Incarceration and the HIV Epidemic

In this chapter, we provide an overview of the overlapping epidemics of Incarceration and HIV and how they impact communities of color. First, we provide a brief overview of the epidemiology of incarceration itself – the epidemiology of HIV within the criminal justice (CJ) system – and review some of the interpersonal-, community-, and system-level factors that contribute to high rates of HIV among CJ-involved individuals. Second, we review HIV prevention in jails and prisons, including the evidence for behavioral and biomedical HIV prevention interventions. Third, we examine the HIV care cascade, extending from diagnosis to linkage to care, retention in care, antiretroviral therapy (ART), and virologic suppression in CJ-involved individuals, including key gaps in the cascade and differences in outcomes by race and ethnicity. Fourth, we examine the issue of re-entry, including the multiple barriers people living with HIV (PLWH) face after incarceration which impact continuity of HIV care and treatment. Lastly, we discuss the issue of stigma for CJ-involved PLWH, which may occur during and after incarceration, including the intersectional stigma and discrimination associated with being a racial or ethnic minority, sexual minority, and someone who has been incarcerated. Finally, we conclude with future directions, including national policies which aim to decrease overall incarceration in the USA and promising partnerships and interventions to address health disparities in this vulnerable population.