TY - JOUR
T1 - Within-prison drug injection among HIV-infected male prisoners in Indonesia
T2 - A highly constrained choice
AU - Culbert, Gabriel J.
AU - Waluyo, Agung
AU - Iriyanti, Mariska
AU - Muchransyah, Azalia P.
AU - Kamarulzaman, Adeeba
AU - Altice, Frederick L.
N1 - Publisher Copyright:
© 2015 Elsevier Ireland Ltd.
PY - 2015/4/1
Y1 - 2015/4/1
N2 - Background: In Indonesia, incarceration of people who inject drugs (PWID) and access to drugs in prison potentiate within-prison drug injection (WP-DI), a preventable and extremely high-risk behavior that may contribute substantially to HIV transmission in prison and communities to which prisoners are released. Aims: This mixed method study examined the prevalence, correlates, and social context of WP-DI among HIV-infected male prisoners in Indonesia. Methods: 102 randomly selected HIV-infected male prisoners completed semi-structured voice-recorded interviews about drug use changes after arrest, drug use cues within prison, and impact of WP-DI on HIV and addiction treatment. Logistic regression identified multivariate correlates of WP-DI and thematic analysis of interview transcripts used grounded-theory. Results: Over half (56%) of participants reported previous WP-DI. Of those, 93% shared injection equipment in prison, and 78.6% estimated sharing needles with ≥10 other prisoners. Multivariate analyses independently correlated WP-DI with being incarcerated for drug offenses (AOR. = 3.29, 95%CI. = 1.30-8.31, p= 0.011) and daily drug injection before arrest (AOR. = 5.23, 95%CI. = 1.42-19.25, p= 0.013). Drug availability and proximity to drug users while incarcerated were associated with frequent drug craving and escalating drug use risk behaviors after arrest. Energetic heroin marketing and stigmatizing attitudes toward methadone contribute to WP-DI and impede addiction and HIV treatment. Conclusions: Frequent WP-DI and needle sharing among these HIV-infected Indonesian prison inmates indicate the need for structural interventions that reduce overcrowding, drug supply, and needle sharing, and improve detection and treatment of substance use disorders upon incarceration to minimize WP-DI and associated harm.
AB - Background: In Indonesia, incarceration of people who inject drugs (PWID) and access to drugs in prison potentiate within-prison drug injection (WP-DI), a preventable and extremely high-risk behavior that may contribute substantially to HIV transmission in prison and communities to which prisoners are released. Aims: This mixed method study examined the prevalence, correlates, and social context of WP-DI among HIV-infected male prisoners in Indonesia. Methods: 102 randomly selected HIV-infected male prisoners completed semi-structured voice-recorded interviews about drug use changes after arrest, drug use cues within prison, and impact of WP-DI on HIV and addiction treatment. Logistic regression identified multivariate correlates of WP-DI and thematic analysis of interview transcripts used grounded-theory. Results: Over half (56%) of participants reported previous WP-DI. Of those, 93% shared injection equipment in prison, and 78.6% estimated sharing needles with ≥10 other prisoners. Multivariate analyses independently correlated WP-DI with being incarcerated for drug offenses (AOR. = 3.29, 95%CI. = 1.30-8.31, p= 0.011) and daily drug injection before arrest (AOR. = 5.23, 95%CI. = 1.42-19.25, p= 0.013). Drug availability and proximity to drug users while incarcerated were associated with frequent drug craving and escalating drug use risk behaviors after arrest. Energetic heroin marketing and stigmatizing attitudes toward methadone contribute to WP-DI and impede addiction and HIV treatment. Conclusions: Frequent WP-DI and needle sharing among these HIV-infected Indonesian prison inmates indicate the need for structural interventions that reduce overcrowding, drug supply, and needle sharing, and improve detection and treatment of substance use disorders upon incarceration to minimize WP-DI and associated harm.
KW - Antiretroviral therapy
KW - Drug injection
KW - HIV
KW - Indonesia
KW - Methadone
KW - Prisons
UR - http://www.scopus.com/inward/record.url?scp=84926172840&partnerID=8YFLogxK
U2 - 10.1016/j.drugalcdep.2015.01.018
DO - 10.1016/j.drugalcdep.2015.01.018
M3 - Article
C2 - 25659895
AN - SCOPUS:84926172840
VL - 149
SP - 71
EP - 79
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
SN - 0376-8716
ER -