High rates of police detention among recently released HIV-infected prisoners in Ukraine: Implications for health outcomes

Abstract

Background Ukraine’s HIV epidemic, primarily affecting people who inject drugs (PWID), is expanding and transitioning despite free opioid substitution therapy (OST) and antiretroviral therapy (ART), two effective ways to reduce HIV transmission. Police detention not resulting in imprisonment, defined as police harassment, of PWID is common, but its prevalence and impact on health is not known. Method HIV-infected individuals (N=97) released from prison within one year were recruited and surveyed in two HIV-endemic Ukrainian cities about post-release police detention experiences. Data on the frequency of police detention, related adverse events, and impact on OST and ART continuity were collected, and correlates of detention were examined using logistic regression. Results Detention responses were available for 94 (96.9%) participants, of which 55 (58.5%) reported police detentions (mean=9.4 per person-year). For those detained while prescribed OST (N=28) and ART (N=27), medication interruption was common (67.9% and 70.4%, respectively); 23 of 27 participants prescribed OST (85.2%) were detained en route to/from OST treatment. Significant independent correlates of detention without charges included post-release ART prescription (AOR 4.98, p=0.021), current high-risk injection practices (AOR 5.03, p=0.011), male gender (AOR 10.88, p=0.010), and lower lifetime months of imprisonment (AOR 0.99, p=0.031). Conclusions HIV-infected individuals recently released from prison in Ukraine experience frequent police detentions, resulting in withdrawal symptoms, confiscation of syringes, and interruptions of essential medications, including ART and OST. Structural changes are urgently needed to reduce police detentions in order to control HIV transmission and improve both individual and public health.

Retention in medication-assisted treatment programs in Ukraine—Identifying factors contributing to a continuing HIV epidemic

“…Alternative explanations include of psychosocial support, inability of some patients to comply with strict program regulations or treatment expectations that OAT was intended as a long-term strategy. Until March 2016, no take-home doses were allowed in Ukraine, requiring OAT patients to travel to OAT sites daily where sites had restricted dispensing times (Bojko et al, 2015; Bojko et al, 2016; The State Service of Ukraine, 2014; UNAIDS, 2009) and where police often harassed OAT clients (Izenberg et al., 2013; Polonsky, Azbel, et al, 2016). Subsequent policy reforms in 2016 have allowed both prescription and take-home dosing for buprenorphine and methadone, although this practice has not yet been widely implemented.…”

“Bureaucracy & Beliefs”: Assessing the barriers to accessing opioid substitution therapy by people who inject drugs in Ukraine

“…Importantly, official “registration” as a drug dependent person was a major obstacle since those who are registered may lose a number of privileges in civil society, including loss of driver’s license, discrimination in some employment opportunities, and being targeted by the police to fill arrest quotas (Bojko, Dvoriak, & Altice, 2013; Izenberg & Altice, 2010; Izenberg, et al, 2013; Mimiaga, et al, 2010). A recent study in China (Lin, Wu, & Detels, 2011) confirmed that such bureaucratic and structural barriers including complex application and registration procedures and police harassment were the strongest barriers to accessing OST and which hinder scale up efforts.…”

“…The national registry requirement deters PWIDs from not only seeking OST, but also other drug treatment, because of imposed restrictions, including exclusion from certain kinds of jobs, loss of their driver’s license and becoming targets by the police (Izenberg et al, 2013; Mimiaga et al, 2010). Some FG participants describe opting for private, paid drug treatment services to avoid registering as a drug user: “ It was anonymous and paid.…”

Assessing police officers’ attitudes and legal knowledge on behaviors that impact HIV transmission among people who inject drugs

“…Such policing practices are especially pervasive in settings where drug use is highly criminalized and stigmatized (e.g. United States (Beletsky et al, 2014), Mexico (Pinedo et al, 2015; Pollini et al, 2008), Russia (Sarang et al, 2006), Ukraine (Izenberg et al, 2013), Vietnam (Ahmed et al, 2015), and Malaysia (Michalopoulos et al, 2016)). These are some of the same settings where HIV prevalence among PWID is much higher than in the general population.…”