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Prevalence and Correlates of an Extremely High Risk Behavior

Within Prison Drug Injection and Injection Equipment Sharing Among HIV-Infected Ukrainian Prisoners. Prevalence and Correlates of an Extremely High Risk Behavior. Jacob M. Izenberg Chethan Bachireddy Michael Soule Jeffrey A. Wickersham Tetiana Kiriazova Sergey Dvoriak Frederick L. Altice.

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Prevalence and Correlates of an Extremely High Risk Behavior

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  1. Within Prison Drug Injection and Injection Equipment Sharing Among HIV-Infected Ukrainian Prisoners Prevalence and Correlates of an Extremely High Risk Behavior Jacob M. Izenberg ChethanBachireddy Michael Soule Jeffrey A. Wickersham TetianaKiriazova Sergey Dvoriak Frederick L. Altice

  2. Source: Jon Cohen Science 2010

  3. Background • Ukraine is home to Europe’s worst HIV epidemic (prevalence >1%). Among 290,000people who inject drugs (PWID) prevalence 21.5-41.8%1,2 • Incarceration rate in Ukraine = 350 / 100,000 population3or ~110,000 people 1. Bobrovskyy 2013 2. Mathers, 2008 3. International Centre for Prison Studies

  4. Source: AzbelPLoS ONE 2013

  5. Source: AzbelPLoS ONE 2013

  6. Background • Globally, within-prison drug injection common (3-53%)1 • In Ukraine, despite high rates of HIV and large PWID population in prison, opioid substitution therapy (OST) and needle and syringe exchange programs (NSP) are not available in prison settings • In general: less injection in prison, but more needle/syringe sharing2 • Relatively few studies in low- and middle-income countries • Lack of studies examining only HIV-infected inmates (the only individuals who can transmit HIV) 1. R JurgensLancet Inf Dis 2009 2. R JurgensJ Int AIDS Soc2011

  7. Study aim To describe both the prevalenceand key correlatesof within-prison drug injection and injection equipment sharing among HIV-infected individuals recently released from prison in Ukraine.

  8. Methods • Recruitment • Kiev (N=47) – prison-release social services agency • Odessa (N=50) – modified snowball sampling • Eligibility criteria • HIV+ • Released from prison 1 to 12 months (mean=5.8) prior • 60-minute cross-sectional interviews • Pre-, within- and post-release time periods covered • Demographics and criminal justice history • Substance use disorder screening • Drug use and injection history • Use of OST and antiretroviral therapy (ART)

  9. Methods (continued) • Dependent variables: • Within-prison drug injection (WP-DI) • Within-prison sharing of injection equipment • Data analysis: • N=95 (2 excluded because dependent variable not answered) • Bivariate modeling of basic characteristics with WP-DI and injection equipment sharing • Multivariate logistic regression for modeling correlates of both dependent variables

  10. Characteristics of the final sample (N=95)

  11. Injection before, during, and after prison N=95 N=95

  12. Injection before, during, and after prison N=95 N=95

  13. Injection before, during, and after prison N=95 N=95 N=54 N=84 N= 55

  14. Outcome 1: Within-Prison Drug Injection

  15. Outcome 2: Within Prison Injection Equipment Sharing

  16. Key findings summarized • More than half reported within-prison drug injection • About three quarters of this group shared needles or syringes in prison, with a mean of 4.43users per / needle • Prison term length not correlated with injection • Correlates of within-prison drug injection • Pre-prison opioid use • Site of recruitment (Kyiv) • Gender (Male) • Correlates of within-prison injection equipment sharing • Pre-prison opioid use • Site of recruitment (Kyiv)

  17. Implications • Prison-based OST and NSP are evidence-based practices that reduce within-prison drug injection and equipment sharing.1,2OST, NSP  urgent need to implement and scale HIV testing and treatment  must ensure availability within prison settings • Need for effective transitional programs for those returning to the community OST and ART linkage 1. Larney 2010 2. Stover 2010

  18. Acknowledgements • Study participants who generously gave their time • Yale Center for Interdisciplinary AIDS Research staff • Ukraine Institute for Public Health Policy staff • Future Without AIDS Foundation, Odessa, Ukraine • Funding support from • International Renaissance Foundation, Ukraine • National Institute on Drug Abuse for research (R01 DA033679 and R01 DA029910) and for career development (K24 DA017072) • Yale University School of Medicine Office of Student Research • Yale University Global Health Initiative

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