Developing a conceptual framework for post-incarceration care for sexual and gender minoritized adults: a concept mapping study

Mass incarceration in the United States is a social-structural driver of health for sexual and gender minoritized adults (SGMA). The aim of this study was to develop a conceptual framework for post-release healthcare to use in adapting a mobile health unit (MHU) for SGMA returning from jail. We used concept mapping to answer a focal prompt regarding health-related needs for SGMA post-release. We recruited SGMA with recent incarceration experience and relevant community partners to participate in 4 concept mapping sessions. Multidimensional scaling produced a two-dimensional point map of all statements and their relative relationships and hierarchical cluster analysis illustrated clusters of needs. SGMA community members (n = 16) and community partners (n = 13) generated 109 unique statements describing post-release healthcare-related needs for SGMA. Participants sorted and rated these items, creating a map of 10 clusters of needs: Physical Health, LGBTQ-Affirming Mental Health Care, Release Planning, Release Aftercare, Peer Support, Immediate Needs, Stabilizing Needs, Resources to Thrive, Access to Education, and Structural Healthcare Advantages. While HIV prevention and treatment were identified as the most important and the best fitting, the vast majority of post-release healthcare needs identified by SGMA related to other social and structural drivers of health to reduce stigma and risk, increase access to important health services like harm reduction and gender-affirming care, improve their economic conditions, and provide social support and safety. This participant-led conceptual framework provides insight regarding important components to include in development and adaptation of interventions to address HIV and other health inequities for SGMA produced and exacerbated by the CLS.