DrPH Dissertation: Priya Srinivasan

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Dissertation Title: Assessing Policy Solutions to Address the Impact of Incarceration and Housing Instability on HIV outcomes

Dissertation Chair: Dr. Harry Heiman

Dissertation Abstract:

Background: Incarceration and housing instability are interconnected social and structural determinants of health that contribute to disparities in HIV-related outcomes, particularly among populations disproportionately affected by the criminal justice system. Individuals transitioning from incarceration to the community frequently encounter barriers to stable housing, healthcare access, and employment, potentially disrupting continuity of HIV care and successful community reintegration.

Objective: This study examined state-level policy approaches that address the interconnected challenges of incarceration, housing instability, and HIV-related outcomes, and explored opportunities to develop an integrated policy framework to support community reentry.

Methods: A qualitative comparative policy analysis was conducted using Bardach’s Eightfold Path for Policy Analysis and an adapted conceptual framework incorporating structural racism and systems-thinking perspectives. Three policy alternatives were examined across six state-level examples: supportive reentry housing in Washington and Louisiana, Medicaid reentry continuity in California and Washington, and criminal record clearance in California and Louisiana. Evidence from peer-reviewed literature, government reports, and policy documents was evaluated across six domains: housing stability and community integration; healthcare access and continuity; HIV-related outcomes; health equity; feasibility; and cost and sustainability.

Results: No single policy alternative demonstrated strong empirical evidence across all six evaluation domains. Supportive reentry housing demonstrated the strongest evidence for improving housing stability and community integration, particularly through Washington’s Reentry Housing Assistance Program, although the assistance provided was time-limited. Medicaid reentry initiatives showed progress in facilitating prerelease healthcare services, medication access, and care coordination; however, evidence of sustained improvements in healthcare access and continuity remained limited. Record-clearance policies addressed procedural and structural barriers to community reintegration, although eligibility restrictions, racial disparities, and implementation challenges constrained their potential reach. Across all three policy alternatives, direct empirical evidence linking the selected policies to improved HIV-related outcomes was scarce.