Adherence to Antiretroviral
Therapy in HIV-infected
BECKY L. STEPHENSON
At least five percent of the HIV-infected women in the United States are incarcerated (Maruschak 2003). Many of these women are inmates in correctional facilities where antiretroviral therapy (HIV medication) is routinely provided (Hammett, Harmon, and Maruschak 1999). Most of these women represent underserved populations for whom access to care is poor. Incarceration may be the first time that these individuals have consistently received medical care. HIV care and treatment in correctional facilities can be challenging because of confidentiality issues, medical understaffing, and inflexible medication line hours (Spaulding et al. 2002). Interventions that are widely used in prisons may enhance adherence or become a barrier. Furthermore, most prisons were designed for men and are not gender specific (U.S. Government Accounting Office [U.S. GAO] 1999). This is important because women prisoners are disproportionately depressed, poorly educated, and sick when compared to their nonincarcerated counterparts (Conklin, Lincoln, and Tuthill 2000; Jordan et al. 2002). They also come from communities that historically have distrusted health care systems and providers (Altice, Mostashari, and Friedland 2001). Despite these challenges, there is data that shows incarcerated populations are able to adhere to HIV medication schedules and to achieve virological outcomes at least equivalent to their nonincarcerated counterparts (Kirkland et al. 2002; Wohl et al. 2003). This chapter reviews the definition, importance, measurements, determinants, and interventions associated with adherence to HIV medications in HIV-infected incarcerated women.
The use of recently developed combination antiretroviral therapy has been associated with decreased morbidity in both incarcerated and nonincarcerated populations (Maruschak 2003; Palella et al. 1998; Wright and Smith 1999). The National Commission on Correctional Health Care advocates the use of antiretroviral therapy in correctional settings in a manner that parallels its use in