The Perfect Storm: Incarceration and the High-Risk Environment Perpetuating Transmission of HIV, Hepatitis C Virus, and Tuberculosis in Eastern Europe and Central Asia

November 2016 - Structural Prevention

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Altice, F.L., Azbel, L., Stone, J., et al. The Lancet (July 2016), 388: 1228–4, doi: org/10.1016/ S0140-6736(16)30856-X.

This review examined the junction of HIV, tuberculosis, hepatitis C virus (HCV), and imprisonment among people who inject drugs (PWID), and HIV risk factors that are associated with incarceration. The region of Eastern Europe and Central Asia is the only area where HIV incidence and mortality, largely associated with PWID, are increasing. In this region, opioid agonist therapies and needle and syringe exchange programs are banned or limited, and HIV diagnosis and treatment availability is limited. Modeling studies show that opioid agonist therapy would be the most cost-effective HIV prevention intervention, and would be even more effective when combined with HIV treatment. Criminalization of injection drug use, high HIV prevalence among PWID within prisons, and needle sharing facilitate high HIV transmission among prisoners. Policies that require PWID to register for opioid agonist therapy outside of prison, allow arrest for accessing harm reduction services, and criminalize same-sex behaviors and sex work increase the risk of arrest and imprisonment. The authors concluded that structural factors significantly contribute to the incarceration of vulnerable populations including PWID, increasing their risk of HIV. Approaches that reduce incarceration risk and increase availability of opioid agonist therapy during and after imprisonment have the potential to reduce HIV and HCV transmission among PWID in the criminal justice system.

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