The HIV epidemic in the countries of the former Soviet Union continues to be a growing public health problem. Currently, it is the only region in the world where the incidence of HIV does not appear to be declining. The epidemic is concentrated among injection drug users (IDUs), however there is increasing concern that the epidemic may shift to the non-drug using heterosexual population. Drug treatment in Russia is largely inadequate to meet the needs of the patient population. Treatment for opioid dependency in Russia suffers from a lack of effective therapies because opioid substitution therapy is illegal. Additionally, Russia has one of the highest incarceration rates in the world. In St. Petersburg, the site of the proposed research, half of those incarcerated were in prison due to drug offenses, a substantial fraction of those who met the criteria for opioid dependency. Due to weak linkages between incarceration facilities and the community, incarcerated IDUs upon release face a high risk of quickly resuming to opioid use, overdose or death, and engaging in risky injection practices. In this proposal, I will pursue a mixed methods approach to characterize the risk environment facing IDUs upon release from prison. Respondents will be recruited from a much larger parent study (R01DA029888). IDUs who have spent time incarcerated will be invited to participate in this study. For the quantitative component, we will inquire about the amount of time that elapsed from when the respondent was released from prison to when the respondent began using opioids again and whether they experienced an overdose after being released. This retrospective cohort analysis will be limited to respondents who have ever been incarcerated. We will identify factors in the respondents risk environment that may have facilitated relapse or overdose after release from prison. We hypothesize that the majority of respondents who have been incarcerated will have relapse to opioid use within a month of release. Our second analysis will focus on the prevalence and frequency of risky injections among respondents who have a history of incarceration and compare these data to respondents who have never been incarcerated. We hypothesize that IDUs who have been incarcerated will have engaged in more risky injections than IDUs who have never been incarcerated. Lastly, we will recruit respondents who have been incarcerated within two years for in-depth qualitative interviewing pertaining to their risk environment after release. The purpose of the qualitative analysis is to confirm and explain the findings from the quantitative components.
Injection drug users who have been incarcerated in Russia face a high-risk environment upon release. This proposal seeks to determine the factors associated with relapse to opioids, overdose, and risky injection behaviors that could facilitate HIV transmission and other blood-borne pathogens among Russian IDUs after release from incarceration.
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