Drug injection within prison in Kyrgyzstan: elevated HIV risk and implications for scaling up opioid agonist treatments

• Date: 10 September 2018
• Published date: 10 September 2018
• DOI: https://doi.org/10.1108/IJPH-03-2017-0016
• Pages: 175-187
• Author: Lyuba Azbel,Martin P. Wegman,Maxim Polonsky,Chethan Bachireddy,Jaimie Meyer,Natalya Shumskaya,Ainura Kurmanalieva,Sergey Dvoryak,Frederick L. Altice
• Subject Matter: Health & social care,Criminology & forensic psychology,Prisoner health,Sociology,Sociology of crime & law,Public policy & environmental management,Policing,Criminal justice

Drug injection within prison in Kyrgyzstan:

elevated HIV risk and implications for

scaling up opioid agonist treatments

Lyuba Azbel, Martin P. Wegman, Maxim Polonsky, Chethan Bachireddy, Jaimie Meyer,

Natalya Shumskaya, Ainura Kurmanalieva, Sergey Dvoryak and Frederick L. Altice

Abstract

Purpose –Within-prison drug injection (WPDI) is a particularly high HIV risk behavior, yet has not been

examined in Central Asia. A unique opportunity in Kyrgyzstan where both methadone maintenancetreatment

(MMT) and needle-syringe programs (NSP) exist allowed further inquiry into this high risk environment.

The paper aims to discuss these issues.

Design/methodology/approach –A randomly selected, nationally representative sample of prisoners

within six months of release in Kyrgyzstan completed biobehavioral surveys. Inquiry about drug injection

focused on three time periods (lifetime, 30 days before incarceration and during incarceration). The authors

performed bivariate and multivariable generalized linear modeling with quasi-binomial distribution and logit

link to determine the independent correlates of current WPDI.

Findings –Of 368 prisoners (13 percent women), 109 (35 percent) had ever injected drugs, with most

(86 percent) reporting WPDI. Among those reporting WPDI, 34.8 percent had initiated drug injection within

prison. Despite nearly all (95 percent) drug injectors having initiated MMT previously, current MMT use was

low with coverage only reaching 11 percent of drug injectors. Two factors were independently correlated with

WPDI: drug injection in the 30 days before the current incarceration (AOR ¼12.6; 95%CI ¼3.3-48.9) and

having hepatitis C infection (AOR: 10.1; 95%CI ¼2.5-41.0).

Originality/value –This study is the only examination of WPDI from a nationally representative survey of

prisoners where both MMT and NSP are available in prisons and in a region where HIV incidence and

mortality are increasing. WPDI levels were extraordinarily high in the presence of low uptake of prison-based

MMT. Interventions that effectively scale-up MMT are urgently required as well as an investigation of the

environmental factors that contribute to the interplay between MMT and WPDI.

Keywords HIV, Prison, Eastern Europe and Central Asia, Methadone, Needle/syringe program,

Within-prison drug injection

Paper type Research paper

1. Introduction

A confluence of policy, economic and social factors result in the criminal justice system being a

leading contributor to HIV transmission (Dolan et al., 2016), especially in Eastern Europe and Central

Asia (EECA). Punitive drug policies concentrate people with substance use disorders, especially

people who inject drugs (PWID), in prisons (Dolan et al., 2016). Incarcerated PWID are

disproportionately infected with HIV and have propensity for high-risk transmission behaviors like

drug injection and syringe-sharing within prisons that contribute to ongoing HIV transmission

(Vagenas et al., 2013). HIV outbreaks associated with drug injection have been documented in

prisons throughout the world (Taylor et al., 1995; Dolan and Wodak, 1999; Dolan et al., 2015). Since

virtually all prisoners are eventually released, the potential for onward transmission of blood-borne

viruses like HIV and hepatitis C to the wider community has significant implications for publichealth.

For example, mathematical modeling suggests that half of all incident HIV cases among PWID in

Received 22 March 2017

Revised 15 August 2017

Accepted 14 September 2017

Lyuba Azbel is based at the

Yale University, New Haven,

Connecticut, USA.

Martin P. Wegman is MD-PhD

Student at the University of

Florida, Gainesville,

Florida, USA.

Maxim Polonsky is based at the

Quinnipiac University, Hamden,

Connecticut, USA.

Chethan Bachireddy is based

at the University of

Pennsylvania Department of

Medicine, Philadelphia,

Pennsylvania, USA.

Jaimie Meyer is based at the

Yale University, New Haven,

Connecticut, USA.

Natalya Shumskaya and Ainura

Kurmanalieva are both based

at the AIDS Foundation East-

West in the Kyrgyz Republic,

Bishkek, Kyrgystan.

Sergey Dvoryak is based at the

Ukrainian Institute on Public

Health Policy, Kyiv, Ukraine.

Frederick L. Altice is Professor

of Medicine at the School of

Medicine, Yale University,

New Haven, Connecticut, USA.

DOI 10.1108/IJPH-03-2017-0016 VOL. 14 NO. 3 2018, pp. 175-187, © Emerald Publishing Limited, ISSN 1744-9200

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