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UBC Theses and Dissertations

Exploring the experience and impact of incarceration for women living with HIV in Metro Vancouver, Canada Erickson, Margaret Mackenzie


Background: Women living with HIV are disproportionately criminalized and overrepresented within correctional facilities. Incarceration is linked to gendered impacts on HIV health, including sub-optimal HIV outcomes for women. Despite this, there is a paucity of evidence on the unique needs and experiences of women living with HIV who face incarceration. This dissertation explores and investigates the social and structural factors that shape incarceration experiences and HIV health outcomes for women living with HIV both during and post-release from incarceration. Methods: This dissertation draws on a mixed methods approach, using qualitative and quantitative data from the SHAWNA (Sexual Health and HIV/AIDS: Women’s Longitudinal Needs Assessment) Project, a community-based research project with over 350 self-identified women living with HIV across Metro Vancouver, Canada. Drawing on in-depth interviews with participants who had experienced a recent incarceration, and interviews with service providers, qualitative analysis explored experiences of incarceration trajectories among women living with HIV. Using longitudinal cohort data, path analysis was conducted to investigate pathways from recent incarceration to optimal antiretroviral therapy (ART) adherence. Results: Qualitative analysis revealed how HIV-related stigma within correctional facilities, reinforced by institutional processes that hinder privacy and confidentiality, was linked to isolation and discrimination, and compromised HIV care for women during incarceration. Findings highlighted heightened vulnerability following release, and elucidated key intersecting structural barriers including limited pre-release planning, a lack of immediate supports, and challenges securing safe housing and addiction services. This perpetuated re-incarceration, and undermined the continuity of HIV care. In path analysis, homelessness, experiences of gender-based violence, and criminalized substance use were identified as key factors that fully mediated the relationship between incarceration and optimal ART adherence for women living with HIV in the post-release period. Conclusion: This dissertation extends the limited body of research concerning the lived experiences and impacts of incarceration for women living with HIV by highlighting the complex ways in which social and structural factors shape unique experiences along incarceration trajectories and perpetuate harms. Findings elucidate specific considerations for interventions and policy reforms designed to improve HIV health outcomes, support overall well-being, and redress rates of incarceration for women living with HIV.

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