Burden of substance use disorders, mental illness, and correlates of infectious diseases among soon-to-be released prisoners in Azerbaijan

Abstract

Background Despite low HIV prevalence in the South Caucasus region, transmission is volatile. Little data are available from this region about addiction and infectious diseases among prisoners who transition back to communities. Methods A nation-wide randomly sampled biobehavioral health survey was conducted in 13 non-specialty Azerbaijani prisons among soon-to-be-released prisoners. After informed consent, participants underwent standardized health assessment surveys and testing for HIV, hepatitis B and C, and syphilis. Results Of the 510 participants (mean age = 38.2 years), 11.4% were female, and 31.9% reported pre-incarceration drug injection, primarily of heroin. Prevalence of HCV (38.2%), HIV (3.7%), syphilis (3.7%), and HBV (2.7%) was high. Among the 19 HIV-infected inmates, 14 (73.7%) were aware of their HIV status, 12 (63.2%) were receiving antiretroviral therapy (ART), and 5 (26.3%) had CD4 < 350 cells/mL (4 of these were on ART). While drug injection was the most significant independent correlate of HCV (AOR = 12.9; p = 0.001) and a significant correlate of HIV (AOR = 8.2; p = 0.001), both unprotected sex (AOR = 3.31; p = 0.049) and working in Russia/Ukraine (AOR = 4.58; p = 0.008) were also correlated with HIV. Conclusion HIV and HCV epidemics are concentrated among people who inject drugs (PWIDs) in Azerbaijan, and magnified among prisoners. A transitioning HIV epidemic is emerging from migration from high endemic countries and heterosexual risk. The high diagnostic rate and ART coverage among Azerbaijani prisoners provides new evidence that HIV treatment as prevention in former Soviet Union (FSU) countries is attainable, and provides new insights for HCV diagnosis and treatment as new medications become available. Within prison evidence-based addiction treatments with linkage to community care are urgently needed.

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

“…Although no reliable data exist for Turkmenistan and Belarus, HIV prevalence in prisons exceeds 10% in four countries—Latvia (20.4%), Ukraine (19.4%), Estonia (14.1%), and Kyrgyzstan (10.3%)—and remains markedly higher than in the community in Uzbekistan (4.7%), Lithuania (3.4%), Kazakhstan (3.9%), Azerbaijan (3.7%), Armenia (2.4%), Tajikistan (2.4%), Moldova (2.6%), and Georgia (0.9%). In nationally representative prison surveillance studies, HIV prevalence is 22 times, 19 times, and 34 times higher in prisons than in surrounding communities in Ukraine, 23,24 Azerbaijan, 59 and Kyrgyzstan, 60 respectively. Factors contributing to this increased concentration include harsh policies, laws, and policing targeted at people who inject drugs, and high levels of within-prison drug injection.…”

“…57,58 Consequently, people who inject drugs represent more than a third of prisoners in EECA, but the level could be as high as 50–80% in some EECA countries. 23,59–61 …”

“…5,6 Additionally, extensive migration between and within some EECA countries results in lack of access to HIV prevention on the basis of citizenship or official registration for governmental health care. 59,62 …”

“…24 In Azerbaijan, however, HIV diagnosis approaches 75% of cases. 59 Although both Azerbaijan and Kyrgyzstan provide high coverage of antiretroviral therapy for people living with HIV who are diagnosed within prison, 59,60 fewer than 4% of people living with HIV in Ukrainian prisons receive it. 23,24 No EECA country has data for antiretroviral therapy coverage after release, but even data from high-income countries suggest that the transition period from prison is one of heightened vulnerability, when antiretroviral therapy coverage falls precipitously and HIV risk is high, 73 especially for women.…”

Attitudes Toward Addiction, Methadone Treatment, and Recovery Among HIV-Infected Ukrainian Prisoners Who Inject Drugs: Incarceration Effects and Exploration of Mediators

“…Moreover, HIV prevalence among Ukrainian prisoners is the highest in Europe (8) and approaches 20% nationally with drug injection of opioids as the major driver of transmission (9, 10). Due to the concentration of PWID among prisoners (11), especially those with HIV (10), interventions targeting prisoners may play a central role in HIV prevention since nearly all prisoners transition back to the community.…”