Background: People who inject drugs (PWID) in Ukraine living with HIV continue to be affected by police abuse. This study aimed to assess the current relationship of police abuse experienced by PWID living with HIV in Ukraine and HIV care and harm reduction outcomes. We hypothesized a relationship between police abuse and adherence to ART, as well as a relationship to harm reduction service utilization.
Methods: We collected cross-sectional survey data at seven addiction care facilities in six regions of Ukraine between August and September 2017. For this analysis, we included 191 PWID living with HIV who received opioid agonist treatment, with a subsection of 156 participants currently on ART. We fit separate regression models to evaluate the association between the independent variables "arrests for needle possession or needles/drugs planted", “physical or verbal violence”, “sexual violence” (being forced to have sex with a police officer; females only) as reported by participants and “adherence to ART” (≥90% adherence on a visual analog scale) and “recent use of harm reduction services” (past 6 months).
Results: 90.5% of study participants reported any police abuse, with 71% reporting unjustified arrests, 86.9% reporting verbal or physical violence or both, and 6.9% (25% of females) reporting sexual violence. Of 156 participants on ART, 87.8% were adherent, and 77.9% had made use of harm reduction services in the last 6 months. We found no significant association between police abuse and ART adherence, or recent use of harm reduction services in this study population.
Conclusions: The high rates of unjustified arrests, violence and sexual violence perpetrated by police towards people in addiction care in Ukraine is concerning. While the lack of association between police abuse, ART adherence and harm reduction utilization might suggest that people in addiction care have overcome police abuse as a barrier to care, structural changes and legal action need to end these human rights infringements. Continued exploration to further elucidate health care implications and health consequences of police abuse is necessary.