Health and human rights: advocacy tools for structural HIV prevention among Russian drug users

Thesis (D.P.H.)--Boston UniversityInjection drug use fuels the HIV/AIDS epidemic in the Russian Federation (Russia). Evidence suggests that repressive drug law enforcement is part of the HIV risk environment and associated with risk behaviors that promote HIV transmission among people who inject drugs (PWID). However, no quantitative studies on police involvement and associated risk behaviors or health outcomes exist from Russia. We conducted a mixed-methods study in St. Petersburg, Moscow, and Vladikavkaz to characterize the impact of current policing practices on HIV-risk behaviors and overdose among PWID; and to explore attitudes of stakeholders about Russian drug policy and opportunities to change. Descriptive and multivariate regression analyses of quantitative cross-sectional data from 582 HIV prevention trial participants showed that reported policing practices such as arbitrary arrests, planting of false evidence, and extrajudicial syringe confiscations, are common in Russia and are associated with adverse risk behaviors and health outcomes such as receptive needle sharing and drug overdose, respectively. These policing practices often constitute human rights violations. We failed to demonstrate any deterrent effect of abusive policing practices on drug use. A qualitative exploration among 23 key stakeholders revealed that police violence in various forms is ubiquitous in the lives of Russian PWID. Police abuse is rooted in stigma and a power imbalance between police and PWID, and reinforced by police corruption and the dehumanization of PWID. This study suggests that police practices are part of the HIV risk environment of Russian PWID. The translation of empiric evidence into policy change in the Russian country context might be facilitated by police trainings emphasizing public health and harm reduction principles as well as the development of joint public safety/public health task forces. Using research evidence from other countries to influence policy in Russia has had limited effects. Therefore, more evidence from Russian studies is needed to advance the alignment of public health and public safety efforts to effectively address drug userelated harm and HIV prevention in Russia

Stigma and Human Rights Abuses against People Who Inject Drugs in Russia—A Qualitative Investigation to Inform Policy and Public Health Strategies

Introduction: Drug policing practices in the Russian Federation (Russia) are often punitive and have been shown to be associated with HIV risk behaviors among people who inject drugs (PWID). Less is known about strategies to address the problem in that setting, where substance use stigma is highly persistent. A better understanding of forms, causes and consequences of drug policing in Russia could inform drug policy in a context of substantial policy resistance. This qualitative study’s goal is to characterize the phenomenon of police involvement with Russian PWID and to explore strategies for drug policing in the Russian country context. Methods: Using a semi-structured interview guide, we collected data from a purposive sample of 23 key informants including PWID, police officers, and experts from civil society and international organizations in Russia. We used a thematic analysis approach to inductively generate new insight into the phenomenon of police involvement and potential strategies to address it. Results: Policing practices involving PWID include unjustified arrests, planting of false evidence and extrajudicial syringe confiscations, and often constitute human rights violations. Russian PWID personally experienced police violence as ubiquitous, taking on various forms such as beating, unjustified arrests, verbal harassment, and coercion. The persistent societal stigma dehumanizes PWID, and such stigmatization facilitates police abuse. To address stigma and overcome the PWID-police adversity, study participants suggested fostering a mutual understanding between the police and public health sectors. Conclusions: Participants describe substantial human rights violations as part of policing illicit drug use in Russia. Police should include principles of effective prevention of substance use and HIV risk reduction in their trainings. Alignment of public safety and public health goals could address drug use-related risks and HIV prevention among key populations in Russia

Expansion of topics emerging from quotes in key informant interviews.

<p>Themes and concepts characterize police involvement as an element of risk environment of Russian PWID, and offer attitudes and insights into possible policy approaches to address structural risks in Russia.</p