Law Enforcement Practices Associated with HIV Infection Among Injection Drug Users in Odessa, Ukraine

Abstract

Despite HIV prevention efforts over the past 10 years in Odessa, Ukraine, HIV rates among injection drug users (IDUs) remain high. We explored whether IDUs’ experiences with the police and court system in Odessa were associated with HIV serostatus, after controlling for other factors. Qualitative methods, including semi-structured interviews with the police and members of court (N = 19), and focus groups with IDUs (N = 42), were employed to aid in developing a survey instrument for a larger quantitative phase and to assist in interpreting the findings from the quantitative phase, which included 200 participants who were interviewed and tested for HIV. Overall, 55 % tested positive for HIV. Negative experiences with the police were noted by 86 % and included having preloaded syringes taken (66 %), rushed injections due to fear of the police (57 %), police planting drugs (18 %), paying police to avoid arrest (61 %) and threatened by the police to inform on other IDUs (23 %). HIV positive participants were more likely than those who were negative to report these experiences. In a multiple logistic regression, the most significant correlate of HIV infection was rushed injections due to fear of the police. Police actions in Odessa may be contributing to the continued escalation of HIV among IDUs, underscoring the need for structural interventions.

Drug use as a driver of HIV risks

“…Methamphetamine plays a role in HIV transmission in that it leads to increased sexual activity, impaired decision-making and inconsistent condom use (42, 43). Use of amphetamine-type stimulants, specifically methamphetamine, has increased in many countries within East and South-East Asia (44). A recent study among PWID in Bangkok found that the availability of heroin, methamphetamine, crystal methamphetamine, midazolam, and illicit methadone increased substantially between 2009 and 2011 (45).…”

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

“…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).…”

Barriers to Access to Sterile Syringes as Perceived by Pharmacists and Injecting Drug Users: Implications for Harm Reduction in Lebanon

“…Actually, previous research indicated that reducing legal, regulatory barriers and community opposition increases pharmacy sales of syringes to IDU which influences sharing syringes and the spread of HIV infection (Beletsky et al, 2014;Booth et al, 2013;McNeil & Small, 2014;Stopka, Garfein, Ross, & Truax, 2007;Taussig, Weinstein, Burris, & Jones, 2000).…”