from jail and six months after release. One third were women. Compared with men, the women studied were significantly less likely to attain any of the three optimal HIV treatment outcomes at six months after release from jail. Those outcomes include having a regular HIV-care provider, gaining access to life-saving antiretroviral therapy, and achieving viral suppression — a phenomenon that can reduce HIV transmission to others. Overall, women were half as likely as men to achieve viral suppression by six months post-release.

Because the women are significantly less likely than men to get the continuing care they need to control their viral load, they have significantly more negative health outcomes, including transmission to their sexual partners.

“Women living with HIV and transitioning from jail often have severe psychiatric and substance use disorders that interfere with healthcare engagement. We have identified a gender-specific resource gap for people with HIV leaving jail and returning to communities,” said first author Jaimie Meyer, M.D., of the infectious diseases section of Yale School of Medicine.

The authors write that it’s urgent that future HIV prevention interventions be tailored to the unique needs of women in the criminal justice system.

Senior author is Frederick Altice, M.D., of Yale School of Medicine. Other authors are Alexei Zelenev and Jeffrey Wickersham of Yale; Paul Teixeira of the New York City Department of Health and Mental Hygiene; and Chyvette Williams of the University of Illinois School of Public Health.

The study was supported by grants from the Health Resources and Services Administration, and the National Institute on Drug Abuse (K24 DA017072, and K23 DA033858).

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