Within-Prison Drug Injection among HIV-Infected Ukrainian Prisoners: Prevalence & Correlates of an Extremely High-Risk Behavior
BACKGROUND:
In
Ukraine, HIV-infection, injection drug use, and incarceration are syndemic;
however, few services are available to incarcerated people who inject drugs
(PWIDs). While data are limited internationally, within-prison drug injection
(WP-DI) appears widespread and may pose significant challenges in countries
like Ukraine, where PWIDs contribute heavily to HIV incidence. To date, WP-DI
has not been specifically examined among HIV-infected prisoners, the only
persons that can transmit HIV.
METHODS:
A
convenience sample of 97 HIV-infected adults recently released from prison
within 1-12 months was recruited in two major Ukrainian cities. Post-release
surveys inquired about WP-DI and injection equipment sharing, as well as
current and prior drug use and injection, mental health, and access to
within-prison treatment for HIV and other comorbidities. Logistic regression
identified independent correlates of WP-DI.
RESULTS:
Complete
data for WP-DI were available for 95 (97.9%) respondents. Overall, 54 (56.8%)
reported WP-DI, among whom 40 (74.1%) shared injecting equipment with a mean of
4.4 (range 0-30) other injectors per needle/syringe. Independent correlates of
WP-DI were recruitment in Kyiv (AOR 7.46, p=0.003), male gender (AOR 22.07,
p=0.006), and active pre-incarceration opioid use (AOR 8.66, p=0.005).
CONCLUSIONS:
Among
these recently released HIV-infected prisoners, WP-DI and injection equipment
sharing were frequent and involved many injecting partners per needle/syringe.
The overwhelming majority of respondents reporting WP-DI used opioids both
before and after incarceration, suggesting that implementation of
evidence-based harm reduction practices, such as opioid substitution therapy
and/or needle/syringe exchange programmes within prison, is crucial to
addressing continuing HIV transmission among PWIDs within prison settings. The
positive correlation between Kyiv site and WP-DI suggests that additional
structural interventions may be useful.
Below: Overview of injection behaviour before incarceration, within prison, and in the last thirty days
- 1Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
- 2Future Without AIDS Foundation, Odessa, Ukraine; Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
- 3Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
- 4Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA. Electronic address: frederick.altice@yale.edu.
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