Skip to main content
NCBI home page
Journal of Correctional Health Care logoLink to Journal of Correctional Health Care
. 2022 Aug 4;28(4):236–242. doi: 10.1089/jchc.20.04.0021

HIV and Incarceration: Implications for HIV-Positive People Who Use Illicit Drugs During a Seek, Test, Treat, and Retain Initiative in Canada

Ezequiel Blumenkrans 1, Jonah Hamilton 1, N A Mohd Salleh 1, Angela Kaida 2, Will Small 1,2, Rolando Barrios 3, M-J Milloy 1,4,*
PMCID: PMC9529366  PMID: 35758827

Abstract

People who use illicit drugs (PWUD) face increased exposure to the criminal justice system and disproportionate burdens of HIV infection. This article investigated the effects of incarceration on HIV cascade of care-related measures in a setting with a community-wide seek, test, treat, and retain (STTR) initiative. Using a multivariable logistic regression analysis of 935 HIV-positive PWUD between 2005 and 2017, this article showed a negative relationship between periods of incarceration and two measures of engagement in clinical care for HIV among PWUD: recent dispensation of antiretroviral therapy and suppression of HIV viral load. These findings suggest the benefits of STTR-based efforts are limited by exposure to the criminal justice system and highlight the need for additional supports for PWUD with HIV exposed to the criminal justice system.

Keywords: HIV, people who use drugs, antiretroviral therapy, harm reduction, incarceration

Introduction

Despite a high prevalence of people who use illicit drugs (PWUD) living with HIV worldwide (Jürgens et al., 2011), members of this key population have yet to experience equitable access, exposure, and beneficial outcomes from antiretroviral therapy (ART; Kerr et al., 2012). Of the more than 15 million PWID, it is estimated that approximately one in five are living with HIV (Milloy et al., 2014). Increased HIV testing coupled with immediate, optimal, and sustained engagement of ART, a strategy known as seek, test, treat, and retain (STTR), is a new cornerstone of the global response to the HIV pandemic (Milloy et al., 2014).

Optimal exposure to ART has been shown to reliably suppress HIV viral load (VL) to below detectable concentrations, resulting in a significant decrease in HIV disease progression, morbidity, and mortality, as well as effectively eliminating the risk of onward HIV transmission (Joseph et al., 2016).

Given the high prevalence of exposure to the criminal justice system among PWUD, correctional facilities are important venues for the provision of HIV testing and treatment (Springer et al., 2004). In some settings, correctional facilities can facilitate the delivery of ART to PWUD by reducing the loss to follow-up, assured dosing schedules, and decreased access to illicit substances (Milloy et al., 2014).

However, a large body of research has shown that incarceration poses a significant barrier to achieving optimal ART adherence (Joseph et al., 2016; Milloy et al., 2011, 2014). In addition to limited availability of evidence-based HIV prevention services (e.g., sterile syringes, condoms, methadone) in most correctional settings, cycles of incarceration may impede the continuity of ART, especially when linkage strategies to HIV care upon release are inadequate (Iroh et al., 2015; Joseph et al., 2016; Milloy et al., 2011, 2014; Springer et al., 2010; Westergaard et al., 2011).

Although the association between recent incarceration and lower likelihood of optimal ART exposure among PWUD is well known, the majority of these studies have been carried out in the United States, a setting without a universal health care system or a nationwide STTR initiative.

Many past studies have raised concerns about the impact of exposure to the criminal justice system on outcomes from STTR initiatives (Iroh et al., 2015; Jürgens et al., 2011; Milloy et al., 2011, 2014; Springer et al., 2004, 2010; Westergaard et al., 2011); however, we are unaware of any empiric evaluations of this question using longitudinal data from community-recruited cohorts of HIV-positive PWUD in settings with ongoing STTR initiatives. Thus, the aim of this study was to investigate the effects of recent exposure to correctional facilities on exposure to ART, ART adherence, and virological outcomes among HIV-positive PWUD during a community-wide STTR initiative.

Method

Study Design and Population

Data for these analyses were collected from the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS), an ongoing community-recruited prospective cohort of HIV-positive PWUD in Vancouver, Canada, which began in 2005. The cohort was primarily recruited through extensive street outreach in Vancouver's Downtown Eastside area (DTES), a neighborhood with high levels of marginalization, poverty, and HIV infection in addition to an open drug market. Details describing the cohort and recruitment procedures have been described previously (Wood et al., 2008). Individuals are eligible for ACCESS if they are 18 years of age or older, used illicit drugs (e.g., heroin, cocaine, methamphetamine) other than or in addition to cannabis in the previous month, are HIV positive, and provide written informed consent.

After recruitment, at baseline and at each 6-month follow-up visit, participants complete an interviewer-administered questionnaire that collects information on drug use patterns, health service utilization, sociodemographic characteristics, and other relevant exposures. A study nurse examines participants and draws blood specimens for determinations of CD4 cell counts, HIV plasma VL, and HIV viral resistance.

Data elicited from participant interviews are confidentially linked to records held by the British Columbia Centre for Excellence in HIV/AIDS Drug Treatment Programme (DTP), the local province-wide ART dispensary and HIV clinical monitoring registry (Wood et al., 2008), producing a complete retrospective and prospective HIV clinical profile for all individuals whether in community or correctional settings.

Of note, all HIV treatment, care, and medication, such as ART, are dispensed through the DTP and provided at no charge to all residents of the province of British Columbia through Canada's universal no-fee health care system. For each study visit, participants are offered an honorarium of $40 (Canadian dollars). The ACCESS study was approved by the Providence Health Care/University of British Columbia Research Ethics Board.

For the present analysis, the study sample was restricted to participants who completed ≥1 study interview between December 2005 and May 2017 and had ≥1 CD4 and ≥1 HIV VL test within 180 days of their baseline interview.

Measures

In these analyses, the primary outcomes of interest were three longitudinal measures of engagement in the HIV cascade of care (Mugavero et al., 2013): dispensation of ART in the previous 180 days (0 days vs. ≥1 day[s]), adherence to ART in the previous 180 days (≤95 vs. >95%), and exhibiting an undetectable (i.e., <50 copies/mL) plasma HIV-1 RNA VL (yes vs. no).

To measure dispensation, we accessed data on the starting and ending dates for ART dispensed and collected by participants for each interview period from the province-wide ART dispensary, dichotomizing at 0 days versus ≥1 day(s) for each interview period.

To measure ART adherence, we used a previously validated measure based on ART dispensation data (Wood et al., 2003). Specifically, for each interview period, we defined adherence as the quotient of the number of days for which ART was dispensed and collected in the previous 180 days divided by the number of days since ART initiation to a maximum of 180 days, dichotomized at ≤95% versus >95%. We have previously demonstrated that this measure of ART adherence is strongly associated with viral suppression and survival (Wood et al., 2003, 2008).

To measure HIV VL detectability, we used the mean of all HIV VL tests (Roche Molecular Systems, Pleasanton, CA) conducted on blood collected by the study or as a part of regular clinical care in the previous 180 days, dichotomized at ≥50 versus <50 copies/mL plasma. If records indicated no tests had been performed in the previous 180 days, we defined HIV VL as ≥50 copies/mL unless dispensation records indicated ART had been dispensed and collected for 180 days during the period. These definitions are consistent with previous analyses from this setting (Milloy, King, et al., 2016; Milloy, Wood, et al., 2016).

The primary explanatory variable of interest was self-reported recent incarceration, defined as spending at least one night held in custody in a juvenile detention facility, municipal holding cell, provincial prison, or federal penitentiary in the previous 180 days, consistent with earlier analyses (Koehn et al., 2015; Milloy et al., 2011, 2013).

Based on prior literature (Joseph et al., 2016; Milloy et al., 2011, 2014; Richardson et al., 2015; Springer et al., 2010; Ti et al., 2014; Westergaard et al., 2011), we also considered a range of secondary explanatory variables that we hypothesized could be associated with HIV treatment engagement and incarceration among PWUD, including age (per year older), gender (male vs. nonmale), self-reported ethnicity (White ancestry vs. non-White ancestry), and level of education attained (≥high school diploma vs. <high school).

In addition to these time-fixed variables, we included time-varying variables: residency in the DTES (yes vs. no), drug dealing (yes vs. no), involvement in sex work (yes vs. no), heroin injection (≥daily vs. <daily), crack smoking (≥daily vs. <daily), and cocaine injection (≥daily vs. <daily). We also included hepatitis C virus antibody status (positive vs. negative). All time-varying variables refer to the 6-month period before the follow-up interview.

Statistical Analyses

As a first step, we examined characteristics of the study sample at baseline stratified by having been recently incarcerated before enrollment. We compared categorical variables with the χ2 test (or Fischer's exact test if any cell included <5 counts). We compared continuous variables using the Wilcoxon rank sum test. Next, we built logistic regression models with generalized estimating equations (GEEs) and a logit link function to account for serial measures per participant over time to estimate the crude longitudinal relationships between each explanatory variable and the three outcomes of interest, that is, recent dispensation of ART, optimal adherence to ART, and undetectable HIV VL.

To estimate the independent effect of incarceration on each outcome of interest, we built multivariable GEE models using an a priori backward selection procedure first suggested by Greenland and colleagues (Maldonado & Greenland, 1993). For each outcome, we first fit a full model including the primary explanatory variable and all secondary explanatory variables with p-values <0.2 in crude analyses.

Using a manual stepwise approach, we fit reduced models each containing one variable removed from the previous set, noting the relative change in the coefficient associated with the primary explanatory variable. We removed the secondary explanatory variable corresponding to the smallest relative change. We continued this iterative process until the minimum change from the full model exceeded 5%. All statistical analyses were performed using R version 3.3.0 and p-values are two sided.

Results

Between May 2005 and June 2017, 935 PWUD were recruited who had ≥1 interview during the study period and ≥1 CD4 and ≥1 HIV VL test within 180 days of their baseline interview. They contributed 9,064 observations (median 11 per participant, interquartile range [IQR]: 5–17) equal to 4,532 person-years of observation. Baseline characteristics of study participants stratified by recent incarceration are presented in Table 1. The median age was 43 years (IQR: 36–48) and 612 (65.5%) were male.

Table 1.

Baseline Characteristics of 935 HIV-Positive People Who Use Illicit Drugs Stratified by Incarceration in the Previous 6 Months, Vancouver, Canada (2005–2017)

Characteristics Total, (%) (N = 935) Recent incarceration
 p
Yes, (%) (N = 123) No, (%) (N = 812)
Individual-level factors
 Male sex 612 (65.5) 82 (66.7) 530 (65.3) 0.806
 White ancestry 517 (55.3) 64 (52.0) 453 (55.8) 0.429
 DTES residencya 605 (64.7) 98 (79.7) 507 (62.4) <0.001
 ≥High school education 431 (46.1) 58 (47.2) 373 (45.9) 0.722
 Age (median, IQR) 43 (36–48) 39 (34–43) 44 (37–49)  
Behavioral factors
 ≥Daily crack smokinga 303 (32.4) 64 (52.0) 239 (29.4) <0.001
 ≥Daily cocaine injectiona 76 (8.1) 12 (9.8) 64 (7.9) 0.484
 ≥Daily heroin injectiona 160 (17.1) 45 (36.6) 115 (14.2) <0.001
Clinical-level factors
 ≥95% ART adherencea 368 (39.4) 35 (28.5) 333 (41) 0.693
 HIV VL <50 copies/mLa 299 (32.0) 24 (19.5) 275 (33.9) 0.002
 ≥1 day on ARTa 591 (63.2) 57 (46.3) 534 (65.8) <0.001
 HCV antibody positive 787 (84.2) 105 (85.4) 682 (84) 0.596
Open in a new tab
a

Refers to the 6-month period before the baseline interview.

ART, antiretroviral therapy; DTES, Downtown Eastside; HCV, hepatitus C virus; IQR, interquartile range; VL, viral load.

Over the study period, 123 (13.2%) of the participants reported at least one recent incarceration. Of note, recently incarcerated individuals were younger (39.0 vs. 44.0 years, p < 0.001), more likely to reside in the DTES (79.9% vs. 62.4%, p < 0.001), more likely to engage in daily crack smoking (52.0% vs. 29.4%, p < 0.001), and more likely to engage in daily heroin injection (36.6% vs. 14.2%, p < 0.001). Most notably, recently incarcerated participants were less likely to have been dispensed ART in the previous 180 days (46.3% vs. 65.8%, p < 0.001) and less likely to have an undetectable HIV VL (19.5% vs. 33.9%, p = 0.002).

The results of the longitudinal analyses of incarceration on the three HIV cascade measures are presented in Table 2. Recent incarceration was negatively and significantly associated with the likelihood of being dispensed ART in the previous 180 days in both crude (odds ratio [OR] = 0.25, 95% confidence interval [CI]: 0.19–0.34) and adjusted (adjusted OR [AOR] = 0.66, 95% CI: 0.45–0.96) analyses.

Table 2.

Crude and Adjusted Longitudinal Estimates of Likelihood of Optimal HIV Treatment Indicators Among 935 HIV-Positive People Who Use Illicit Drugs, Vancouver, Canada (2005–2017)

Characteristic OR 95% CI p AOR 95% CI p
≥1 day of ART in previous 180 days
 Incarceration 0.25 0.19–0.34 <0.0001 0.66 0.45–0.96 0.0295
 DTES residency 0.51 0.41–0.64 <0.0001      
 ≥High school education 0.98 0.59–1.64 0.9446      
 White ancestry 1.22 0.75–2.01 0.4236      
 Daily noninjecting crack use 0.17 0.14–0.22 <0.0001 0.41 0.30–0.55 <0.0001
 Daily injecting cocaine use 0.58 0.42–0.79 0.0007      
 Daily injecting heroin use 0.31 0.24–0.39 <0.0001 0.45 0.32–0.62 <0.0001
 HCV antibody (yes vs. no) 1.02 0.54–1.92 0.9562      
 Sex (male vs. nonmale) 2.34 1.41–3.90 0.0011      
 Age (per year)a 1.96 1.86–2.07 <0.0001 1.85 1.75–1.96 <0.0001
 Drug dealing 0.36 0.29–0.45 <0.001      
 Sex work 0.43 0.31–0.60 <0.001      
≥95% ART adherence in previous 180 daysb
 Incarceration 0.75 0.59–0.97 0.0258 0.96 0.74–1.25 0.773
 DTES residency 0.89 0.77–1.03 0.1045      
 ≥High school education 1.00 0.78–1.27 0.9796      
 White ancestry 1.67 1.31–2.12 <0.0001      
 Daily noninjecting crack use 0.53 0.45–0.62 <0.0001 0.64 0.54–0.76 <0.0001
 Daily injecting cocaine use 0.82 0.64–1.04 0.1068      
 Daily injecting heroin use 0.60 0.49–0.74 <0.0001 0.69 0.56–0.84 0.0001
 HCV antibody (yes vs. no) 1.21 0.88–1.68 0.2469      
 Sex (male vs. nonmale) 1.39 1.08–1.79 0.0113 1.03 0.79–1.33 0.849
 Age (per year)a 1.06 1.05–1.08 <0.0001 1.05 1.04–1.07 <0.0001
 Drug dealing 0.59 0.50–0.70 <0.001 0.76 0.63–0.90 0.002
 Sex work 0.88 0.69–1.11 0.282      
Plasma HIV-1 RNA VL <50 copies/mL
 Incarceration 0.37 0.29–0.47 <0.0001 0.62 0.47–0.80 0.0003
 DTES residency 0.57 0.49–0.67 <0.0001      
 ≥High school education 1.03 0.76–1.39 0.8655      
 White ancestry 1.28 0.95–1.73 0.1094      
 Daily noninjecting crack use 0.31 0.27–0.37 <0.0001 0.48 0.40–0.57 <0.0001
 Daily injecting cocaine use 0.74 0.58–0.94 0.0148      
 Daily injecting heroin use 0.52 0.43–0.63 <0.0001 0.65 0.53–0.81 0.0001
 HCV antibody (yes vs. no) 1.45 0.99–2.12 0.0588      
 Sex (male vs. nonmale) 1.57 1.15–2.14 0.0049      
 Age (per year)a 1.26 1.24–1.29 <0.0001 1.23 1.21–1.26 <0.0001
 Drug dealing 0.96 0.80–1.16 0.7      
 Sex work 0.82 0.63–1.08 1.57      
Open in a new tab
a

At baseline.

b

Among 935 HIV-positive individuals.

AOR, adjusted odds ratio; CI, confidence interval; DTES, Downtown Eastside; HCV, hepatitis C virus; OR, odds ratio; VL, viral load.

In addition, recently incarcerated individuals were also significantly less likely to have undetectable HIV VL in both crude (OR = 0.37, 95% CI: 0.29–0.47) and adjusted (AOR = 0.62, 95% CI: 0.47–0.80) analyses. However, we did not observe a significant link between recent incarceration and the likelihood of participants attaining 95% adherence in the past 6 months in either crude (OR = 0.75, 95% CI: 0.59–0.97) or adjusted (AOR = 0.96, 95% CI: 0.74–1.25) analyses.

In light of the presence of the criminal behavior measures in the multivariate analysis (Table 2), we conducted a subanalysis to test for the presence of multicollinearity that may have affected the incarceration variable. For all the multivariable models with the main predictor variable (incarceration in previous 180 days) and covariates with p-values <0.1 in the bivariate analysis, the variance inflation factor did not provide evidence of multicollinearity.

In addition, to assess whether the observed deleterious effects of incarceration on engagement in ART and HIV VL nondetectability were the result of engagement in criminalized behaviors (e.g., drug dealing and sex work), we conducted two further subanalyses: first, we forced these variables into the final multivariable models as already described; second, we fit multivariable models including terms for incarceration, drug dealing, and sex work (results not shown). In all cases, the estimate for incarceration was not substantially changed.

Discussion

In line with a large body of research documenting the detrimental effects of the criminalization of illegal drug use on the health of HIV-positive PWUD, including links between incarceration and suboptimal access and adherence to ART (Milloy et al., 2011, 2013, 2014), our research demonstrated that recent incarceration was negatively associated with two HIV cascade-of-care measures: optimal ART exposure and undetectable HIV VL in the context of a community-wide STTR initiative. In addition, we found that recent incarceration was not significantly associated with adherence to ART. Our findings suggest that HIV-positive PWUD's exposure to correctional settings not only exerts a negative impact on individual-level disease progression but also increases the risk of HIV transmission.

The finding that suboptimal ART exposure and increased risk of detectable HIV VL are associated with incarceration is consistent with previous observations supporting the detrimental effect of incarceration on HIV care outcomes (Iroh et al., 2015; Loeliger et al., 2018; Westergaard et al., 2011). For example, a 2011 study based in Baltimore, Maryland, involving more than 400 recently incarcerated HIV-positive PWUD observed that incarceration increased the risk of HIV viral rebound among PWUD who had achieved viral suppression before incarceration, even when adjusting for continuous use of ART (Westergaard et al., 2011). The same study also observed that incarcerations were only significantly linked with virological failure in PWUD who were incarcerated for less than 30 days (Westergaard et al., 2011).

These findings could be attributed to interruptions in obtaining ART medication resulting from the transfer between custodial and community settings, a well-known risk factor for treatment disengagement. For example, a 2009 retrospective cohort study of over 2,000 HIV-positive individuals released from the Texas state prison system found that of those receiving ART at the time of release, only 5% filled their ART prescription in the first 10 days (Baillargeon et al., 2009).

Previous research has consistently identified considerable barriers to achieving optimal access and adherence to ART for people held in correctional facilities, including delays in dispensing ART medications, lack of confidentiality regarding HIV status, and inadequate continuity of care between community-based and in-prison providers (Milloy et al., 2011, 2012). In addition, a substantial body of research has observed that the postrelease period is a highly vulnerable time for PWUD, especially those infected with HIV (Springer et al., 2010; Westergaard et al., 2011).

The postrelease period has been associated with increased risks of relapse to drug use, recidivism to prison, poor virological treatment outcomes, and HIV risk behaviors resulting in increased rates of sexually transmitted infections and syringe lending (Springer et al., 2010; Westergaard et al., 2011; Wood et al., 2012).

In our study, we observed that periods of incarceration were associated with approximately 34% lower odds of at least 1 day of antiretroviral dispensation during that interview period, despite the existence of a community-wide STTR initiative, a universal health care system, and the provision of ART within correctional facilities. This is consistent with an earlier finding from our setting that found incarceration was associated with lower rates of ART initiation independent of CD4 cell count and illicit drug use patterns for local HIV-positive PWUD (Joseph et al., 2016). Clearly, these results point to the need for additional supports for HIV-positive people to initiate or maintain access to HIV treatment when held in correctional facilities.

The positive association between periods of incarceration and detectable HIV VL has important implications for viral transmission, especially given the lack of evidence-based HIV prevention and treatment efforts in many correctional settings (Milloy et al., 2013, 2014; Springer et al., 2004). According to a 2010 report by the Correctional Service of Canada, approximately half of incarcerated PWUD in Canada have shared used injection equipment including needles while in prison (HIV Prevalence in Prison, 2010).

Moreover, recent incarceration was strongly linked to a greater than twofold increase in needle sharing among HIV-positive PWUD in Maryland (Westergaard et al., 2011), with further risk of HIV and hepatitis C transmission (Hagan, 2003). Although prison-based needle exchange programs have demonstrated effectiveness in decreasing risks of syringe sharing, injection drug use, and violence (HIV Prevalence in Prison, 2010; Maru et al., 2008), the provision of sterile syringes and needles for individuals in Canadian correctional settings remains challenging.

In addition, the delivery of opioid agonist therapy (OAT) within correctional facilities has been associated with reduced risky injecting practices (Hedrich et al., 2012) and transmission of infectious diseases (Dolan et al., 2005), as well as improved HIV care outcomes, including adherence to treatment (Culbert et al., 2019). Despite these benefits, there is evidence demonstrating that recent incarceration is linked to lower odds of methadone use (Koehn et al., 2015). The link we observed between incarceration and risk of HIV transmissibility highlights the need to prioritize the implementation of evidence-based medical care, including distribution of sterile injection equipment and OAT in correctional settings as a part of STTR-based efforts.

Several limitations to this study must be considered. First, our study relied on self-reported data, which is subject to biases, including socially desirable reporting, recall bias, and underreporting of stigmatized behaviors, such as income generation from illegal activities. Nevertheless, previous studies have shown self-reports to be reliable measures of drug use and other HIV risk behaviors (Darke, 1998). In addition, we note that our outcomes of interest were derived not from self-report but from administrative data.

Second, the study sample was not randomly selected and, therefore, generalizability to the larger population of HIV-positive PWUD or to other settings is limited. A third limitation is the potential influence of unmeasured confounding variables. To reduce the effects of confounding, we utilized multivariable modeling. Finally, our study lacks data on the length of self-reported incarceration events. This information would add to the analysis and should be a priority for future research to include. Although the length of incarceration was not available for the entire study period, a past study from our setting found incarceration in a prison or penitentiary (but not in pretrial detention) was the strongest nonclinical indicator of viral rebound, suggesting possible differential effects of distinct correctional environments (Milloy et al., 2012).

As many jurisdictions implement and scale up STTR-based efforts to provide more effective care for HIV-positive individuals and decrease community-level HIV VL to curb the incidence of new infections, incarceration has emerged as a major barrier (Joseph et al., 2016; Jürgens et al., 2011; Milloy et al., 2014). Here, it is important to note that a large body of research on offender risk assessment has highlighted the importance of addressing criminogenic needs—that is, specific aspects of an individual or their situation, such as substance use, that act as dynamic risk factors related to the risk of recidivism (Andrews et al., 1990; Bonta, 2002; Dhaliwal et al., 1994).

Although a positive correlation has been shown to exist between the number and intensity of criminogenic needs and risk of exposure to the criminal justice system (Andrews et al., 2006), our findings clearly show that the link between incarceration and poorer HIV outcomes is independent of these individual-level criminal behaviors. Our current findings reinforce the concern that the benefits of STTR-based campaigns for PWUD are compromised by incarceration and, more generally, legal regimes based on prohibition of some psychoactive substances.

In addition to their impact on prevention and treatment of HIV, it is important to note that both international conventions and, in many countries including our own, national laws governing criminal justice systems affirm the right of people held in custody to access health care consistent with what is available in noncustodial settings (UNODC, 2015).

To conclude, our findings document poorer HIV treatment patterns associated with incarceration in a setting with a universal health care system and an ongoing STTR-based initiative. They point to the need for STTR programs to incorporate elements to mitigate the deleterious effects of exposure to the criminal justice system on the health of PWUD as a central part of their efforts to reduce rates of HIV morbidity, mortality, and viral transmission.

Acknowledgments

We thank the study participants for their contribution to the research, as well as current and past researchers and staff.

Author Disclosure Statement

The authors disclosed no conflicts of interest with respect to the research, authorship, or publication of this article.

Funding Information

This research was undertaken, in part, thanks to funding from the Canadian Institutes of Health Research (CIHR) Canadian Research Initiative on Substance Misuse (SMN-139148). M-J.M. is supported by the U.S. National Institutes of Health (U01-DA0251525), a New Investigator Award from CIHR, and a Scholar Award from the Michael Smith Foundation for Health Research. His institution has received an unstructured gift from NG Biomed, Ltd., a private firm seeking a license to produce cannabis, to support him. He is the Canopy Growth professor of cannabis science at the University of British Columbia, a position created by arms' length gifts to the university from Canopy Growth, a licensed producer of cannabis, and the Government of British Columbia's Ministry of Mental Health and Addictions.

References

  1. Andrews, D. A., Bonta, J., & Wormith, J. S. (2006). The recent past and near future of risk and/or need assessment. Crime & Delinquency, 52(1), 7–27. 10.1177/0011128705281756 [DOI] [Google Scholar]
  2. Andrews, D. A., Zinger, I., Hoge, R. D., Bonta, J., Gendreau, P., & Cullen, F. T. (1990). Does correctional treatment work? A clinically relevant and psychologically informed meta-analysis. Criminology, 28(3), 369–404. 10.1111/j.1745-9125.1990.tb01330.x [DOI] [Google Scholar]
  3. Baillargeon, J., Giordano, T. P., Rich, J. D., Wu, Z. H., Wells, K., Pollock, B. H., & Paar, D. P. (2009). Accessing antiretroviral therapy following release from prison. JAMA, 301(8), 848–857. 10.1001/jama.2009.202 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bonta, J. (2002). Offender risk assessment: Guidelines for selection and use. Criminal Justice and Behavior, 29(4), 355–379. 10.1177/0093854802029004002 [DOI] [Google Scholar]
  5. Culbert, G. J., Waluyo, A., Wang, M., Putri, T. A., Bazazi, A. R., & Altice, F. L. (2019). Adherence to antiretroviral therapy among incarcerated persons with HIV: Associations with methadone and perceived safety. AIDS and Behavior, 23(8), 2048–2058. 10.1007/s10461-018-2344-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Darke, S. (1998). Self-report among injecting drug users: A review. Drug and Alcohol Dependence, 51(3), 253–268. 10.1016/s0376-8716(98)00028-3 [DOI] [PubMed] [Google Scholar]
  7. Dhaliwal, G. K., Porporino, F., & Ross, R. R. (1994). Assessment of criminogenic factors, program assignment, and recidivism. Criminal Justice and Behavior, 21(4), 454–467. 10.1177/0093854894021004005 [DOI] [Google Scholar]
  8. Dolan, K. A., Shearer, J., White, B., Zhou, J., Kaldor, J., & Wodak, A. D. (2005). Four-year follow-up of imprisoned male heroin users and methadone treatment: Mortality, re-incarceration and hepatitis C infection. Addiction, 100(6), 820–828. 10.1111/j.1360-0443.2005.01050.x [DOI] [PubMed] [Google Scholar]
  9. Hagan, H. (2003). The relevance of attributable risk measures to HIV prevention planning. AIDS, 17(6), 911–913. 10.1097/00002030-200304110-00017 [DOI] [PubMed] [Google Scholar]
  10. Hedrich, D., Alves, P., Farrell, M., Stöver, H., Møller, L., & Mayet, S. (2012). The effectiveness of opioid maintenance treatment in prison settings: A systematic review. Addiction, 107(3), 501–517. 10.1111/j.1360-0443.2011.03676.x [DOI] [PubMed] [Google Scholar]
  11. HIV prevalence in prison is 15 times greater than in the community as a whole. (2010). HIV/AIDS Policy & Law Review, 15(1), 5–6. [PubMed] [Google Scholar]
  12. Iroh, P. A., Mayo, H., & Nijhawan, A. E. (2015). The HIV care cascade before, during, and after incarceration: A systematic review and data synthesis. American Journal of Public Health, 105(7), e5–e16. 10.2105/AJPH.2015.302635 [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Joseph, B., Wood, E., Hayashi, K., Kerr, T., Barrios, R., Parashar, S., Richardson, L., Dobrer, S., Guillemi, S., Montaner, J., & Milloy, M-J., (2016). Factors associated with initiation of antiretroviral therapy among HIV-positive people who use injection drugs in a Canadian setting. AIDS, 30(6), 925–932. 10.1097/QAD.0000000000000989 [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Jürgens, R., Nowak, M., & Day, M. (2011). HIV and incarceration: Prisons and detention. Journal of the International AIDS Society, 14, 26. 10.1186/1758-2652-14-26 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Kerr, T., Marshall, B. D., Milloy, M-J., Zhang, R., Guillemi, S., Montaner, J. S., & Wood, E. (2012). Patterns of heroin and cocaine injection and plasma HIV-1 RNA suppression among a long-term cohort of injection drug users. Drug and Alcohol Dependence, 124(1–2), 108–112. 10.1016/j.drugalcdep.2011.12.019 [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Koehn, J. D., Bach, P., Hayashi, K., Nguyen, P., Kerr, T., Milloy, M-J., Rieb, L., & Wood, E. (2015). Impact of incarceration on rates of methadone use in a community recruited cohort of injection drug users. Addictive Behaviors, 46, 1–4. 10.1016/j.addbeh.2015.01.038 [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Loeliger, K. B., Altice, F. L., Desai, M. M., Ciarleglio, M. M., Gallagher, C., & Meyer, J. P. (2018). Predictors of linkage to HIV care and viral suppression after release from jails and prisons: A retrospective cohort study. Lancet HIV, 5(2), e96–e106. 10.1016/S2352-3018(17)30209-6 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Maldonado, G., & Greenland, S. (1993). Simulation study of confounder-selection strategies. American Journal of Epidemiology, 138(11), 923–936. 10.1093/oxfordjournals.aje.a116813 [DOI] [PubMed] [Google Scholar]
  19. Maru, D. S., Bruce, R. D., Walton, M., Mezger, J. A., Springer, S. A., Shield, D., & Altice, F. L. (2008). Initiation, adherence, and retention in a randomized controlled trial of directly administered antiretroviral therapy. AIDS and Behavior, 12(2), 284–293. 10.1007/s10461-007-9336-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Milloy, M-J., Kerr, T., Buxton, J., Rhodes, T., Guillemi, S., Hogg, R., Montaner, J., & Wood, E. (2011). Dose-response effect of incarceration events on nonadherence to HIV antiretroviral therapy among injection drug users. Journal of Infectious Diseases, 203(9), 1215–1221. 10.1093/infdis/jir032 [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Milloy, M-J., Kerr, T., Buxton, J., Rhodes, T., Krusi, A., Guillemi, S., Hogg, R., Montaner, J., & Wood, E. (2012). Social and environmental predictors of plasma HIV RNA rebound among injection drug users treated with antiretroviral therapy. Journal of Acquired Immune Deficiency Syndromes, 59(4), 393–399. 10.1097/QAI.0b013e3182433288 [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Milloy, M-J., Kerr, T., Salters, K., Samji, H., Guillemi, S., Montaner, J., & Wood, E. (2013). Incarceration is associated with used syringe lending among active injection drug users with detectable plasma HIV-1 RNA: A longitudinal analysis. BMC Infectious Diseases, 13, 565. 10.1186/1471-2334-13-565 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Milloy, M-J., King, A., Kerr, T., Adams, E., Samji, H., Guillemi, S., Wood, E., & Montaner, J. (2016). Improvements in HIV treatment outcomes among indigenous and non-indigenous people who use illicit drugs in a Canadian setting. Journal of the International AIDS Society, 19(1), 20617. 10.7448/IAS.19.1.20617 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Milloy, M-J., Montaner, J. S., & Wood, E. (2014). Incarceration of people living with HIV/AIDS: Implications for treatment-as-prevention. Current HIV/AIDS Reports, 11(3), 308–316. 10.1007/s11904-014-0214-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Milloy, M-J., Wood, E., Kerr, T., Hogg, B., Guillemi, S., Harrigan, P. R., & Montaner, J. (2016). Increased prevalence of controlled viremia and decreased rates of HIV drug resistance among HIV-positive people who use illicit drugs during a community-wide treatment-as-prevention initiative. Clinical Infectious Diseases, 62(5), 640–647. 10.1093/cid/civ929 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Mugavero, M-J., Amico, K. R., Horn, T., & Thompson, M. A. (2013). The state of engagement in HIV care in the United States: From cascade to continuum to control. Clinical Infectious Diseases, 57(8), 1164–1171. 10.1093/cid/cit420 [DOI] [PubMed] [Google Scholar]
  27. Richardson, L. A., Kerr, T. H., Dobrer, S., Puskas, C. M., Guillemi, S. A., Montaner, J. S., Wood, E., & Milloy, M-J. (2015). Socioeconomic marginalization and plasma HIV-1 RNA nondetectability among individuals who use illicit drugs in a Canadian setting. AIDS, 29(18), 2487–2495. 10.1097/QAD.0000000000000853 [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Springer, S. A., Chen, S., & Altice, F. L. (2010). Improved HIV and substance abuse treatment outcomes for released HIV-infected prisoners: The impact of buprenorphine treatment. Journal of Urban Health, 87(4), 592–602. 10.1007/s11524-010-9438-4 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Springer, S. A., Pesanti, E., Hodges, J., Macura, T., Doros, G., & Altice, F. L. (2004). Effectiveness of antiretroviral therapy among HIV-infected prisoners: Reincarceration and the lack of sustained benefit after release to the community. Clinical Infectious Diseases, 38(12), 1754–1760. 10.1086/421392 [DOI] [PubMed] [Google Scholar]
  30. Ti, L., Milloy, M-J., Shannon, K., Simo, A., Hogg, R. S., Guillemi, S., Montaner, J., Kerr, T., & Wood, E. (2014). Suboptimal plasma HIV-1 RNA suppression and adherence among sex workers who use illicit drugs in a Canadian setting: An observational cohort study. Sexually Transmitted Infections, 90(5), 418–422. 10.1136/sextrans-2013-051408 [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. United Nations Office on Drugs and Crime. (2015). The United Nations standard minimum rules for the treatment of prisoners (the Nelson Mandela rules). https://www.unodc.org/documents/justice-and-prison-reform/GA-RESOLUTION/E_ebook.pdf
  32. Westergaard, R. P., Kirk, G. D., Richesson, D. R., Galai, N., & Mehta, S. H. (2011). Incarceration predicts virologic failure for HIV-infected injection drug users receiving antiretroviral therapy. Clinical Infectious Diseases, 53(7), 725–731. 10.1093/cid/cir491 [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Wood, E., Hogg, R. S., Lima, V. D., Kerr, T., Yip, B., Marshall, B. D., & Montaner, J. S. (2008). Highly active antiretroviral therapy and survival in HIV-infected injection drug users. JAMA, 300(5), 550–554. 10.1001/jama.300.5.550 [DOI] [PubMed] [Google Scholar]
  34. Wood, E., Milloy, M-J., & Montaner, J. S. (2012). HIV treatment as prevention among injection drug users. Current Opinion in HIV and AIDS, 7(2), 151–156. 10.1097/COH.0b013e32834f9927 [DOI] [PubMed] [Google Scholar]
  35. Wood, E., Montaner, J. S., Yip, B., Tyndall, M. W., Schechter, M. T., O'Shaughnessy, M. V., & Hogg, R. S. (2003). Adherence and plasma HIV RNA responses to highly active antiretroviral therapy among HIV-1 infected injection drug users. Canadian Medical Association Journal, 169(7), 656–661. [PMC free article] [PubMed] [Google Scholar]

Articles from Journal of Correctional Health Care are provided here courtesy of Mary Ann Liebert, Inc. and National Commission on Correctional Health Care

RESOURCES