Pre-Incarceration Healthcare Use and Access Barriers among Men with HIV and those at-Risk for Contracting HIV: A Case Study of an Urban Jail.

Abstract

Approximately 1.5% of incarcerated people live with HIV. Limited information on their pre-incarceration healthcare use which could inform discharge planning efforts to link them to treatment is available. We investigate factors associated with pre-incarceration healthcare use and access barriers for a status-neutral HIV cohort. We collected data via self-report from men with HIV (n = 22) or at-risk of contracting HIV (n = 77) who entered the Washington, DC, Department of Corrections jail from November 2020 to June 2021. We analyzed pre-incarceration hospital, emergency department (ED), physician and mental health visits, and access barriers using t-tests, chi-square tests, and logistic regressions informed by the Anderson Behavioral Model of healthcare utilization. During the year prior to incarceration, more than half of men visited the ED, while less than 20% visited a physician. Over half the sample viewed medical care as too expensive, even though 75% were insured. Depressed men were significantly more likely to report access barriers. Homelessness was the only factor found to be significantly associated with a greater likelihood of urgent and acute care use. Neither HIV status, insurance status, educational level nor race affected healthcare use by type of service. Pre-incarceration men with or at-risk of contracting HIV have limited contact with community physicians who are critical to HIV management. Given the effect of unstable housing on the types of healthcare used, programs to promote HIV treatment and pre-exposure prophylaxis (PrEP) should consider embedding condition-specific discharge planning into an approach addressing a wider array of needs.