Women, incarceration and HIV: A systematic review of HIV treatment access, continuity of care and health outcomes across incarceration trajectories

OBJECTIVE: To systematically review the literature on gendered implications of incarceration for HIV outcomes and engagement in care for women living with HIV (WLWH). DESIGN: We systematically searched 7 bibliographic databases, for peer-reviewed English-language studies, published between 2007 and 2017 reporting on: Incarceration, Women (transgender inclusive), and HIV. METHODS: Articles were included for evaluation if they reported outcomes for at least one of three measures of interest: Viral Load (VL), antiretroviral therapy (ART) adherence, or engagement in care among WLWH along incarceration trajectories. RESULTS: Of 1119 studies, 24 (2%) met the inclusion criteria. Of these 24 studies, the majority (n = 23) were conducted in the United States, 19 included samples of women and men and 7 studies were transgender inclusive. Our review did not reveal clear gender differences in HIV outcomes during periods of incarceration, however studies reporting post-incarceration outcomes demonstrated significant gender disparities in all three outcomes of interest. Following incarceration, women were less likely to be virally suppressed, less likely to achieve optimal ART adherence, and less likely to be engaged in care. CONCLUSIONS: Despite growing numbers of incarcerated WLWH globally, there is a substantial gap in research examining the impact of incarceration on HIV outcomes for WLWH. Significant gender disparities in HIV outcomes and engagement in care exist along incarceration trajectories for WLWH, especially post-incarceration. For improved health outcomes, research is needed to examine the experiences of WLWH throughout incarceration trajectories to develop interventions tailored to the specific needs of WLWH both during and following incarceration

• Population(s)
  • Women
  • Transgender communities
  • Prisoners
  • General HIV+ population
• Engagement and Care Cascade
  • Linkage/engagement in care
  • Treatment