Abstract
BackgroundThe epidemics of incarceration, substance use disorders (SUDs), and infectious diseases are inextricably intertwined, especially in the Former Soviet Union (FSU). Few objective data documenting this relationship regionally are available. We therefore conducted a comprehensive, representative country-wide prison health survey in Ukraine, where one of the world’s most volatile HIV epidemics persists, in order to address HIV prevention and treatment needs.MethodsA nation-wide, multi-site randomly sampled biobehavioral health survey was conducted in four Ukrainian regions in 13 prisons among individuals being released within six months. After consent, participants underwent standardized health assessment surveys and serological testing for HIV, viral hepatitis, and syphilis.ResultsOf the 402 participants (mean age = 31.9 years), 20.1% were female. Prevalence of HIV, HCV, HBV, and syphilis was 19.4% (95% CI = 15.5%–23.3%), 60.2% (95% CI = 55.1%–65.4%), 5.2% (95% CI = 3.3%–7.2%), and 10% (95% CI = 7.4%–13.2%), respectively, with regional differences observed; HIV prevalence in the south was 28.6%. Among the 78 HIV-infected inmates, 50.7% were unaware of their HIV status and 44 (56.4%) had CD4<350 cells/mL, of which only five (11%) antiretroviral-eligible inmates were receiving it. Nearly half of the participants (48.7%) reported pre-incarcertion drug injection, primarily of opioids, yet multiple substance use (31.6%) and alcohol use disorders (56.6%) were common and 40.3% met screening criteria for depression.ConclusionsThis is the only such representative health study of prisoners in the FSU. This study has important implications for regional prevention and treatment because, unlike elsewhere, there is no recent evidence for reduction in HIV incidence and mortality in the region. The prevalence of infectious diseases and SUDs is high among this sample of prisoners transitioning to the community. It is critical to address pre- and post-release prevention and treatment needs with the development of linkage programs for the continuity of care in the community after release.
Highlights
[2] Ukraine and Russia account for 90% of the region’s infections [3] while Ukraine has one of the most volatile HIV epidemics in the world, with 1.63% of the adult population currently living with HIV/AIDS (PLWHA) [4]–a number that is estimated to double by the year 2014
While incarceration itself can lead to increased risk for HIV, [7] prisons can serve as important sentinel surveillance sites for detection and treatment and can be leveraged to introduce HIV risk reduction interventions. [8,9] Ukraine, similar to other countries grappling with a transitional epidemic, houses a large percentage of prisoners incarcerated for crimes associated with increased HIV risk including commercial sex work and substance use disorders (SUDs)
78 (19.4%: 95% confidence interval (CI) = 15.5%–23.3%) participants were HIVinfected, 242 (60.2%:95% CI = 55.1%–65.4%) were antibody positive for HCV, 21 (5.2%: 95% CI = 3.3%–7.2%) were positive for active HBV infection, and 40 (10.0%: 95% CI = 7.4%–13.2%) tested positive for syphilis
Summary
By 2009, HIV incidence globally had decreased by 19%, yet Eastern Europe and Central Asia remain at the center of one the world’s most rapidly expanding HIV epidemics, with a 24% increase in new HIV cases. [1] This regional HIV epidemic manifests itself primarily among people who inject drugs (PWIDs), but there is evidence for a transitioning epidemic. [2] Ukraine and Russia account for 90% of the region’s infections [3] while Ukraine has one of the most volatile HIV epidemics in the world, with 1.63% of the adult population currently living with HIV/AIDS (PLWHA) [4]–a number that is estimated to double by the year 2014. [5] HIV infection among PWIDs accounts for 10% of all HIV infections globally, but 33% outside of Subsaharan Africa, [6] suggesting an altogether different regional epidemic that needs special prevention and treatment needs.Due to high incarceration rates among PWIDs, HIV is often concentrated within prisons, yet definitive data are lacking from well-conducted serosurveillance studies in Eastern Europe. An effective approach in this regard could be expanded to the countries of Eastern Europe and Central Asia where HIV infection among PWIDs prevails. Systematic approaches to address incarceration as a means to curbing the HIV and substance use epidemics, are currently limited This is true because of a lack of scientifically rigorous data to describe the magnitude of the problem within prisons. The epidemics of incarceration, substance use disorders (SUDs), and infectious diseases are inextricably intertwined, especially in the Former Soviet Union (FSU). We conducted a comprehensive, representative country-wide prison health survey in Ukraine, where one of the world’s most volatile HIV epidemics persists, in order to address HIV prevention and treatment needs
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