Violence and other social structural factors linked to incarceration for women living with HIV in Metro Vancouver: need for trauma-informed HIV care in prisons and post-Release

ABSTRACT

Despite women living with HIV (WLWH) being disproportionately criminalized and overrepresented within correctional facilities, there remains limited longitudinal research with WLWH examining factors that make WLWH vulnerable to incarceration. Data are drawn from SHAWNA (Sexual health and HIV/AIDS: Women's Longitudinal Needs Assessment), a community-based research cohort with cisgender and transgender WLWH in Metro Vancouver, Canada. Multivariable logistic regression using generalized estimating equations (GEE) and an exchangeable working correlation matrix was used to prospectively model correlates of recent incarceration exposure over a seven-year period. Amongst 289 WLWH, 76% had been incarcerated in their lifetime, and 17% had experienced recent incarceration. In multivariable GEE analysis, younger age (AOR: 0.92 per year older, 95% CI: 0.89–0.96), recent homelessness (AOR: 2.81, 95% CI: 1.46–5.41), recent gender-based (physical and/or sexual) violence (AOR: 2.26, 95% CI: 1.20–4.22) and recent opioid use (AOR: 1.83, 95% CI: 1.00–3.36), were significantly associated with recent incarceration. Lifetime exposure to gender-based violence by police (AOR: 1.97, CI: 0.97–4.02) was marginally associated with increased odds of recent incarceration. This research suggests a critical need for trauma-informed interventions for WLWH during and following incarceration. Interventions must be gender specific, include housing and substance use supports, and address the impact of gender-based violence.

KEYWORDS:

• Women living with HIV
• Incarceration
• Gendered-based violence
• Illicit substance use
• Prison

Acknowledgements

The authors wish to thank all who contributed to this research, particularly the cis and trans women who participated in our project, community partners, the SHAWNA Positive Women’s Advisory Board and Community Partner Advisory Board and SHAWNA team members: Sarah Moreheart, Flo Ranville, Lulu Gurney, Barbara Boden, Brittney Udall, Bridget Simpson, Lauren Martin McCraw, Jenn McDermid, Shannon Bundock, Kate Noyes, Ankaee Yamaki, Maya Henriquez and Desire Tibashoboka. We also acknowledge Abby Rolston, Sylvia Machat, Peter Vann, and Megan Bobetsis for their research and administrative support. ME and KS conceptualized the study, MB provided advice and support for statistical analysis, FR collected data as part of the peer research team; NP and MK provided feedback on the drafts and expertise related to providing care to WLWH at Oak Tree Clinic and within correctional facilities in British Columbia, AK and REM provided critical support and feedback on the initial and revised version of the manuscript. KS takes overall responsibility for integrity of the data as senior author and principal investigator.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This research was supported by the Canadian Institutes of Health Research (MOP-133617). KS is supported in part by the National Institutes of Health (20R64007) and a Canada Research Chair in Gender Equity, Sexual Health and Global Policy (https://www.chairs-chaires.gc.ca/chairholders-titulaires/profile-eng.aspx?profileId=3299).