Study finds gender disparities for inmates with HIV

In the largest study of inmates with HIV receiving antiretroviral therapy, Yale researchers uncovered significant differences in HIV treatment outcomes for men and women in the justice system. Their findings point to the need for gender-specific HIV prevention strategies for incarcerated individuals.

In the largest study of inmates with HIV receiving antiretroviral therapy, Yale researchers uncovered significant differences in HIV treatment outcomes for men and women in the justice system. Their findings point to the need for gender-specific HIV prevention strategies for incarcerated individuals.

The study was published July 16 in the American Journal of Public Health.

One in six people living with HIV in the United States passes through the criminal justice system each year. Incarceration of HIV-infected individuals has high fiscal and social costs, including disruption in HIV treatment. “In other studies, we see that women with HIV tend to have much better health outcomes than men while incarcerated, but they tend to fall apart much faster after release,” said Dr. Jaimie Meyer, assistant professor of medicine at Yale School of Medicine and first author on the study.

To further explore these gender differences, the Yale-led team used data from the Connecticut Department of Corrections that included more than 1,000 men and women with HIV who were incarcerated more than 2,000 times cumulatively over a seven-year period. They studied incarceration rates, criminal offense charges, and HIV treatment outcomes.

Their study revealed striking disparities between men and women. “Compared to men, women tend to be incarcerated for much shorter periods of time and for less severe crimes, like violation of probation or parole, prostitution, and drug-related offenses,” said Meyer. Additionally they found that men who were the most likely to re-offend were also most likely to have uncontrolled HIV infection on entry into the system.

The findings suggest a gender-specific approach to the intertwined issues of HIV and crime, said Meyer. “Women are being locked up for low-level, non-violent crimes,” she explained. “Our study provides evidence that women might have better outcomes with alternatives to incarceration that keep them out in the community longer.”

Such alternatives might include probation or specialty courts that refer offenders to community-based treatment programs instead of prison, said Meyer, noting that these community-based alternatives may be more effective because they address the underlying issues, like substance abuse, that are associated with criminal behavior.

“We’re talking about a population that is incredibly vulnerable to falling out of systems of care and support,” she noted. “We need to develop interventions that jointly address both public health and public safety.”

Other authors include Javier Cepeda, Faye S. Taxman, and Dr. Frederick L. Altice.

The study was supported by a Bristol Myers-Squibb Virology Fellows Award, a Patterson Trust Award in Clinical Research, and the National Institute on Drug Abuse (K23 DA033858 for JPM, F31 DA035709 for JC, K24 DA017072 for FLA, and R01 DA030768 for FST).

(Image by Michael S. Helfenbein. Photo via Shutterstock)