Intersecting epidemics of HIV,HCV, and syphilis among soon-to-be released prisoners in Kyrgyzstan: Implications for prevention and treatment |
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| Affiliation: | 1. London School of Hygiene & Tropical Medicine, London, United Kingdom;2. Yale University School of Medicine, Section of Infectious Diseases, New Haven, CT, USA;3. University of Florida, Departments of Epidemiology and of Health Outcomes and Policy, Gainesville, FL, USA;4. AIDS Foundation East-West in the Kyrgyz Republic, Bishkek, Kyrgyzstan;5. Department for Medical and Sanitary Services of the State Service on Penalty Execution, Kyrgyzstan;6. Centre of Excellence of Research in AIDS (CERiA), University of Malaya, Kuala Lumpur, Malaysia;7. Ukrainian Institute on Public Health Policy, Kyiv, Ukraine;8. Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA;1. Section of Infectious Diseases, AIDS Program, Yale School of Medicine, New Haven, CT, United States;2. Department of Behavioral Health, Whitman-Walker Health, Washington, DC, United States;3. Section of Digestive Diseases, Viral Hepatitis Program, Yale School of Medicine, New Haven, CT, United States;4. Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, NY, United States;5. Department of Psychiatry and Behavioral Sciences, Montefiore Medical Center, Albert Einstein College of Medicine, NY, United States;6. Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, United States;1. Centre of Excellence for Research in AIDS, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia;2. Yale School of Medicine, New Haven, CT, USA;3. Centre for Infectious Disease Research in Zambia, Lusaka, Zambia;4. University of Alabama at Birmingham, Birmingham, AL, USA;5. Department of HIV/AIDS, WHO, Geneva, Switzerland;6. European Monitoring Centre for Drugs and Drug Addiction, Lisbon, Portugal;7. Columbia University School of Social Work, New York, NY, USA;8. National Drug and Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia;9. Non-Communicable Diseases Research Centre, Endocrinology and Metabolism Population Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran;10. Institute of Public Health, University of Heidelberg, Heidelberg, Germany;11. Center for Public Health and Human Rights, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA;1. ICF Alliance for Public Health, Kyiv, Ukraine;2. Yale University School of Medicine, Section of Infectious Diseases, AIDS Program, New Haven, CT, USA;3. Yale University School of Medicine, Department of Psychiatry, New Haven, CT, USA;4. APT Foundation, New Haven, CT, USA;5. Ukrainian Institute on Public Health Policy, Kyiv, Ukraine;6. Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA;1. Department of Medicine, Brown University, Providence, RI, USA;2. Department of Social Medicine and Center for Health Equity Research, University of North Carolina, Chapel Hill, NC, USA;3. The Center for Prisoner Health and Human Rights, The Miriam Hospital, Providence, RI, USA;4. Department of Epidemiology, Brown University School of Public Health, Providence, RI, USA;5. Health and Human Rights Division, Human Rights Watch, New York City, NY, USA;6. Department of Medicine, University of British Columbia, Vancouver, Canada;7. Centro de Investigaciones Tecnológicas, Biomédicas y Medioambientales, Lima, Peru;8. Department of Global Health, University of Washington, Seattle, WA, USA;9. Moi University School of Medicine, Eldoret, Kenya;10. Section of Infectious Diseases, Yale School of Medicine, New Haven, CT, USA;11. Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, CT, USA;1. Ukrainian Institute on Public Health Policy, Kyiv, Ukraine;2. Yale University School of Public Health, Division of Epidemiology of Microbial Diseases, New Haven, CT, USA;3. Yale University School of Medicine and School of Public Health, New Haven, CT, USA;1. The Miriam Hospital, Providence, RI, United States;2. Brown Medical School, Providence, RI, United States;3. The International HIV/AIDS Alliance, Kiev, Ukraine;4. National Drug and Alcohol Research Centre, University of New South Wales, Australia |
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| Abstract: | BackgroundCentral Asia is afflicted with increasing HIV incidence, low antiretroviral therapy (ART) coverage and increasing AIDS mortality, driven primarily by people who inject drugs (PWID). Reliable data about HIV, other infectious diseases, and substance use disorders in prisoners in this region is lacking and could provide important insights into how to improve HIV prevention and treatment efforts in the region.MethodsA randomly sampled, nationwide biobehavioural health survey was conducted in 8 prisons in Kyrgyzstan among all soon-to-be-released prisoners; women were oversampled. Consented participants underwent computer-assisted, standardized behavioural health assessment surveys and testing for HIV, HCV, HBV, and syphilis. Prevalence and means were computed, and generalized linear modelling was conducted, with all analyses using weights to account for disproportionate sampling by strata.ResultsAmong 381 prisoners who underwent consent procedures, 368 (96.6%) were enrolled in the study. Women were significantly older than men (40.6 vs. 36.5; p = 0.004). Weighted prevalence (%), with confidence interval (CI), for each infection was high: HCV (49.7%; CI: 44.8–54.6%), syphilis (19.2%; CI: 15.1–23.5%), HIV (10.3%; CI: 6.9–13.8%), and HBV (6.2%; CI: 3.6–8.9%). Among the 31 people with HIV, 46.5% were aware of being HIV-infected. Men, compared to women, were significantly more likely to have injected drugs (38.3% vs.16.0%; p = 0.001). Pre-incarceration and within-prison drug injection, primarily of opioids, was 35.4% and 30.8%, respectively. Independent correlates of HIV infection included lifetime drug injection (adjusted odds ratio [AOR] = 38.75; p = 0.001), mean number of years injecting (AOR = 0.93; p = 0.018), mean number of days experiencing drug problems (AOR = 1.09; p = 0.025), increasing duration of imprisonment (AOR = 1.08; p = 0.02 for each year) and having syphilis (AOR = 3.51; p = 0.003), while being female (AOR = 3.06; p = 0.004) and being a recidivist offender (AOR = 2.67; p = 0.008) were independently correlated with syphilis infection.ConclusionDrug injection, syphilis co-infection, and exposure to increased risk during incarceration are likely to be important contributors to HIV transmission among prisoners in Kyrgyzstan. Compared to the community, HIV is concentrated 34-fold higher in prisoners. A high proportion of undiagnosed syphilis and HIV infections presents a significant gap in the HIV care continuum. Findings highlight the critical importance of evidence-based responses within prison, including enhanced testing for HIV and sexually transmitted infections, to stem the evolving HIV epidemic in the region. |
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| Keywords: | Prisons Kyrgyzstan HIV prevalence Syphilis Opioid use disorders People who inject drugs (PWID) |
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