The volatile HIV epidemic
in Moldova, driven primarily by people who inject drugs (PWIDs), is
concentrated in prisons. Although internationally recommended opioid agonist
therapy (OAT) is available in Moldovan prisons, coverage remains inadequate and
expansion efforts have failed to meet national and international goals.
Methods:
To better understand why eligible prisoners are
reluctant to initiate OAT, we surveyed recently released prisoners who met
criteria for opioid dependence and compared those who had and had not been
enrolled in within-prison OAT (N = 56) using standardized scales on OAT
knowledge and attitudes as well as within-prison harassment experiences.
Results:
Knowledge about OAT was similar between both
groups, but this knowledge and myths about OAT had independent and opposite
direct effects on OAT attitudes. Those who were enrolled in OAT in prison were
significantly more likely to perceive it as an effective form of treatment and
had more tolerable attitudes toward OAT but were also more likely to have been
bullied and to express concerns about their personal safety. Prisoners who had
not been enrolled in OAT were more likely to endorse negative myths about
methadone; only one person among them intended to receive OAT in the future.
Conclusion:
In Moldovan prisons, OAT enrollment and
treatment continuation are influenced by ideological biases and myths that are
largely formed, amplified, and reinforced behaviorally in restricted prison
settings. Future interventions that expand OAT in prisons should target
individual-level ideological prejudices and myths, as well as the prison
environment.
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By:
Affiliations
Yale University School of Medicine, Section of Infectious
Diseases, New Haven, Connecticut, USA
Correspondence
Corresponding author. 135 College Street, Suite 323, New
Haven, CT, USA 06511, Tel.: +1 203 737 2883, Facsimile: +1 203 737 4051.
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