Date on Master's Thesis/Doctoral Dissertation

8-2020

Document Type

Doctoral Dissertation

Degree Name

Ph. D.

Department

Social Work

Degree Program

Social Work, PhD

Committee Chair

Harris, Lesley

Committee Co-Chair (if applicable)

Sar, Bibhuti

Committee Member

Sar, Bibhuti

Committee Member

Rote, Sunshine

Committee Member

Kerr, Jelani

Author's Keywords

older African American adults; incarceration experiences; HIV/AIDS; constructivist grounded theory

Abstract

Two epidemics disproportionally impact older (50 years and over) African Americans compared to the general U.S. population: Incarceration and HIV/AIDS. Those aged 50 and older constitute the fastest growing age group of persons who are incarcerated in the United States. It is estimated that by the year 2030 about one third of the incarcerated population in the U.S. will be aged 55 years and older. While areas of “Incarceration, racial disparities and HIV” as well as “Aging and HIV” have been well studied and discussed in the literature, little is known about the lived incarceration experiences of African American persons living with HIV/AIDS (AAPLWHA). Thus, the purpose of this constructivist grounded theory study was to understand the processes older AAPLWHA experience related to their incarceration and engagement in care. The two main goals of this study were: 1) To understand and provide deep description of the varied dimensions of the experience of incarceration among older AAPLWHAs and 2) To develop an inductive theory of the process related to incarceration experiences among older AAPLWHAs and their engagement in care. Questions supporting and guiding these goals included: 1) How do older AAPLWHA draw meaning from their incarceration experiences? 2) How do incarceration experiences and understandings of their meaning relate to the process of engagement in care for older AAPLWHA? The nature of these questions warranted a qualitative approach designed to gain an in-depth understanding from older AAPLWHAs and their incarceration experiences. Methods included in-depth interviews with twenty-two older AAPLWHA who had an incarceration history. Additionally, seven participants were selected for in-depth follow-up interviews. The results include an exploration of the influence of HIV and incarceration stigma, different pathways (jail versus prison), and the impact of age and race on older AAPLWHAs incarceration experience. This study investigated the behavioral and psychological processes related to engagement in care for formerly incarcerated older AAPLWHA resulting in the formulation of an inductive theory titled: “Older AAPLWHAs Journey Towards Engagement in Care during Incarceration.” The inductive theory explains how older AAPLWHAs engaged in the process related to their HIV care from the point of entering the correctional system to in-care experiences and of linkage to care post-release. In the context of program and policy development, the findings of this study can provide the following insights: 1) Interventions within correctional settings that prioritize HIV care and decrease HIV related stigma 2) Greater access to long-term services and linkage to care post-release, and 3) Collaboration of AIDS Service Organizations (ASOs), correctional facilities and health care providers to guide improvements of the HIV care cascade for older incarcerated AAPLWHAs and post-incarceration continuity of care.

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