title: In Their Own Voices: Breaking the Vicious Cycle of Addiction, Treatment and Criminal Justice Among People who Inject Drugs in Ukraine.
abstract: OBJECTIVE
  To understand how perceived law enforcement policies and practices contribute to the low rates of utilization of opioid agonist therapies (OAT) among people who inject drugs (PWIDs) in Ukraine.
  
  
  METHODS
  Qualitative data from 25 focus groups (FGs) with 199 opioid-dependent PWIDs in Ukraine examined domains related to lived or learned experiences with OAT, police, arrest, incarceration, and criminal activity were analyzed using grounded theory principles.
  
  
  RESULTS
  Most participants were male (66%), in their late 30s, and previously incarcerated (85%) mainly for drug-related activities. When imprisoned, PWIDs perceived themselves as being "addiction-free". After prison-release, the confluence of police surveillance, societal stress contributed to participants' drug use relapse, perpetuating a cycle of searching for money and drugs, followed by re-arrest and re-incarceration. Fear of police and arrest both facilitated OAT entry and simultaneously contributed to avoiding OAT since system-level requirements identified OAT clients as targets for police harassment. OAT represents an evidence-based option to 'break the cycle', however, law enforcement practices still thwart OAT capacity to improve individual and public health.
  
  
  CONCLUSIONS
  In the absence of structural changes in law enforcement policies and practices in Ukraine, PWIDs will continue to avoid OAT and perpetuate the addiction cycle with high imprisonment rates.
authors.affiliation: ICF International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine.
authors.forename: Alyona
authors.initials: A
authors.lastname: Mazhnaya
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Bojko
authors.affiliation: Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA.
authors.forename: Ruthanne
authors.initials: R
authors.lastname: Marcus
authors.affiliation: ICF International HIV/AIDS Alliance in Ukraine, Kyiv, Ukraine.
authors.forename: Sergii
authors.initials: S
authors.lastname: Filippovych
authors.affiliation: Management Science for Health, USA.
authors.forename: Zahedsul
authors.initials: Z
authors.lastname: Islam
authors.affiliation: Ukrainian Institute for Public Health Policy, Kyiv, Ukraine.
authors.forename: Sergey
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.
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Altice
keywords: Addiction; Ukraine; addiction trajectories; opioid agonist treatment; opioid substitution treatment; people who inject drugs; police harassment; qualitative research