HIV This Week

Sarang A, Rhodes T, Platt L, Kirzhanova V, Shelkovnikova O, Volnov V, Blagovo D, Rylkov A. Drug injecting and syringe use in the HIV risk environment of Russian penitentiary institutions: qualitative study. Addiction 2006;101:1787-96.

Evidence highlights the prison as a high risk environment in relation to HIV and hepatitis C virus (HCV) transmission associated with injecting drug use. Sarang and colleagues undertook qualitative studies among 209 people who inject drugs in three Russian cities: Moscow (n=56), Volgograd (n=83) and Barnaul in western Siberia (n=70). Over three-quarters (77%) reported experience of police arrest related to their drug use, and 35% (55% of men) a history of imprisonment or detention. Findings emphasise the critical role that penitentiary institutions may play as a structural factor in the diffusion of HIV associated with drug injection in the Russian Federation. While drugs were perceived to be generally available in penitentiary institutions, sterile injection equipment was scarce and as a consequence routinely reused, including within large groups. Attempts to clean borrowed needles or syringes were inadequate, and risk reduction was severely constrained by a combination of lack of injecting equipment availability and punishment for its possession. Perceptions of relative safety were also found to be associated with assumptions of HIV negativity, resulting from a perception that all prisoners are HIV tested upon entry with those found HIV positive segregated. The authors conclude that the study shows an urgent need for HIV prevention interventions in the Russian penitentiary system.

Dolan K, Kite B, Black E, Aceijas C, Stimson GV, for the Reference Group on HIV/AIDS Prevention and Care among Injecting Drug Users in Developing and Transitional Countries. HIV in prison in low-income and middle-income countries. Lancet Infect Dis 2007;7:32-41

High prevalence of HIV infection and the over-representation of people who inject drugs in prisons combined with HIV risk behaviour create a crucial public-health issue for correctional institutions and, at a broader level, the communities in which they are situated. However, data relevant to this problem are limited and difficult to access. Dolan and colleagues reviewed imprisonment, HIV prevalence, and the proportion of prisoners who inject drugs in 152 low-income and middle-income countries. Information on imprisonment was obtained for 142 countries. Imprisonment rates ranged from 23 per 100000 population in Burkina Faso to 532 per 100000 in Belarus and Russia. Information on HIV prevalence in prisons was found for 75 countries. Prevalence was greater than 10% in prisons in 20 countries. Eight countries reported prevalence of people who inject drugs in prison of greater than 10%. HIV prevalence among prisoners who inject drugs was reported in eight countries and was greater than 10% in seven of those. Evidence of HIV transmission in prison was found for seven low-income and middle-income countries. HIV is a serious problem for many countries, especially where injection drug use occurs. The authors conclude that because of the paucity of data available, the contribution of HIV within prison settings is difficult to determine in many low-income and middle-income countries. They add that systematic collection of data to inform HIV prevention strategies in prison is urgently needed. The introduction and evaluation of HIV prevention strategies in prisons are warranted.

Editors’ note: No institution outside hospitals has higher HIV prevalence around the world. Although more data are needed, the actions needed to prevent intramural transmission are well known – implementation and evaluation are urgently needed.