title: High-risk behaviors after release from incarceration among people who inject drugs in St. Petersburg, Russia.
abstract: BACKGROUND
  Injection drug use, infectious disease, and incarceration are inextricably linked in Russia. We aimed to identify factors associated with time to relapse (first opioid injection after release from prison) and using a non-sterile, previously used syringe at relapse in a sample of people who inject drugs in St. Petersburg.
  
  
  METHODS
  We collected data on time from release to relapse among individuals with a history of incarceration, a subsample of a larger study among people who inject drugs. Proportional hazards and logistic regression were used to identify factors associated with time to relapse and injection with a non-sterile previously used syringe at relapse, respectively.
  
  
  RESULTS
  The median time to relapse after release was 30 days. Factors that were independently associated with relapsing sooner were being a native of St. Petersburg compared to not being native (AHR: 1.64; 95% CI 1.15-2.33), unemployed at relapse compared to employed (AHR: 4.49; 95% CI 2.96-6.82) and receiving a previous diagnosis of HBV and HCV compared to no previous diagnosis (AHR: 1.49; 95% CI 1.03-2.14). Unemployment at relapse was also significant in modeling injection with a non-sterile, previously used syringe at relapse compared to those who were employed (AOR: 6.80; 95% CI 1.96-23.59).
  
  
  CONCLUSIONS
  Unemployment was an important correlate for both resuming opioid injection after release and using a non-sterile previously used syringe at relapse. Linkage to medical, harm reduction, and employment services should be developed for incarcerated Russian people who inject drugs prior to release.
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, 135 College Street, New Haven, CT, USA. Electronic address: Javier.cepeda@yale.edu.
authors.forename: Javier A
authors.initials: JA
authors.lastname: Cepeda
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, 135 College Street, New Haven, CT, USA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Niccolai
authors.affiliation: NGO Stellit, 3 Mira Street, St. Petersburg, Russia.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Lyubimova
authors.affiliation: Center for Interdisciplinary Research on AIDS, 135 College Street, New Haven, CT, USA; Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, USA.
authors.forename: Trace
authors.initials: T
authors.lastname: Kershaw
authors.affiliation: NGO Stellit, 3 Mira Street, St. Petersburg, Russia.
authors.forename: Olga
authors.initials: O
authors.lastname: Levina
authors.affiliation: Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT, USA; Center for Interdisciplinary Research on AIDS, 135 College Street, New Haven, CT, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Heimer
mesh_terms: D000293:Adolescent; D000328:Adult; D005006:Ethnicity; D005260:Female; D040261:Harm Reduction; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D011330:Prisons; D012309:Risk-Taking; D012426:Russia; D012959:Socioeconomic Factors; D015819:Substance Abuse, Intravenous / Q000453:epidemiology*; D016019:Survival Analysis; D013594:Syringes; D055815:Young Adult
keywords: Drugs; Incarceration; Inject; Relapse; Russia