title: Within-prison drug injection among HIV-infected Ukrainian prisoners: prevalence and correlates of an extremely high-risk behaviour.
abstract: 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.
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Izenberg
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
authors.forename: Chethan
authors.initials: C
authors.lastname: Bachireddy
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Wickersham
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Soule
authors.affiliation: Future Without AIDS Foundation, Odessa, Ukraine; Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
authors.forename: Tetiana
authors.initials: T
authors.lastname: Kiriazova
authors.affiliation: Ukrainian Institute on Public Health Policy, Kyiv, Ukraine.
authors.forename: Sergii
authors.initials: S
authors.lastname: Dvoriak
authors.affiliation: Yale 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.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
mesh_terms: D000328:Adult; D003625:Data Collection; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D016485:Needle Sharing / Q000706:statistics & numerical data; D058850:Opiate Substitution Treatment / Q000379:methods; D009293:Opioid-Related Disorders / Q000453:epidemiology*; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons / Q000706:statistics & numerical data; D012309:Risk-Taking; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D014455:Ukraine / Q000453:epidemiology
keywords: HIV; Injecting drug use; Prison; Syringe exchange