title: Burden of substance use disorders, mental illness, and correlates of infectious diseases among soon-to-be released prisoners in Azerbaijan.
abstract: BACKGROUND
  Despite low HIV prevalence in the South Caucasus region, transmission is volatile. Little data are available from this region about addiction and infectious diseases among prisoners who transition back to communities.
  
  
  METHODS
  A nation-wide randomly sampled biobehavioral health survey was conducted in 13 non-specialty Azerbaijani prisons among soon-to-be-released prisoners. After informed consent, participants underwent standardized health assessment surveys and testing for HIV, hepatitis B and C, and syphilis.
  
  
  RESULTS
  Of the 510 participants (mean age = 38.2 years), 11.4% were female, and 31.9% reported pre-incarceration drug injection, primarily of heroin. Prevalence of HCV (38.2%), HIV (3.7%), syphilis (3.7%), and HBV (2.7%) was high. Among the 19 HIV-infected inmates, 14 (73.7%) were aware of their HIV status, 12 (63.2%) were receiving antiretroviral therapy (ART), and 5 (26.3%) had CD4 < 350 cells/mL (4 of these were on ART). While drug injection was the most significant independent correlate of HCV (AOR = 12.9; p = 0.001) and a significant correlate of HIV (AOR = 8.2; p = 0.001), both unprotected sex (AOR = 3.31; p = 0.049) and working in Russia/Ukraine (AOR = 4.58; p = 0.008) were also correlated with HIV.
  
  
  CONCLUSIONS
  HIV and HCV epidemics are concentrated among people who inject drugs (PWIDs) in Azerbaijan, and magnified among prisoners. A transitioning HIV epidemic is emerging from migration from high endemic countries and heterosexual risk. The high diagnostic rate and ART coverage among Azerbaijani prisoners provides new evidence that HIV treatment as prevention in former Soviet Union (FSU) countries is attainable, and provides new insights for HCV diagnosis and treatment as new medications become available. Within prison evidence-based addiction treatments with linkage to community care are urgently needed.
authors: Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
authors: Lyuba
authors: L
authors: Azbel
authors: Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
authors: Jeffrey A
authors: JA
authors: Wickersham
authors: Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
authors: Martin P
authors: MP
authors: Wegman
authors: Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA.
authors: Maxim
authors: M
authors: Polonsky
authors: Main Medical Department of the Ministry of Justice of the Azerbaijan Republic, Baku, Azerbaijan.
authors: Murad
authors: M
authors: Suleymanov
authors: Independent Assistance and Consultancy Center "For the Sake of Civil Society", Baku, Azerbaijan.
authors: Rafik
authors: R
authors: Ismayilov
authors: Ukrainian Institute on Public Health Policy, Kiev, Ukraine.
authors: Sergey
authors: S
authors: Dvoryak
authors: Head of UNODC Program Office in Kazakhstan, Astana, Kazakhstan.
authors: Signe
authors: S
authors: Rotberga
authors: Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA; Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA. Electronic address: lyuba.azbel@yale.edu.
authors: Frederick L
authors: FL
authors: Altice
mesh_terms: D000328:Adult; D001382:Azerbaijan / Q000453:epidemiology; D003141:Communicable Diseases / Q000453:epidemiology*; D005260:Female; D015658:HIV Infections / Q000453:epidemiology; D006306:Health Surveys; D006509:Hepatitis B / Q000453:epidemiology; D003932:Heroin / Q000009:adverse effects; D006801:Humans; D008297:Male; D009294:Narcotics / Q000009:adverse effects; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D019966:Substance-Related Disorders / Q000453:epidemiology*; D013587:Syphilis / Q000453:epidemiology; D014586:USSR
chemical_list: D009294:Narcotics; D003932:Heroin
keywords: Azerbaijan; HIV/AIDS; Hepatitis C virus; Opioid substitution therapy; Prisons; Substance abuse