A review of medical and substance use co-morbidities in Central Asian prisons: Implications for HIV prevention and treatment

Vagenas, Panagiotis; Azbel, Lyuba; Polonsky, Maxim; Kerimi, Nina; Mamyrov, Mirlan; Dvoryak, Sergey; Altice, Frederick L.

doi:10.1016/j.drugalcdep.2013.07.010

Cited by 31 publications

(34 citation statements)

References 28 publications

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“…Cohen, 2010; UNAIDS, 2010; Vagenas et al, 2013; Wolfe, Carrieri, & Shepard, 2010). From 2000–2009, new HIV cases in this region increased by 24%, even while declining by 19% throughout the rest of the world (UNAIDS, 2010).…”

Section: Discussionmentioning

confidence: 99%

Within-prison drug injection among HIV-infected Ukrainian prisoners: Prevalence and correlates of an extremely high-risk behaviour

Izenberg

Bachireddy

Wickersham

et al. 2014

International Journal of Drug Policy

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Background In Ukraine, HIV-infection, injection drug use, and incarceration are syndemic; however, few services are available to incarcerated people who inject drugs (PWIDs). While data are limited internationally, within-prison drug injection (WP-DI) appears widespread and may pose significant challenges in countries like Ukraine, where PWIDs contribute heavily to HIV incidence. To date, WP-DI has not been specifically examined among HIV-infected prisoners, the only persons that can transmit HIV. Methods A convenience sample of 97 HIV-infected adults recently released from prison within 1–12 months was recruited in two major Ukrainian cities. Post-release surveys inquired about WP-DI and injection equipment sharing, as well as current and prior drug use and injection, mental health, and access to within-prison treatment for HIV and other comorbidities. Logistic regression identified independent correlates of WP-DI. Results Complete data for WP-DI were available for 95 (97.9%) respondents. Overall, 54 (56.8%) reported WP-DI, among whom 40 (74.1%) shared injecting equipment with a mean of 4.4 (range 0–30) other injectors per needle/syringe. Independent correlates of WP-DI were recruitment in Kyiv (AOR 7.46, p=0.003), male gender (AOR 22.07, p=0.006), and active pre-incarceration opioid use (AOR 8.66, p=0.005). Conclusions Among these recently released HIV-infected prisoners, WP-DI and injection equipment sharing were frequent and involved many injecting partners per needle/syringe. The overwhelming majority of respondents reporting WP-DI used opioids both before and after incarceration, suggesting that implementation of evidence-based harm reduction practices, such as opioid substitution therapy and/or needle/syringe exchange programs within prison, is crucial to addressing continuing HIV transmission among PWIDs within prison settings. The positive correlation between Kyiv site and WP-DI suggests that additional structural interventions may be useful.

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Section: Discussionmentioning

confidence: 99%

Within-prison drug injection among HIV-infected Ukrainian prisoners: Prevalence and correlates of an extremely high-risk behaviour

Izenberg

Bachireddy

Wickersham

et al. 2014

International Journal of Drug Policy

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“…75 Unlike their counterparts in Western Europe, EECA countries generally have inadequate coverage, quality, and accessibility of NSP and limited or no access to OST. 76,77 …”

Section: Drug Policy and Infectious Diseasesmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

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Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

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“…While there have been examples of clashes between evidence-based addiction treatments and punitive approaches resulting in opioid agonist therapy (OAT) expansion with either methadone or buprenorphine maintenance globally (Cohen, 2010b; Degenhardt et al, 2014), drug policies favoring police interdiction and incarceration over community-based OAT have resulted in high incarceration rates in many countries of Eastern Europe and Central Asia (EECA) (Walmsley, 2014). Consequently in many of these countries, people with psychiatric and substance use disorders (SUD) and people at risk for or living with HIV (PLH) interface with the penal system (Vagenas et al, 2013), including the police (Izenberg et al, 2013; Mimiaga et al, 2010). Treatment of SUDs in EECA, mostly as vestiges of antiquated influences from the former Soviet Union, has been restricted more by moral biases and prejudices than by scientific evidence (Bojko, Dvoriak, & Altice, 2013; Cohen, 2010a, 2010b).…”

Section: Introductionmentioning

confidence: 99%

In their own voices: Breaking the vicious cycle of addiction, treatment and criminal justice among people who inject drugs in Ukraine

Mazhnaya

Bojko

Marcus

et al. 2016

Drugs: Education, Prevention and Policy

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Aims To understand how perceived law enforcement policies and practices contribute to the low rates of utilization of opioid agonist therapies (OAT) among people who inject drugs (PWIDs) in Ukraine. Methods Qualitative data from 25 focus groups (FGs) with 199 opioid-dependent PWIDs in Ukraine examined domains related to lived or learned experiences with OAT, police, arrest, incarceration, and criminal activity were analyzed using grounded theory principles. Findings Most participants were male (66%), in their late 30s, and previously incarcerated (85%) mainly for drug-related activities. When imprisoned, PWIDs perceived themselves as being “addiction-free”. After prison-release, the confluence of police surveillance, societal stress contributed to participants' drug use relapse, perpetuating a cycle of searching for money and drugs, followed by re-arrest and re-incarceration. Fear of police and arrest both facilitated OAT entry and simultaneously contributed to avoiding OAT since system-level requirements identified OAT clients as targets for police harassment. OAT represents an evidence-based option to ‘break the cycle’, however, law enforcement practices still thwart OAT capacity to improve individual and public health. Conclusion In the absence of structural changes in law enforcement policies and practices in Ukraine, PWIDs will continue to avoid OAT and perpetuate the addiction cycle with high imprisonment rates.

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A review of medical and substance use co-morbidities in Central Asian prisons: Implications for HIV prevention and treatment

Cited by 31 publications

References 28 publications

Within-prison drug injection among HIV-infected Ukrainian prisoners: Prevalence and correlates of an extremely high-risk behaviour

Within-prison drug injection among HIV-infected Ukrainian prisoners: Prevalence and correlates of an extremely high-risk behaviour

Public health and international drug policy

In their own voices: Breaking the vicious cycle of addiction, treatment and criminal justice among people who inject drugs in Ukraine

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