Abstract
Despite HIV prevention efforts over the past 10 years in Odessa, Ukraine, HIV rates among injection drug users (IDUs) remain high. We explored whether IDUs’ experiences with the police and court system in Odessa were associated with HIV serostatus, after controlling for other factors. Qualitative methods, including semi-structured interviews with the police and members of court (N = 19), and focus groups with IDUs (N = 42), were employed to aid in developing a survey instrument for a larger quantitative phase and to assist in interpreting the findings from the quantitative phase, which included 200 participants who were interviewed and tested for HIV. Overall, 55 % tested positive for HIV. Negative experiences with the police were noted by 86 % and included having preloaded syringes taken (66 %), rushed injections due to fear of the police (57 %), police planting drugs (18 %), paying police to avoid arrest (61 %) and threatened by the police to inform on other IDUs (23 %). HIV positive participants were more likely than those who were negative to report these experiences. In a multiple logistic regression, the most significant correlate of HIV infection was rushed injections due to fear of the police. Police actions in Odessa may be contributing to the continued escalation of HIV among IDUs, underscoring the need for structural interventions.
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References
World Health Organization. The current global situation of the HIV/AIDS pandemic. Wkly Epidemiol Rec. 1995;70:355.
Khodakevich L, Dehne KL. HIV epidemics in drug-using population and increasing drug use in Central and Eastern Europe. Presented at the inaugural meeting of the global research network on HIV prevention in drug-using populations. Geneva, 1998.
Kobyshcha Y, Shcherbinskaya A, Khodakevich L, Andrushchak L, Kruglov Y. HIV infection among drug users in the Ukraine: beginning of the epidemic [TUC2041]. Presented at the XI international AIDS conference. Vancouver, 1996.
UNAIDS/WHO–Joint United Nations Programme on HIV/AIDS. AIDS epidemic update. Geneva, 2002.
Ministry of Health of Ukraine, Ukrainian AIDS Center, The LV Gromashevskyi Institute of Epidemiology and Infectious Diseases of AMS of Ukraine. HIV-infection in Ukraine: information bulletin No. 27. 2007.
Ministry of Health of Ukraine. National report on monitoring progress towards the UNGASS (United National General Assembly Special Session) Declaration of Commitment on HIV/AIDS; Kiev, Ukraine. Available at: http://www.unaids.org/en/CountryResponses/Countries/ukraine.asp. Accessed 4 Nov 2008.
International HIV/AIDS Alliance in Ukraine. HIV and ID epidemiology overview in Ukraine. Ukrainian AIDS Center; Summer School on Epidemiology Studies, V. Marcinovska. 2010.
Ministry of Health Ukraine, Ukrainian AIDS Center, The LV Gromashevskyi Institute of Epidemiology and Infectious Diseases of AMS of Ukraine. HIV in Ukraine: informational bulletin. No. 37. 2011.
Ministry of Health Ukraine. Report on the National consensus estimates on HIV and AIDS in Ukraine as of end of 2005. Ministry of Health Ukraine. Ukraine AIDS Centre, WHO, International HIV/AIDS Alliance in Ukraine. 2006.
The World Bank/International HIV/AIDS Alliance in Ukraine. Socioeconomic impact of HIV/AIDS in Ukraine. Washington: Library of Congress; 2006.
The World Bank. Yearend report: HIV/AIDS in Eastern Europe, 2007.
Kuzio T. Census: Ukraine, more Ukrainian. Russian and Eurasia Review. Washington, DC : The Jamestown Foundation, 2003.
Pozynyak VB, Pelipas VE, Vievski AN, Miroshnichenko L. Illicit drug use and its health consequences in Belarus, Russian Federation and Ukraine: impact of transition. Eur Addict Res. 2002;8:184–9.
Rhodes T, Ball A, Stimson GV, et al. HIV Infection associated with drug injecting in the newly independent states, Eastern Europe: the social and economic context of epidemics. Addiction. 1999;94:1323–36.
Dehne KL, Pokrovskiy V, Kobyshcha Y, Schwartlander B. Update on the epidemic of HIV and other sexually transmitted infections in the newly independent states of the former Soviet Union. AIDS. 2000;14(Suppl. 3):S75–84.
Schneider F. Illegal activities and the generation of value added: size, causes and measurement of shadow economics. Bull Narc. 2000;LII:102–4.
United Nations International Drug Control Programme (UNIDCP). World Drug Report. New York: Oxford University Press; 1997.
Rhodes T, Sarang A, Bobrik A, Bobkov A, Strathdee E, Platt L. HIV transmission and HIV prevention associated with injecting drug use in the Russian Federation. Int J Drug Policy. 2004;15:1–16.
Booth RE, Mikulich-Gilbertson SK, Brewster JT, Salomonson-Sautel S, Semerik O. Predictors of self-reported HIV infection among drug injectors in Ukraine. J Acquir Immune Defic Syndr. 2004;35:82–8.
Booth RE, Kwiatkowski CF, Mikulich-Gilbertson SK, et al. Predictors of risky needle use following interventions with drug injectors in Ukraine. Drug Alcohol Depend. 2006;82:S49–57.
Booth RE, Kennedy JK, Brewster JT, Semerik O. Drug injectors and dealers in Odessa, Ukraine. J Psychoactive Drugs. 2003;35:419–26.
Rhodes T, Stimson GV, Quirk A. Sex, drugs, intervention, and research: from the individual to the social. Subs Use Misuse. 1996;31(3):375–407.
Dehne KL, Grund JC, Khodakevich L, Kobyshcha Y. The HIV/AIDS epidemic among drug injectors in Eastern Europe: patterns, trends and determinants. J Drug Issues. 1999;29:729–76.
Ball A, Rana S, Dehne KL. HIV prevention among injecting drug users: responses in developing and transitional countries. Public Health Rep. 1998;113(Suppl 1):170–81.
International HIV/AIDS Alliance in Ukraine. Analytical Report: Behavioral monitoring and HIV-prevalence among injecting drug users as a component of second generation surveillance. Kiev; 2012.
Bluthenthal RN, Kral AH, Erringer EA, Edlin BR. Drug paraphernalia laws and injection related infectious disease risk among drug injectors. J Drug Issues. 1999;29:1–16.
Werb D, Wood E, Small W, et al. Effects of police confiscation of illicit drugs and syringes among injection drug users in Vancouver. Int J Drug Policy. 2008;19:332–8.
Pollini RA, Brouwer KC, Lozada RM, et al. Syringe possession arrests are associated with receptive syringe sharing in two Mexico-US border cities. Addiction. 2007;103:101–8.
Bobrova N, Rhodes T, Power R, et al. Barriers to accessing drug treatment in Russia: a qualitative study among injecting drug users in two cities. Drug Alcohol Depend. 2008;82(Suppl 1):S57–63.
Shannon K, Rusch M, Shoveller J, Alexson D, Gibson K, Tyndall MW. Mapping violence and policing as an environmental-structural barrier to health service and syringe availability among substance-using women in street-level sex work. Int J Drug Policy. 2008;19:140–7.
Mimiaga MJ, Safren SA, Dvoryak S, Resiner SL, Needle R, Woody G. “We fear the police and the police fear us”: structural and individual barriers to HIV medication adherence among injection drug users in Kiev, Ukraine. AIDS Care. 2010;22:1305–13.
Strathdee SA, Lozada R, Pollini RA, et al. Individual, social, and environmental, influences among injection drug users in Tijuana, Mexico. J Acquir Immune Defic Syndr. 2008;47:369–76.
Friedman SR, Cooper HLF, Tempalaski B, et al. Relationship of deterrence and law enforcement to drug-related harms among drug injectors in US metropolitan areas. AIDS. 2006;S20:93–9.
Spicer N, Bogdan D, Brugha R, Harmer A, Murzalieva G, Semigina T. ‘It’s risky to walk in the streets with syringes’: understanding access to HIV/AIDS services for injecting drug users in the former Soviet Union countries of Ukraine and Kyrgystan. Global Health. 2011;7:22. doi:10.1186/1744-8603-7-22.
Shedlin MG, Schreiber JM. Using focus groups in drug abuse and HIV/AIDS research. NIDA Res Monogr. 1995;157:136–55.
Sterk-Elifson C. Just for fun: middle class cocaine use among women. J Drug Issues. 1996;26:65–78.
Dowling-Guyer S, Johnson ME, Fisher DG, et al. Reliability of drug users’ self-reported HIV risk behaviors and validity of self-reported recent drug use. Assessment. 1994;1:383–92.
Weatherby NL, Needle R, Cesar H, et al. Validity of self-reported drug use among injection drug users and crack smokers recruited through street outreach. Eval Program Plann. 1994;17:347–55.
Nagelkerke NJD. A note on a general definition of the coefficient of determination. Biometrika. 1991;78:691–2.
Hosmer DW Jr, Lemeshow S. Applied logistic regression. 2nd ed. New York: Wiley; 2000.
Weisberg S. Applied linear regression. 2nd ed. New York: Wiley; 1985.
Neter J, Kutner MH, Nachtsheim CJ, Wasserman Q. Applied linear statistical models. 4th ed. Chicago: Irwin; 1996.
Rhodes T. The “risk environment”: a framework for understanding and reducing drug-related harm. Int J Drug Policy. 2002;13:84–94.
Burris S, Blankenship KM, Donoghoe M, et al. Addressing the “risk environment” for injection drug users: the mysterious case of the missing cop. Milbank Q. 2004;82:125–56.
Bourgois P. The moral economies of homeless heroin addicts: confronting ethnography, HIV risk, and everyday violence in San Francisco shooting encampments. Subst Use Misuse. 1998;33:2323–51.
Maher L, Dixon D. Policing and public health: law enforcement and harm minimization in a street-level drug market. Brit J Crim. 1999;39:488–511.
Aitken C, Moore D, Higgs P, Kelsall J, Kerger M. The impact of a police crackdown on a street drug scene: evidence from the street. Int J Drug Policy. 2002;13:189–98.
Cooper H, Moore L, Gruskin S, Kreiger N. The impact of a police crackdown on drug injectors’ ability to practice harm reduction: a qualitative study. Soc Sci Med. 2005;61:673–84.
Rhodes T, Kimber J, Small W, et al. Public injecting and the need for ‘safer environment interventions’ in the reduction of drug-related harm. Addiction. 2006;101:1384–93.
Vlahov D, Sullivan M, Astemborski L, Nelson K. Bacterial infections and skin cleaning prior to injection among intravenous drug users. Public Health Rep. 1992;107:595–8.
Murphy E, Devita D, Lui H, et al. Risk factors for skin and soft-tissue abscesses among injection drug users: a case-control study. Clin Infect Dis. 2001;33:35–40.
Beletsky L, Lozada R, Gaines T et al. Syringe confiscation as an HIV risk factor: The public health implications of arbitrary policing in Tijuana and Ciudad Juarez, Mexico. J Urban Health. 2013;90:284–98.
Kerr T, Small W, Wood E. The public health impacts of drug market enforcement: a review of the evidence. Int J Drug Policy. 2005;16:210–20.
Samet JH, Walley AY, Cheng DM, et al. Police involvement with HIV-infected Russian heroin users from the HERMITAGE study. Presented at: 72th annual scientific meeting of the college on problems of drug dependence. Scottsdale, 2010.
Lovel AM. Risking risk: the influence of types of capital and social networks on the injection practices of drug users. Soc Sci Med. 2002;55:803–21.
Bohnert ASB, Nandi A, Tracy M, et al. Policing and risk of overdose mortality in urban neighborhoods. Drug Alcohol Depend. 2011;113:62–8.
Dovey KJ, Fitzgerald J, Choi Y. Safety becomes danger: dilemmas of drug-use in public space. Health Place. 2001;7:319–23.
Maisto S, McKay J, Conners G. Self-reported issues in substance abuse: state of the art and future directions. Behav Assess. 1960;121:117–34.
Booth RE, Crowley TJ, Zhang Y. Substance abuse treatment entry, retention, and effectiveness: out-of-treatment opiate injection drug users. Drug Alcohol Depend. 1996;42:11–20.
EuroHIV. HIV/AIDS surveillance in Europe: end-year report 2005. Saint-Maurice: Institute de Veille Sanitaire. 2005.
Amirkhanian YA, Kelly JA, Benotsch EG, et al. HIV prevention nongovernmental organizations in Central and Eastern Europe: programs, resources and challenges. Cent Euro J Public Health. 2004;5:12–8.
Goldstein H. Problem-oriented policing. Philadelphia: Temple University Press; 1990.
Grund JP, Stern LS, Kaplan CD, Adriaans NF, Dricker E. Drug use contexts and HIV-consequences: the effect of drug policy on patterns of everyday drug use in Rotterdam and the Bronx. British J Add. 1992;87:381–92.
Midford R, Acres J, Lenton S, Loxley W, Boots K. Cops, drugs and the community: establishing consultative harm reduction structures in two Western Australian locations. Int J Drug Policy. 2002;93:L181–8.
Smith BW, Novak KJ, Frank J, Travis LF. Multi-jurisdictional drug task forces: an analysis of impacts. J Crim Justice. 2000;28:543–56.
Zurhold H, Degkwitz P, Verthein U, Haasen C. Drug consumption rooms in Hamburg, Germany: evaluation of the effects on harm reduction and the reduction of public nuisance. J Drug Issues. 2003;33:663–88.
Wood R, Tyndall MW, Li K, et al. Do supervised injecting facilities attract higher-risk injection drug users. Am J Prev Med. 2005;29:126–30.
van Beek I, Kimber J, Dakin A, Gilmour S. The Sydney medically supervised injecting centre: reducing harm associated with heroin overdose. Crit Public Health. 2004;14:391–406.
Strathdee SA, Hallett TB, Bobrova N, et al. HIV and risk environment for injecting drug users: the past, present, and future. Lancet. 2010;379:268–84.
Acknowledgments
This work was supported by National Institute on Drug Abuse (DA024590). The authors would like to acknowledge the dedicated NGO staff, Tatiana Semikop, Director of Faith, Hope and Love in Odessa from which the study was conducted, and Olga Martinuk, Project Coordinator. We are also indebted to the officials and drug users who agreed to participate and gave their time that allowed us to produce this paper. Finally, we would like to express our sincere appreciation to the two reviewers who provided helpful and insightful comments regarding the first draft of this manuscript. We feel the revised manuscript is a great improvement over our original submission.
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Booth, R.E., Dvoryak, S., Sung-Joon, M. et al. Law Enforcement Practices Associated with HIV Infection Among Injection Drug Users in Odessa, Ukraine. AIDS Behav 17, 2604–2614 (2013). https://doi.org/10.1007/s10461-013-0500-6
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DOI: https://doi.org/10.1007/s10461-013-0500-6