title: Drug injecting and syringe use in the HIV risk environment of Russian penitentiary institutions: Qualitative study.
abstract: BACKGROUND
  Evidence highlights the prison as a high risk environment in relation to human immunodeficiency virus (HIV) and hepatitis C virus (HCV) transmission associated with injecting drug use.
  
  
  METHODS
  We undertook qualitative studies among 209 injecting drug users (IDUs) in three Russian cities: Moscow (n = 56), Volgograd (n = 83) and Barnaul in western Siberia (n = 70).
  
  
  RESULTS
  Over three-quarters (77%) reported experience of police arrest related to their drug use, and 35% (55% of men) a history of imprisonment or detention. Findings emphasize the critical role that penitentiary institutions may play as a structural factor in the diffusion of HIV associated with drug injection in the Russian Federation. While drugs were perceived to be generally available in penitentiary institutions, sterile injection equipment was scarce and as a consequence routinely shared, including within large groups. Attempts to clean borrowed needles or syringes were inadequate, and risk reduction was severely constrained by a combination of lack of injecting equipment availability and punishment for its possession. Perceptions of relative safety were also found to be associated with assumptions of HIV negativity, resulting from a perception that all prisoners are HIV tested upon entry with those found HIV positive segregated.
  
  
  CONCLUSIONS
  This study shows an urgent need for HIV prevention interventions in the Russian penitentiary system.
authors.affiliation: Russian Harm Reduction Network, Moscow, Russia.
authors.forename: Anya
authors.initials: A
authors.lastname: Sarang
authors.forename: Tim
authors.initials: T
authors.lastname: Rhodes
authors.forename: Lucy
authors.initials: L
authors.lastname: Platt
authors.forename: Valentina
authors.initials: V
authors.lastname: Kirzhanova
authors.forename: Olga
authors.initials: O
authors.lastname: Shelkovnikova
authors.forename: Venyamin
authors.initials: V
authors.lastname: Volnov
authors.forename: Dmitri
authors.initials: D
authors.lastname: Blagovo
authors.forename: Andrei
authors.initials: A
authors.lastname: Rylkov
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016485:Needle Sharing; D015995:Prevalence; D011330:Prisons / Q000706:statistics & numerical data*; D012309:Risk-Taking; D012426:Russia / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D011795:Surveys and Questionnaires