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

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.