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