Strategies to Enhance HIV Care Continuum Outcomes for Individuals with HIV and a History of Incarceration

Overview

People with HIV who have experienced incarceration face significant barriers to continuous HIV care, leading to poorer health outcomes post-release. Recent interventions (2020–2023) show limited but promising results in improving engagement and viral suppression, highlighting the need for innovative, multilevel strategies.

Background

Incarceration disproportionately affects people with HIV, particularly among marginalized populations such as Black/African American, Hispanic/Latino/a, and sexual minorities. While HIV care outcomes are generally better during incarceration due to structured treatment access, post-release periods see steep declines in viral suppression and care engagement. Barriers include unstable housing, unemployment, untreated mental health and substance use disorders, and fragmented healthcare coordination. Addressing these challenges is critical to ending the HIV epidemic in the United States.

Data Highlights

Between 2020 and 2023, 6 peer-reviewed and 4 gray literature interventions targeting people with HIV and incarceration history were identified. Only 2 peer-reviewed studies demonstrated statistically significant improvements in HIV-related outcomes. The CDC reports that in 2021, 1.1% of incarcerated individuals had diagnosed HIV, and 5.4% of all people with HIV in the US were incarcerated in the previous year. Despite CDC recommendations for routine HIV testing and treatment in correctional settings, post-release care disruptions remain common.

Key Findings

• Eight interventions focused on providing reentry services to support engagement in HIV care and social services after incarceration release.
• Only two peer-reviewed interventions showed statistically significant improvements in HIV outcomes, indicating limited evidence of effectiveness.
• Gray literature interventions lacked sufficient methodological detail, limiting interpretation of their impact.
• Systems-level and multilevel interventions appear promising but require more rigorous evaluation.
• People with HIV and incarceration experience achieve viral suppression at rates comparable to the general HIV population when successfully linked and retained in care post-release.
• Barriers such as stigma, housing instability, mental health, and substance use disorders significantly impede HIV care engagement after incarceration.

Clinical Implications

Clinicians and public health practitioners should prioritize comprehensive reentry services that address social determinants of health alongside HIV care to improve outcomes for formerly incarcerated individuals. Enhanced coordination between correctional facilities and community-based providers is essential to ensure continuity of antiretroviral therapy and retention in care. Multilevel interventions that integrate medical, behavioral, and social support services may offer the most promise in overcoming barriers faced by this population.

Conclusion

Addressing the complex barriers to HIV care for people with incarceration experience requires innovative, rigorously evaluated interventions that span individual, community, and systems levels. Strengthening reentry support and care coordination is vital to improving HIV outcomes and advancing efforts to end the HIV epidemic.

References

1. CDC 2021 -- HIV in Correctional Facilities
2. HRSA Ryan White HIV/AIDS Program 2iS Initiative