Within-prison drug injection among HIV-infected male prisoners in Indonesia: A highly constrained choice

Culbert, Gabriel J.; Waluyo, Agung; Iriyanti, Mariska; Muchransyah, Azalia P.; Kamarulzaman, Adeeba; Altice, Frederick L.

doi:10.1016/j.drugalcdep.2015.01.018

Cited by 39 publications

(47 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…CD4 testing) would result in more timely ART initiation among those ready to start ART, lead to more appropriate medication selection, and provide crucial feedback about ART efficacy. Concerns that ART could precipitate withdrawal or be harmful if “mixed” with methadone, which although available in some Indonesian prisons may be highly stigmatized [55], could lead patients to skip doses or stop treatment [56]. Increased coordination between HIV care and addiction treatment is needed to address interactive toxicity beliefs and proactively adjust methadone dose when starting ART to prevent symptoms of withdrawal [57].…”

Section: Discussionmentioning

confidence: 99%

The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons

et al. 2015

Self Cite

View full text Add to dashboard Cite

Negative attitudes toward HIV medications may restrict utilization of antiretroviral therapy (ART) in Indonesian prisons where many people living with HIV (PLH) are diagnosed and first offered ART. This mixed-method study examines the influence of medication attitudes on ART utilization among HIV-infected Indonesian prisoners. Randomly-selected HIV-infected male prisoners (n = 102) completed face-to-face in-depth interviews and structured surveys assessing ART attitudes. Results show that although half of participants utilized ART, a quarter of those meeting ART eligibility guidelines did not. Participants not utilizing ART endorsed greater concerns about ART efficacy, safety, and adverse effects, and more certainty that ART should be deferred in PLH who feel healthy. In multivariate analyses, ART utilization was independently associated with more positive ART attitudes (AOR = 1.09, 95 % CI 1.03–1.16, p = 0.002) and higher internalized HIV stigma (AOR = 1.03, 95 % CI 1.00–1.07, p = 0.016). Social marketing of ART is needed to counteract negative ART attitudes that limit ART utilization among Indonesian prisoners.

show abstract

Section: Discussionmentioning

confidence: 99%

The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons

et al. 2015

Self Cite

View full text Add to dashboard Cite

show abstract

“…This is not only affected by social conditions (eg, incarceration, poverty) but also includes the policing practices that influence arrest and entry into the criminal justice system and the experiences within the prison environment itself, which result in the syndemic of social and medical comorbidities. The amplification of drug-related harm in prisons 17–19 is best understood using the risk environment framework. 15 This conceptual model posits that individual decisions about disease prevention and treatment are rooted in structural risk such as spaces (in this case, prisons) that, while exogenous to the individual, independently contribute to risk-taking and health-seeking behaviours.…”

Section: Methodsmentioning

confidence: 99%

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

et al. 2016

View full text Add to dashboard Cite

Despite global reductions in HIV incidence and mortality, the 15 UNAIDS-designated countries of Eastern Europe and Central Asia (EECA) that gained independence from the Soviet Union in 1991 constitute the only region where both continue to rise. HIV transmission in EECA is fuelled primarily by injection of opioids, with harsh criminalisation of drug use that has resulted in extraordinarily high levels of incarceration. Consequently, people who inject drugs, including those with HIV, hepatitis C virus, and tuberculosis, are concentrated within prisons. Evidence-based primary and secondary prevention of HIV using opioid agonist therapies such as methadone and buprenorphine is available in prisons in only a handful of EECA countries (methadone or buprenorphine in five countries and needle and syringe programmes in three countries), with none of them meeting recommended coverage levels. Similarly, antiretroviral therapy coverage, especially among people who inject drugs, is markedly under-scaled. Russia completely bans opioid agonist therapies and does not support needle and syringe programmes—with neither available in prisons—despite the country’s high incarceration rate and having the largest burden of people with HIV who inject drugs in the region. Mathematical modelling for Ukraine suggests that high levels of incarceration in EECA countries facilitate HIV transmission among people who inject drugs, with 28–55% of all new HIV infections over the next 15 years predicted to be attributable to heightened HIV transmission risk among currently or previously incarcerated people who inject drugs. Scaling up of opioid agonist therapies within prisons and maintaining treatment after release would yield the greatest HIV transmission reduction in people who inject drugs. Additional analyses also suggest that at least 6% of all incident tuberculosis cases, and 75% of incident tuberculosis cases in people who inject drugs are due to incarceration. Interventions that reduce incarceration itself and effectively intervene with prisoners to screen, diagnose, and treat addiction and HIV, hepatitis C virus, and tuberculosis are urgently needed to stem the multiple overlapping epidemics concentrated in prisons.

show abstract

“…Over 90% of men surveyed in a 2015 study in Indonesia said they shared injection equipment while injecting drugs in prison, and 78% said they shared equipment with ten or more other prisoners. 203 UNODC in 2015 summarized reports from 43 UN member states that had estimated or surveyed lifetime, annual, and past-month drug use while in prison among people in custody (Figure 16). 7 A study of drug use in prison in the European Union, found that reported rates of ever having injected drugs in prisons among the countries providing data were in the range of 15–30%.…”

Section: Drug-related Incarceration and Healthmentioning

confidence: 99%

Public health and international drug policy

et al. 2016

Self Cite

View full text Add to dashboard Cite

Executive summary In September 2015, the member states of the United Nations endorsed sustainable development goals (SDG) for 2030 that aspire to human rights-centered approaches to ensuring the health and well-being of all people. The SDGs embody both the UN Charter values of rights and justice for all and the responsibility of states to rely on the best scientific evidence as they seek to better humankind. In April 2016, these same states will consider control of illicit drugs, an area of social policy that has been fraught with controversy, seen as inconsistent with human rights norms, and for which scientific evidence and public health approaches have arguably played too limited a role. The previous UN General Assembly Special Session (UNGASS) on drugs in 1998 – convened under the theme “a drug-free world, we can do it!” – endorsed drug control policies based on the goal of prohibiting all use, possession, production, and trafficking of illicit drugs. This goal is enshrined in national law in many countries. In pronouncing drugs a “grave threat to the health and well-being of all mankind,” the 1998 UNGASS echoed the foundational 1961 convention of the international drug control regime, which justified eliminating the “evil” of drugs in the name of “the health and welfare of mankind.” But neither of these international agreements refers to the ways in which pursuing drug prohibition itself might affect public health. The “war on drugs” and “zero-tolerance” policies that grew out of the prohibitionist consensus are now being challenged on multiple fronts, including their health, human rights, and development impact. The Johns Hopkins – Lancet Commission on Drug Policy and Health has sought to examine the emerging scientific evidence on public health issues arising from drug control policy and to inform and encourage a central focus on public health evidence and outcomes in drug policy debates, such as the important deliberations of the 2016 UNGASS on drugs. The Johns Hopkins-Lancet Commission is concerned that drug policies are often colored by ideas about drug use and drug dependence that are not scientifically grounded. The 1998 UNGASS declaration, for example, like the UN drug conventions and many national drug laws, does not distinguish between drug use and drug abuse. A 2015 report by the UN High Commissioner for Human Rights, by contrast, found it important to emphasize that “[d]rug use is neither a medical condition nor does it necessarily lead to drug dependence.” The idea that all drug use is dangerous and evil has led to enforcement-heavy policies and has made it difficult to see potentially dangerous drugs in the same light as potentially dangerous foods, tobacco, alcohol for which the goal of social policy is to reduce potential harms. Health impact of drug policy based on enforcement of prohibition The pursuit of drug prohibition has generated a parallel economy run by criminal networks. Both these networks, which resort to violence to protect their markets, and the police and sometimes military ...

show abstract

Within-prison drug injection among HIV-infected male prisoners in Indonesia: A highly constrained choice

Cited by 39 publications

References 52 publications

The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons

The Influence of Medication Attitudes on Utilization of Antiretroviral Therapy (ART) in Indonesian Prisons

The perfect storm: incarceration and the high-risk environment perpetuating transmission of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia

Public health and international drug policy

Contact Info

Product

Resources

About