The domestic HIV epidemic remains a serious public health concern in the United States. The rate of HIV in prisons is three five times higher than the national average. The process of reentering the community after release from prisons places formerly incarcerated individuals at high risk of disengagement from HIV care. The purpose of the current study was to explore the factors that distinguish patterns in care engagement and disengagement over a 39-month period following release from prison. Using a socioecological framework, this project combined archival and interview data to investigate the impact of individual- and relational-level factors on these patterns. Rates of disengagement in this sample were very high, with only 17% of the sample consistently engaging in care. Non-engagers made up 30% of the sample and inconsistent engagers made up 50% of the sample. The accumulation of individual-level risk factors predicted engagement such that those with more individual-level risk were more likely to never engage or inconsistently engage in care when compared to consistent engagers. Poverty, history of substance use, and heterosexual identity were associated with non-engagement and inconsistent engagement. Consistent engagers were more likely to be satisfied with their patient-provider relationships than inconsistent engagers. The varied patterns of engagement suggest it is doubtful that there is a "one-size-fits-all" intervention for HIV care engagement for ex-offenders. Practitioners should tailor interventions to individuals' specific needs.
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