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

Abstract

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.

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

“…This finding is supported from qualitative data in Ukrainian PWID who perceive that OAT is a treatment of last resort and should be reserved only for those who have no other options (67). It is important to note that our study was the first to inquire about and compare addiction severity during the time of incarceration with PLH who were currently incarcerated, and thus findings here complement previous research on within-prison drug use as reported by a sample of recently released prisoners (68). …”

“…Group 2 had been recently released from prison. More details about the recruitment process (41) have been described previously. Briefly, for Group 1, the prison first provided a list of all HIV-infected prisoners, then a random sample generator provided a list that was used to recruit for interviews.…”

Correlates of HIV infection and being unaware of HIV status among soon‐to‐be‐released Ukrainian prisoners

“…For opioid injectors, opioid substitution therapy (OST) with either methadone or buprenorphine remains the single most effective therapy to reduce HIV transmission. Recent data from Ukraine suggest that in the absence of prison-based OST, the prevalence of within-prison drug injection among PLWHA is extraordinarily high and often involves multiple sharing partners [15, 16]. Our data support within-prison HIV transmission since we minimally identify three instances of seroconversion during the current incarceration.…”

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

“…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). Without evidence-based interventions (EBIs) (Fazel & Baillargeon, 2011), detained persons often engage in risky HIV behaviors both within prison and post-release (Izenberg et al, 2014; Rhodes, 2002), creating a high-risk environment.…”

“…Police harassment practices toward PWIDs, though, have been reported as a substantial contributor to the suboptimal OAT scale-up (Bachireddy et al, 2014; Izenberg et al, 2014; Polonsky et al, 2015; Zabransky, Mravcik, Talu, & Jasaitis, 2014) both through preventing PWIDs from initiating treatment and creating barriers to retention in care.…”