Injecting drug use, sexual risk, HIV knowledge and harm reduction uptake in a large prison in Bali, Indonesia

Sawitri, Anak Agung Sagung; Hartawan, Anak Agung Gede; Craine, Noel; Sari, Ayu Kartika; Septarini, Ni Wayan; Wirawan, Dewa Nyoman

doi:10.1108/ijph-05-2014-0011

Cited by 8 publications

(10 citation statements)

References 28 publications

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“…No records are kept of the number of drug injecting prisoners. However, a study in Kerobokan Prison (Bali) reported 7.4 % of 230 prisoner participants had injected drugs while in prison, of whom 47% had also shared needles with between two and ten other prisoners (Sawitri et al 2016).…”

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confidence: 99%

Multiple burdens of stigma for prisoners participating in opioid antagonist treatment (OAT) programmes in Indonesian prisons: a qualitative study

Komalasari

Wilson

Nasir

et al. 2020

IJPH

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Purpose In spite of the effectiveness of opioid antagonist treatment (OAT) in reducing injecting drug use and needle sharing, programmes in prison continue to be largely stigmatised. This affects programme participation and the quality of programmes delivered. This study aims to explore how Indonesian prison staff and prisoners perceived and experienced stigma relating to prison OAT programmes and identify potential strategies to alleviate this stigma. Design/methodology/approach Three prisons in Indonesia were selected as part of a qualitative case study. Two of the prisons provided OAT, in the form of methadone maintenance treatment (MMT). Purposive and snowball sampling were used to recruit study participants. In total, 57 semi-structured interviews were conducted with prison governors, health-care staff, prison officers and prisoners. Prisoners included both participants and non-participants in methadone programmes. The data were analysed thematically. Findings MMT programme participants were perceived by both prison staff and other prisoners to be engaged in illicit drug use, and as lazy, poor, dirty and unproductive people. They were also presumed to be HIV-positive. These multi-layered, intersectional sources of (inter-personal) stigma amplified the effects on prisoners affecting not only their quality of life and mental health but also their access to prison parole programmes, and therefore the possibility of early release. In addition, organisational factors – notably non-confidential programme delivery and lack of both family and institutional supports for methadone prisoners – exacerbated the stigmatisation of MMT programme participants. Practical implications Effective strategies to alleviate stigma surrounding OAT programmes such as MMT programmes are urgently needed to ensure participation in and the quality of programmes in prisons. Originality/value Many prisoners reported experiencing stigma relating to their participation in MMT programmes in both the methadone prisons studied. They often emphasised the ways that this stigmatisation was amplified by the ways that MMT programme participation was associated with drug use and HIV infection. However, these intersecting experiences and concerns were not recognised by health-care staff or other prison staff. Effective strategies to alleviate stigma surrounding OAT programmes such as MMT programmes are urgently needed to ensure participation in and the quality of programmes in prisons.

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confidence: 99%

Multiple burdens of stigma for prisoners participating in opioid antagonist treatment (OAT) programmes in Indonesian prisons: a qualitative study

Komalasari

Wilson

Nasir

et al. 2020

IJPH

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“…This perception contrasts with the evidence that HIV transmission is more common in prison settings because of the much higher frequency of sharing injecting equipment (Culbert et al, 2015;Indig et al, 2010;Ju ¨rgens et al, 2009). Furthermore, this association has been reported (Dolan et al, 2015) both for prisons situated in high-income countries (Lindbom et al, 2017) and for middle-income countries including Indonesia (Sawitri et al, 2016).…”

Section: Discussionmentioning

confidence: 88%

A social ecological model (SEM) to exploring barriers of and facilitators to the implementation of opioid agonist treatment (OAT) programmes in prisons

Komalasari

Wilson

Haw

2021

IJPH

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Purpose Opioid agonist treatment (OAT) programmes in prisons play a significant role in preventing the human immunodeficiency virus (HIV). Despite its proven effectiveness, both the availability and coverage of prison OAT programmes remain low. This Indonesian study explores facilitators of, and barriers to, the delivery of methadone programmes in prisons using the social ecological model (SEM). Design/methodology/approach The study used a qualitative case study approach comprising two prisons with, and one prison without, methadone programmes. Purposive and snowball sampling was used to recruit study participants. In total, 57 in-depth interviews were conducted with prison governors, health-care staff, prison officers and prisoners. Data was analysed thematically. Findings The study findings identified facilitators of and barriers to the delivery of prison OAT programmes at all three levels of the SEM as follows: intrapersonal barriers including misperceptions relating to HIV transmission, the harm reduction role of OAT programmes, methadone dependency and withdrawal symptoms; interpersonal barriers such as inflexible OAT treatment processes and the wide availability of illicit drugs in prisons and; social-structural barriers, notably the general lack of resources. Research limitations/implications The findings highlight the importance of and overlap between, organisational and inter-personal, as well as intrapersonal factors. Such an approach is particularly important in the context of the implementation and delivery of methadone programmes in low/middle income countries, where the lack of resources is so significant. Practical implications Three main strategies for improvement were suggested as follows: the development of comprehensive education and training programmes for prisoners and all prison staff; the re-assessment of practices relating to the delivery of methadone, and a comprehensive review of harm reduction strategy in prisons, that should consider the role of prisoners’ families to increase support for prisoner participation; the re-assessment of prison policies to support the delivery of methadone programmes in prisons. Social implications The author suggests that ongoing international support and national drug policies are vital to the continuation and sustainability of methadone programmes in prisons. Originality/value This study contributes to the overall evidence base for OAT programmes in middle-income prison contexts.

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“…Also, personal and psychosocial factors appear to in uence sexual risk behavior among PWID while possibly playing a role in promoting sexual risk behavior among MWID. [11][12][13] In addition, aggressive policing tactics and harassment that re ect government-enacted stigma toward migrants and MWID may form a "driving force" that increases MWID engagement in HIV sexual risk behavior. 14 Consequently, in addition to examining HIV knowledge and self-perceived risk, the analysis also investigates the possible effects of demographic and key psychosocial factors (depression, loneliness, and societal stigma toward migrants as manifested through police harassment) on sexual risk behavior.…”

Section: Introductionmentioning

confidence: 99%

HIV Knowledge, Self-Perception of HIV Risk, and Sexual Risk Behaviors among Male Tajik Labor Migrants who inject Drugs in Moscow

Luc

Levy

Bakhromov

et al. 2023

Preprint

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Background: The interplay of HIV knowledge and self-perception of risk for HIV among people who inject drugs is complex and understudied, especially among temporary migrant workers (MWID) who inject drugs while in a host country. In Russia, Tajik migrants make up the largest proportion of Moscow’s foreign labor. Yet, HIV knowledge and self-perceived risk in association with sexual risk behavior among Tajik MWID in Moscow remains unknown. Objective: This research examines knowledge about HIV transmission, self-perception of HIV risk, and key psychosocial factors that possibly contribute to sexual risk behaviors among male Tajik MWIDs living in Moscow. Methods: Structured interviews were conducted with 420 male Tajik MWIDs. Modified Poisson regression models investigated possible associations between major risk factors and HIV sexual risk behavior. Results: Of the 420 MWIDs, 255 men (61%) reported sexual activity in the last 30 days. Level of HIV knowledge was not associated in either direction with condom use or risky sexual partnering, as measured by sex with multiple partners or female sex workers. Higher self-perceived HIV risk predicted less risky sexual partnering, but not condom use. Depression and police-enacted societal stigma were positively associated with risky sexual partnering, while loneliness and depression were associated with condomless sex. Conclusions: HIV prevention programing for male Tajik MWIDs must go beyond solely educating about factors associated with HIV transmission to include increased awareness of personal risk based on engaging in these behaviors. Additionally, psychological services to counter loneliness, depression, and societal stigma through police harassment are needed.

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Injecting drug use, sexual risk, HIV knowledge and harm reduction uptake in a large prison in Bali, Indonesia

Abstract: This is the first study reporting HIV-related risk behavior from an Indonesian prison with an established methadone substitution program.

Cited by 8 publications

References 28 publications

Multiple burdens of stigma for prisoners participating in opioid antagonist treatment (OAT) programmes in Indonesian prisons: a qualitative study

Multiple burdens of stigma for prisoners participating in opioid antagonist treatment (OAT) programmes in Indonesian prisons: a qualitative study

A social ecological model (SEM) to exploring barriers of and facilitators to the implementation of opioid agonist treatment (OAT) programmes in prisons

HIV Knowledge, Self-Perception of HIV Risk, and Sexual Risk Behaviors among Male Tajik Labor Migrants who inject Drugs in Moscow

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