title: Punitive policing and associated substance use risks among HIV-positive people in Russia who inject drugs.
abstract: BACKGROUND
  Drug law enforcement is part of the HIV risk environment among people who inject drugs (PWID). Punitive policing practices such as extrajudicial arrests for needle possession and police planting of drugs have been described anecdotally in Russia, but these experiences and their associations with risky drug behaviours have not been quantified. This study aims to quantify the burden of extrajudicial police arrests among a cohort of HIV-positive PWID in Russia and to explore its links to drug-related health outcomes.
  
  
  METHODS
  In a cross-sectional study of 582 HIV-positive people with lifetime injection drug use (IDU) in St. Petersburg, Russia, we estimated the prevalence of self-reported extrajudicial police arrests. We used multiple logistic regression to evaluate associations between arrests and the following outcomes: overdose, recent IDU and receptive needle sharing.
  
  
  RESULTS
  This cohort's mean age was 29.8 years, 60.8% were male; 75.3% reported non-fatal drug overdose, 50.3% recent IDU and 47.3% receptive needle sharing. Extrajudicial arrests were reported by more than half (60.5%, 95% confidence interval [CI]: 56.5-64.5) and were associated with higher odds of non-fatal drug overdose (AOR 1.52, 95% CI: 1.02-2.25) but not with recent IDU (AOR 1.17, arrests were associated with receptive needle sharing (AOR 1.84, 95% CI: 1.09-3.09).
  
  
  CONCLUSIONS
  Extrajudicial police arrests were common among this cohort of Russian HIV-positive PWID and associated with non-fatal overdose and, among those with recent IDU, receptive needle sharing. As a part of the HIV risk environment of PWIDs, these practices might contribute to HIV transmission and overdose mortality. Further research is needed to relate these findings to the operational environment of law enforcement and to better understand how police interventions among PWIDs can improve the HIV risk environment.
authors.affiliation: Boston University School of Medicine, Boston, MA, USA; lunze@bu.edu.
authors.forename: Karsten
authors.initials: K
authors.lastname: Lunze
authors.affiliation: Division of Global Public Health, University of California, San Diego, CA, USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Debbie M
authors.initials: DM
authors.lastname: Cheng
authors.affiliation: Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
authors.forename: Emily K
authors.initials: EK
authors.lastname: Quinn
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA.
authors.forename: Carly
authors.initials: C
authors.lastname: Bridden
authors.affiliation: Laboratory of Clinical Psychopharmacology of Addictions, St. Petersburg Pavlov State Medical University, St. Petersburg, Russia.
authors.forename: Elena
authors.initials: E
authors.lastname: Blokhina
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA.
authors.forename: Alexander Y
authors.initials: AY
authors.lastname: Walley
authors.affiliation: Laboratory of Clinical Psychopharmacology of Addictions, St. Petersburg Pavlov State Medical University, St. Petersburg, Russia.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Krupitsky
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston, MA, USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
mesh_terms: D000328:Adult; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D016495:Police; D012309:Risk-Taking; D012426:Russia; D015819:Substance Abuse, Intravenous / Q000453:epidemiology* / Q000523:psychology*
keywords: PLHA; Russian Federation; human rights; injection drug use; key populations; police involvement