title: High rates of police detention among recently released HIV-infected prisoners in Ukraine: implications for health outcomes.
abstract: BACKGROUND
  Ukraine's HIV epidemic, primarily affecting people who inject drugs (PWID), is expanding and transitioning despite free opioid substitution therapy (OST) and antiretroviral therapy (ART), two effective ways to reduce HIV transmission. Police detention of PWID not resulting in a formal charge or imprisonment is common, but its prevalence and impact on health are not known.
  
  
  METHODS
  HIV-infected individuals (N=97) released from prison within one year were recruited and surveyed in two HIV-endemic Ukrainian cities about post-release police detention experiences. Data on the frequency of police detention, related adverse events, and impact on OST and ART continuity were collected, and correlates of detention were examined using logistic regression.
  
  
  RESULTS
  Detention responses were available for 94 (96.9%) participants, of which 55 (58.5%) reported police detentions (mean=9.4 per person-year). For those detained while prescribed OST (N=28) and ART (N=27), medication interruption was common (67.9% and 70.4%, respectively); 23 of 27 participants prescribed OST (85.2%) were detained en route to/from OST treatment. Significant independent correlates of detention without charges included post-release ART prescription (AOR 4.98, p=0.021), current high-risk injection practices (AOR 5.03, p=0.011), male gender (AOR 10.88, p=0.010), and lower lifetime months of imprisonment (AOR 0.99, p=0.031).
  
  
  CONCLUSIONS
  HIV-infected individuals recently released from prison in Ukraine experience frequent police detentions, resulting in withdrawal symptoms, confiscation of syringes, and interruptions of essential medications, including ART and OST. Structural changes are urgently needed to reduce police detentions in order to control HIV transmission and improve both individual and public health.
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA. Electronic address: Jacobizenberg@gmail.com.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Izenberg
authors.forename: Chethan
authors.initials: C
authors.lastname: Bachireddy
authors.forename: Michael
authors.initials: M
authors.lastname: Soule
authors.forename: Tetiana
authors.initials: T
authors.lastname: Kiriazova
authors.forename: Sergey
authors.initials: S
authors.lastname: Dvoryak
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D005260:Female; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D058850:Opiate Substitution Treatment / Q000523:psychology; D016495:Police; D012307:Risk Factors; D015819:Substance Abuse, Intravenous / Q000150:complications / Q000188:drug therapy / Q000523:psychology; D014455:Ukraine
chemical_list: D044966:Anti-Retroviral Agents
keywords: Eastern Europe; HIV; HIV services; Injection drug use; Police detention; Ukraine