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

Abstract

IntroductionPrisoners bear a disproportionate burden of Ukraine's volatile and transitional HIV epidemic, yet little is known in Eastern Europe about HIV testing, treatment and HIV-related risk among prisoners.MethodsA nationally representative biobehavioural health survey linked with serological testing was conducted among soon-to-be released prisoners in 13 Ukrainian prisons from June to November 2011.ResultsAmong 402 participants, 78 (19.4%) tested HIV seropositive of whom 38 (50.7%) were previously unaware of their HIV status. Independent correlates of HIV infection included drug injection (AOR=4.26; 95% CI: 2.23–8.15), female gender (AOR=2.00; 95% CI: 1.06–3.78), previous incarceration (AOR=1.99; 95% CI: 1.07–3.70) and being from Southern Ukraine (AOR=5.46; 95% CI: 2.21–13.46). Those aware of being HIV-positive reported significantly more pre-incarceration sex- and drug-related HIV risk behaviours than those who were unaware.ConclusionsRoutine rather than risk-based HIV testing and expansion of opioid substitution and antiretroviral therapy among prisoners is urgently needed to reduce HIV transmission in volatile transitional HIV epidemics.

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

“…While structural changes may be slow, many police practices stem from societal attitudes and beliefs around drug use and people who use drugs, and as such, are susceptible to change through ad hoc interventions, especially at the regional level (Bojko et al, 2013; Degenhardt et al, 2010; Polonsky et al, 2015; Wolfe et al, 2010). There are several opportunities for effective interventions that include changing police beliefs and norms (Beletsky et al, 2011; Beletsky, Thomas, Shumskaya, Artamonova, & Smelyanskaya, 2013; Beletsky et al, 2012; Compton et al, 2014), implementing transitional care (Azbel et al, 2013, 2014; Kinlock et al, 2009; Morozova et al, 2013; Wickersham, Marcus, Kamarulzaman, Zahari, & Altice, 2013; Wickersham, Zahari, Azar, Kamarulzaman, & Altice, 2013), engaging law enforcement by empowering and encouraging police to facilitate “referral” for OAT and harm reduction services (Beletsky et al, 2012; DeBeck et al, 2008) that can have a ‘bottom-up’ effect to facilitate change rather than waiting for authoritative choices at the highest official levels (Stevens & Ritter, 2013). …”

“…People who use drugs often suffer from collateral damage brought by these practices in the form of basic human rights violations consisting of harassment, detention, and coercion (Bluthenthal, Lorvick, Kral, Erringer, & Kahn, 1999; Singer, 2006a, 2006b; Singer, Scott, Wilson, Easton, & Weeks, 2001; UNAIDS, 2014), which undermine social networks and accelerate HIV risk (Maru, Basu, & Altice, 2007). Moreover, widespread punitive national responses to PWIDs also define therapeutic trajectories (Raikhel & Garriott, 2013) and result in higher morbidity and mortality (Azbel, Wickersham, Grishaev, Dvoryak, & Altice, 2013, 2014; Drucker, 2002; Maru et al, 2007), decreased effectiveness of HIV prevention and treatment programs (Azbel et al, 2014; Booth et al, 2013) and ineffective application of public resources (Burns, 2014; Sabet, 2014). 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).…”

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

“…Among PWID, who account for the majority of cumulative HIV cases, HIV prevalence exceeds 40% (6, 7). 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.…”

Challenges to implementing opioid substitution therapy in Ukrainian prisons: Personnel attitudes toward addiction, treatment, and people with HIV/AIDS

“…Furthermore, despite 2011 legislation allowing it, OST has not yet been introduced into the Ukrainian criminal justice system (CJS) despite evidence of its benefit to reduce the negative consequences of drug injection within prison (Larney et al, 2012), and to improve transitional care post-release (Kinlock et al, 2009; Springer et al, 2012). With almost 138,000 prisoners (305 prisoners per 100,000 population) in Ukraine (Walmsley, 2014), of which 48.7% are estimated to be PWIDs, HIV/AIDS and other infectious diseases are concentrated within Ukraine’s prisons (Azbel et al, 2013, 2014). As prisoners cycle in and out of criminal justice settings (CJS), access to and retention in treatment is disrupted (Maru et al, 2007).…”

“…The few published studies on the health status of prisoners in countries of the FSU, and Ukraine in particular, report on the burden of infectious diseases (Azbel et al, 2013, 2014) and numerous patient-centered barriers to adequate care and community reentry (Morozova et al, 2013). A review of substance use disorders and HIV in prisons available from government sources in Central Asia strongly suggests that the existing estimates of drug abuse and infectious diseases remain markedly under-reported (Vagenas et al, 2013).…”