‘Discretion is 99.9% of it’: confidentiality, stigma and peer navigation for HIV care after jail

People with HIV are disproportionately incarcerated in the United States, and cycling through local jails disrupts HIV care continuity, antiretroviral adherence, and viral suppression. Peer navigation interventions show promise for supporting care engagement during reentry, yet little research has examined how such programs should be designed to function within the harmful conditions of carceral settings. This qualitative study draws on 26 semi-structured interviews with people living with HIV who were recently incarcerated in a large Florida county jail to examine the feasibility and acceptability of a peer-led navigation intervention for HIV care during and after jail incarceration. Guided by a modified social ecological model, findings reveal multilevel design considerations across interpersonal, community, organizational, and institutional levels. Participants identified peer navigators with shared lived experience of HIV and incarceration as foundational to building trust. They emphasized the need for wraparound reentry supports addressing housing, food, and transportation as preconditions for sustained HIV care. Most critically, participants stressed that strict confidentiality protections and status-neutral program structures were essential to prevent inadvertent HIV disclosure within the jail. These findings offer concrete, participant-driven design principles for adapting peer navigation programs in carceral contexts to improve HIV outcomes during reentry.