“It’s my room and my life”: Housing’s influence on medication adherence for HIV-positive women released from incarceration

Abstract

A high prevalence of homelessness among women with HIV released from incarceration (WHRI) poses significant challenges to antiretroviral therapy. This research examines the pathways through which housing shapes adherence for previously homeless WHRI. In-depth semi-structured interviews were conducted with 43 WHRI in a supportive transitional housing program. Interviews were analyzed using grounded theory. Housing triggered subjective and material processes that increased adherence. Subjectively, housing increased empowerment, boosted cognitive and emotional re-engagement with post-carceral life, and established health-seeking behavior norms. Materially, housing increased reintegration into community life, reduced exposure to chaos and risk, and increased access to services. Our results suggest how a modified Theory of Planned Behavior (TPB) framework explains adherence by exploring subjective and material facets of TPB. Attitudes were described by subjective re-engagement and material reintegration; norms were established through subjective meaning-making and engagement in services; self-efficacy improved through subjective empowerment and reduction in the material risk environment.