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Police abuse, stigma and HIV care utilization in people with HIV who inject drugs in St. Petersburg, Russia

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BACKGROUND: Various barriers limit care utilization of people with HIV who inject drugs in the Russian Federation (Russia). Police abuse's link with healthcare, stigma and health is not well understood. This study examined police abuse reported by people with HIV who inject drugs, and assessed its association with HIV care utilization, stigma and mental health.
METHODS: In a cross-sectional sample of 111 HIV-positive PWID recruited from October 2019 to September 2020 in Saint Petersburg, Russia, we examined the following outcomes: recent HIV care utilization (past 6 months), Berger HIV stigma Scale, Self-Stigma in Substance Abuse Scale, anxiety (GAD-7), and depressive symptoms (PHQ-9). We used logistic and linear regression to assess the association between each of these outcomes and recent police abuse (unjustified arrests, physical and verbal violence or sexual abuse in past six months). All models were adjusted for age, gender, HIV stigma (where not outcome), past incarceration, and willingness to begin ART (utilization model).
RESULTS: Among 111 participants, 12(10.8%) reported experiencing any recent police abuse in the past 6 months, 4(4%) unjustified arrests, 9(8%) physical and verbal violence, and 1(1%) sexual abuse. Recent police abuse was not associated with recent HIV care utilization (adjusted odds ratio(AOR): 2.83, 95%CI:0.79 '10.92, p=0.113) nor with HIV stigma (adjusted mean difference (aMD): -0.10, 95%CI:-2.58 ' 2.38, p=0.938). Recent police abuse was positively associated with substance use stigma (aMD:4.54, 95%CI: 0.06 ' 9.03, p=0.047), moderate to severe depressive symptoms (AOR: 4.1, 95%CI:1.11 ' 17.36, p=0.039) and moderate to severe anxiety symptoms (AOR: 5.15, 95%CI:1.24 ' 21.12, p=0.021).

Demographics and Clinical Characteristics
CharacteristicOverall n=111 (column%)Police Abuse in the past 6 months - Yes
n=99 (row%)
Police Abuse in the past 6 months - No
n=99 (row%)
p-value
Age
Mean (SD)

39 (5)

39 (5)

40 (4)
0.405
Sex
Male
Female

59 (53%)
52 (47%)

51 (86%)
48 (92%)

8 (14%)
4 (8%)
0.321
Ever Incarcerated
No
Yes

28 (25%)
83 (75%)

22 (79%)
77 (93%)

6 (21%)
6 (7%)
0.071
Health Care Utilization
No
Yes

72 (65%)
39 (35%)

67 (93%)
32 (82%)

5 (7%)
7 (18%)
0.108
ART Willingness
Not willing
Willing

35 (32%)
76 (68%)

31 (89%)
68 (89%)

4 (11%)
8 (11%)
>0.999
HIV Stigma
Mean (SD)

24 (4)

24 (4)

25 (4)
0.574
Substance Use Stigma
Mean (SD)

32 (7)

31 (7)

35 (7)
0.125
PHQ9
Minimal/Mild
Moderate/Severe

70 (63%)
41 (37%)

66 (94%)
33 (80%)

4 (6%)
8 (20%)
0.031
GAD7
Minimal / Mild
Moderate / Severe

94 (85%)
17 (15%)

87 (93%)
12 (71%)

7 (7%)
5 (29%)
0.019

CONCLUSIONS: People with HIV who inject drugs and report recent police abuse in Russia are likely to manifest higher substance use stigma and impaired mental health. These findings call for stigma and mental health interventions, and for policy and practice changes regarding the oppressive policing of this HIV key population.