Displaying publications 21 - 40 of 47 in total

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  1. Al-Darraji HA, Altice FL, Kamarulzaman A
    Trop Med Int Health, 2016 Aug;21(8):1049-1058.
    PMID: 27197601 DOI: 10.1111/tmi.12726
    OBJECTIVES: To investigate the prevalence of previously undiagnosed active tuberculosis (TB) cases among prisoners in Malaysia's largest prison using an intensified TB case-finding strategy.

    METHODS: From October 2012 to May 2013, prisoners housed in two distinct units (HIV-negative and HIV-positive) were approached to participate in the TB screening study. Consenting prisoners submitted two sputum samples that were examined using GeneXpert MTB/RIF, smear microscopy and liquid culture. Socio-demographic and clinical information was collected and correlates of active TB, defined as having either a positive GeneXpert MTB/RIF or culture results, were assessed using regression analyses.

    RESULTS: Among the total of 559 prisoners, 442 (79.1%) had complete data; 28.7% were HIV-infected, 80.8% were men and the average age was 36.4 (SD 9.8) years. Overall, 34 (7.7%) had previously undiagnosed active TB, of whom 64.7% were unable to complete their TB treatment in prison due to insufficient time (<6 months) remaining in prison. Previously undiagnosed active TB was independently associated with older age groups (AOR 11.44 and 6.06 for age ≥ 50 and age 40-49 years, respectively) and with higher levels of immunosuppression (CD4 < 200 cells/ml) in HIV-infected prisoners (AOR 3.07, 95% CI 1.03-9.17).

    CONCLUSIONS: The high prevalence of previously undiagnosed active TB in this prison highlights the inadequate performance of internationally recommended case-finding strategies and suggests that passive case-finding policies should be abandoned, especially in prison settings where HIV infection is prevalent. Moreover, partnerships between criminal justice and public health treatment systems are crucial to continue TB treatment after release.

    Matched MeSH terms: Prisons
  2. Nurul Hazrina, M., Affizal, A.
    MyJurnal
    Background: Personality disorders is one of the most assessed mental health problems among prison population. To date, no local psychometric instrument to assess personality disorder is available in Malaysia. Objective: The aim of this study is to validate the Malay-translated version of the McLean Screening Instrument for Borderline Personality Disorder (MSI-BPD) among prisoner. Methods: A cross-sectional study was designed, involving female prisoners (n=90). Face validity, factor analysis, and reliability testing were conducted with a one-week interval test-retest. Results: The translated instrument produced four factors structure. The internal consistency is moderate (α=.64), with high test-retest reliability (ICC=.82). Conclusion: The Malay-translated version of the MSI-BPD was found valid and reliable to identify borderline personality disorder among female prisoner in future studies.
    Matched MeSH terms: Prisons
  3. Mohammad Rahim Kamaluddin, Nadiah Syariani Md. Shariff, Geshina Ayu Mat Saat
    MyJurnal
    Introduction: Crime is an immoral act capable of tearing the well-being of society and the nation. Various factors have been accredited as potential factors for crime engagement for example natural inclination, nurture or a combination of these factors. Within the domain of natural inclination, lack of self-control is often viewed as the primary cause of crime and delinquency. However, there are no valid and reliable Malay language psychometric instruments to measure the level of self-control among Malaysians.
    Objective: The aim of this study was to validate the Self Control Scale (SCS) for use among Malay speaking populations. Henceforth the Malay language version is identified as SCS-M.
    Method: A cross-sectional study was carried out on 150 inmates incarcerated within two prisons in Peninsular Malaysia in June 2012. Forward and Backward translations of the original SCS were carried out followed by content and face validation processes. Exploratory factor analysis and Cronbach's Alpha reliability analysis were performed.
    Result: Both content and face validation processes showed promising and good outcomes. Preliminary analysis for factor analysis supported factorability of the items. The factor loadings of SCS-M items did not correspond to the original six SCS dimensions. Since SCS is often administered as a unidimensional scale, a forced one factor analysis was performed and items with factor loadings exceeding 0.3 were retained. The result of internal consistency reliability of SCS-M demonstrated a good Cronbach's alpha value of 0.80.
    Conclusion: The findings supported that SCS-M is a valid and reliable unidimensional scale to measure the level of self-control among Malay speaking populations. It is anticipated that the emergence of SCS-M is vital for self-control assessment, treatment, and rehabilitation purposes.
    Matched MeSH terms: Prisons
  4. Azlin, B., Salina Akhtar, M. Y., Nik Ruzyanei, N. J., Hazli, Z., Normala, I.
    MyJurnal
    Introduction: In recent years there has been an increase in the number of young people in prison. This
    study is the first to look at the proportion of psychiatric disorders among young adult prisoners. Objective: The main objective is to determine the percentage of psychiatric disorders among young adult male prisoners Method: A cross sectional study of young adult male prisoners, with ages ranged between 18 and 21 years old, was conducted between September and December, 2008 at the Kajang Prison. A total of 225 inmates participated in the study which used the Mini International Neuropsychiatric Interview (M.I.N.I) as its instrument. Results: The percentage of psychiatric disorders was 60.0%. Alcohol and substance related disorders had the highest prevalence at 50.2%, followed by Major Depressive Disorders and Dysthymia at 16.9%. About 39.6% were observed to have antisocial personality disorder. Psychiatric disorders were found to have significant differences (p
    Matched MeSH terms: Prisons
  5. Nazirah H, Daniella M
    Jurnal Psikologi Malaysia, 2018;32:146-164.
    This study investigates bullying and victimisation in juvenile rehabilitation institutions in Malaysia, where research on this phenomenon has been particularly limited. It examines the prevalence of bullying and victimisation in these settings and investigates the role of personal characteristics and aspects of institutional environments, and explores how these factors relate to bullying behaviour. The study comprised a survey completed by 289 male and female young people, aged 12 to 21 years old, in 8 juvenile rehabilitation institutions, using the scale version of Direct and Indirect Prisoner Behaviour Checklist (DIPC-SCALEDr) and the Measuring the Quality of Prison Life (MQPL) instruments. The findings showed that 95 percent of young people reported at least one behaviour indicative of bullying others, and 99 percent reported at least one behaviour indicative of victimisation in a month. Seven predictors were found to underpin bullying behaviour, including three personal characteristics (i.e. time spent in the institution, experiences of punishment inside the institution, and gang membership) and four institutional dimensions (i.e respect; bureaucratic legitimacy; fairness; and family contact). To conclude, bullying behaviour seemed to be normalized in juvenile rehabilitation institutions. As the heart of institution, staff members play an important role to control bullying behaviour amongst young people. The importance of these findings for bullying prevention strategies and directions for future research are discussed.
    Matched MeSH terms: Prisons
  6. Bazazi AR, Culbert GJ, Wegman MP, Heimer R, Kamarulzaman A, Altice FL
    BMC Infect Dis, 2022 Nov 11;22(1):837.
    PMID: 36368939 DOI: 10.1186/s12879-022-07804-6
    INTRODUCTION: Mortality is elevated after prison release and may be higher in people with HIV and opioid use disorder (OUD). Maintenance with opioid agonist therapy (OAT) like methadone or buprenorphine reduces mortality in people with OUD and may confer benefits to people with OUD and HIV leaving prison. Survival benefits of OAT, however, have not been evaluated prospectively in people with OUD and HIV leaving prison.

    METHODS: This study prospectively evaluated mortality after prison release and whether methadone initiated before release increased survival after release in a sample of men with HIV and OUD (n = 291). We linked national death records to data from a controlled trial of prerelease methadone initiation conducted from 2010 to 2014 with men with HIV and OUD imprisoned in Malaysia. Vital statistics were collected through 2015. Allocation to prerelease methadone was by randomization (n = 64) and participant choice (n = 246). Cox proportional hazards models were used to estimate treatment effects of prerelease methadone on postrelease survival.

    RESULTS: Overall, 62 deaths occurred over 872.5 person-years (PY) of postrelease follow-up, a crude mortality rate of 71.1 deaths per 1000 PY (95% confidence interval [CI] 54.5-89.4). Most deaths were of infectious etiology, mostly related to HIV. In a modified intention-to-treat analysis, the impact of prerelease methadone on postrelease mortality was consistent with a null effect in unadjusted (hazard ratio [HR] 1.3, 95% CI 0.6-3.1) and covariate-adjusted (HR 1.2, 95% CI 0.5-2.8) models. Predictors of mortality were educational level (HR 1.4, 95% CI 1.0-1.8), pre-incarceration alcohol use (HR 2.0, 95% CI 1.1-3.9), and lower CD4+ T-lymphocyte count (HR 0.8 per 100-cell/mL increase, 95% CI 0.7-1.0).

    CONCLUSIONS: Postrelease mortality in this sample of men with HIV and OUD was extraordinarily high, and most deaths were likely of infectious etiology. No effect of prerelease methadone on postrelease mortality was observed, which may be due to study limitations or an epidemiological context in which inadequately treated HIV, and not inadequately treated OUD, is the main cause of death after prison release.

    TRIAL REGISTRATION: NCT02396979. Retrospectively registered 24/03/2015.

    Matched MeSH terms: Prisons
  7. Culbert GJ, Waluyo A, Iriyanti M, Muchransyah AP, Kamarulzaman A, Altice FL
    Drug Alcohol Depend, 2015 Apr 01;149:71-9.
    PMID: 25659895 DOI: 10.1016/j.drugalcdep.2015.01.018
    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.

    Matched MeSH terms: Prisoners/psychology*; Prisons*
  8. Al-Darraji HA, Kamarulzaman A, Altice FL
    Int J Tuberc Lung Dis, 2012 Jul;16(7):871-9.
    PMID: 22410101 DOI: 10.5588/ijtld.11.0447
    Tuberculosis (TB) remains a major cause of morbidity and mortality worldwide and the main cause of death in correctional facilities in middle- and low-income countries. Due to the closed environment and the concentration of individuals with TB-related risk factors, effective measures are required to control TB in such settings. Isoniazid preventive therapy (IPT) represents an effective and cost-effective measure. Despite international recommendations that IPT be integral to TB control, it is seldom deployed. A systematic review of interventions used to assess IPT initiation and completion in correctional facilities was conducted using published studies from two biomedical databases and relevant keywords. Additional references were reviewed, resulting in 18 eligible studies. Most (72%) studies were conducted in the United States and in jail settings (60%), with the main objective of improving completion rates inside the facility or after release. Studies that provided data about initiation and completion rates showed poor success in correctional facilities. Adverse consequences and treatment interruption ranged from 1% to 55% (median 5%) in reported studies; hepatotoxicity was the most prevalent adverse reaction. Despite its accelerating effect on the development of active TB, information on human immunodeficiency virus (HIV) status was provided in only half of the studies. Among the four studies where IPT effectiveness was assessed, the results mirror those described in community settings. Future studies require thorough assessments of IPT initiation and completion rates and adverse effects, particularly in low- and middle-income countries and where comorbid viral hepatitis may contribute significantly to outcomes, and in settings where TB and HIV are more endemic.
    Matched MeSH terms: Prisons*
  9. Culbert GJ, Bazazi AR, Waluyo A, Murni A, Muchransyah AP, Iriyanti M, et al.
    AIDS Behav, 2016 05;20(5):1026-38.
    PMID: 26400080 DOI: 10.1007/s10461-015-1198-4
    Negative attitudes toward HIV medications may restrict utilization of antiretroviral therapy (ART) in Indonesian prisons where many people living with HIV (PLH) are diagnosed and first offered ART. This mixed-method study examines the influence of medication attitudes on ART utilization among HIV-infected Indonesian prisoners. Randomly-selected HIV-infected male prisoners (n = 102) completed face-to-face in-depth interviews and structured surveys assessing ART attitudes. Results show that although half of participants utilized ART, a quarter of those meeting ART eligibility guidelines did not. Participants not utilizing ART endorsed greater concerns about ART efficacy, safety, and adverse effects, and more certainty that ART should be deferred in PLH who feel healthy. In multivariate analyses, ART utilization was independently associated with more positive ART attitudes (AOR = 1.09, 95 % CI 1.03-1.16, p = 0.002) and higher internalized HIV stigma (AOR = 1.03, 95 % CI 1.00-1.07, p = 0.016). Social marketing of ART is needed to counteract negative ART attitudes that limit ART utilization among Indonesian prisoners.
    Matched MeSH terms: Prisoners/psychology*; Prisons*
  10. Loeliger KB, Biggs ML, Young R, Seal DW, Beckwith CG, Kuo I, et al.
    AIDS Behav, 2017 Oct;21(10):2945-2957.
    PMID: 28188460 DOI: 10.1007/s10461-017-1722-9
    The U.S. female criminal justice (CJ) population is rapidly growing, yet large-scale studies exploring gender-specific HIV risk behaviors in the CJ population are lacking. This analysis uses baseline data on adults with a CJ history from eight U.S. studies in an NIH-funded "Seek, Test, Treat, Retain" harmonization consortium. Data were collected using a standardized HIV risk behavior assessment tool and pooled across studies to describe participants' characteristics and risk behaviors. Multilevel mixed-effects logistic regression models were used to test for gender-based behavior differences. Among 784 HIV-positive (21.4% female) and 5521 HIV-negative (8.5% female) participants, HIV-positive women had higher odds than HIV-positive men of engaging in condomless sexual intercourse (AOR 1.84 [1.16-2.95]) with potentially sero-discordant partners (AOR 2.40 [1.41-4.09]) and of sharing injection equipment (AOR 3.36 [1.31-8.63]). HIV risk reduction interventions targeting CJ-involved women with HIV are urgently needed as this population may represent an under-recognized potential source of HIV transmission.
    Matched MeSH terms: Prisons*
  11. Meyer JP, Cepeda J, Wu J, Trestman RL, Altice FL, Springer SA
    JAMA Intern Med, 2014 May;174(5):721-9.
    PMID: 24687044 DOI: 10.1001/jamainternmed.2014.601
    Human immunodeficiency virus (HIV) management in correctional settings is logistically feasible, but HIV-related outcomes before release have not been recently systematically examined.
    Matched MeSH terms: Prisons/statistics & numerical data*
  12. Wickersham JA, Marcus R, Kamarulzaman A, Zahari MM, Altice FL
    Bull World Health Organ, 2013 Feb 01;91(2):124-9.
    PMID: 23554524 DOI: 10.2471/BLT.12.109132
    PROBLEM: In Malaysia, human immunodeficiency virus (HIV) infection is highly concentrated among people who inject opioids. For this reason, the country undertook a three-phase roll-out of a methadone maintenance treatment (MMT) programme. In Phase 3, described in this paper, MMT was implemented within prisons and retention in care was assessed.

    APPROACH: After developing standard operating procedures and agreement between its Prisons Department and Ministry of Health, Malaysia established pilot MMT programmes in two prisons in the states of Kelantan (2008) and Selangor (2009) - those with the highest proportions of HIV-infected prisoners. Community-based MMT programmes were also established in Malaysia to integrate treatment activities after prisoners' release.

    LOCAL SETTING: Having failed to reduce the incidence of HIV infection, in 2005 Malaysia embarked on a harm reduction strategy.

    RELEVANT CHANGES: STANDARD OPERATING PROCEDURES WERE MODIFIED TO: (i) escalate the dose of methadone more slowly; (ii) provide ongoing education and training for medical and correctional staff and inmates; (iii) increase the duration of methadone treatment before releasing prisoners; (iv) reinforce linkages with community MMT programmes after prisoners' release; (v) screen for and treat tuberculosis; (vi) escalate the dose of methadone during treatment for HIV infection and tuberculosis; and (vii) optimize the daily oral dose of methadone (> 80 mg) before releasing prisoners.

    LESSONS LEARNT: Prison-based MMT programmes can be effectively implemented but require adequate dosing and measures are needed to improve communication between prison and police authorities, prevent police harassment of MMT clients after their release, and improve systems for tracking release dates.

    Matched MeSH terms: Prisons/trends*
  13. Wickersham JA, Zahari MM, Azar MM, Kamarulzaman A, Altice FL
    Drug Alcohol Depend, 2013 Sep 1;132(1-2):378-82.
    PMID: 23414931 DOI: 10.1016/j.drugalcdep.2013.01.005
    To evaluate the impact of methadone dose on post-release retention in treatment among HIV-infected prisoners initiating methadone maintenance treatment (MMT) within prison.
    Matched MeSH terms: Prisoners/psychology*; Prisons*
  14. Polonsky M, Azbel L, Wegman MP, Izenberg JM, Bachireddy C, Wickersham JA, et al.
    J Int AIDS Soc, 2016;19(4 Suppl 3):20880.
    PMID: 27435715 DOI: 10.7448/IAS.19.4.20880
    INTRODUCTION: The expanding HIV epidemic in Azerbaijan and Kyrgyzstan is concentrated among people who inject drugs (PWID), who comprise a third of prisoners there. Detention of PWID is common but its impact on health has not been previously studied in the region. We aimed to understand the relationship between official and unofficial (police harassment) detention of PWID and HIV risk behaviours.

    METHODS: In a nationally representative cross-sectional study, soon-to-be released prisoners in Kyrgyzstan (N=368) and Azerbaijan (N=510) completed standardized health assessment surveys. After identifying correlated variables through bivariate testing, we built multi-group path models with pre-incarceration official and unofficial detention as exogenous variables and pre-incarceration composite HIV risk as an endogenous variable, controlling for potential confounders and estimating indirect effects.

    RESULTS: Overall, 463 (51%) prisoners reported at least one detention in the year before incarceration with an average of 1.3 detentions in that period. Unofficial detentions (13%) were less common than official detentions (41%). Optimal model fit was achieved (X (2)=5.83, p=0.44; Goodness of Fit Index (GFI) GFI=0.99; Comparative Fit Index (CFI) CFI=1.00; Root Mean Square Error of Approximation (RMSEA) RMSEA=0.00; PCLOSE=0.98) when unofficial detention had an indirect effect on HIV risk, mediated by drug addiction severity, with more detentions associated with higher addiction severity, which in turn correlated with increased HIV risk. The final model explained 35% of the variance in the outcome. The effect was maintained for both countries, but stronger for Kyrgyzstan. The model also holds for Kyrgyzstan using unique data on within-prison drug injection as the outcome, which was frequent in prisoners there.

    CONCLUSIONS: Detention by police is a strong correlate of addiction severity, which mediates its effect on HIV risk behaviour. This pattern suggests that police may target drug users and that such harassment may result in an increase in HIV risk-taking behaviours, primarily because of the continued drug use within prisons. These findings highlight the important negative role that police play in the HIV epidemic response and point to the urgent need for interventions to reduce police harassment, in parallel with interventions to reduce HIV transmission within and outside of prison.

    Matched MeSH terms: Prisons/legislation & jurisprudence
  15. Chandra DK, Bazazi AR, Nahaboo Solim MA, Kamarulzaman A, Altice FL, Culbert GJ
    HIV Res Clin Pract, 2019 Feb;20(1):12-23.
    PMID: 31303149 DOI: 10.1080/15284336.2019.1603433
    Background: Study retention is a major challenge in HIV clinical trials conducted with persons recruited from correctional facilities. Objective: To examine study retention in a trial of within-prison methadone initiation and a behavioral intervention among incarcerated men with HIV and opioid dependence in Malaysia. Methods: In this 2x2 factorial trial, 296 incarcerated men with HIV and opioid dependence were allocated to (1) an HIV risk reduction intervention, the Holistic Health Recovery Program for Malaysia (HHRP-M), (2) pre-release methadone initiation, (3) both interventions, or (4) standard care (NCT02396979). Here we estimate effects of these interventions on linkage to the study after prison release and completion of post-release study visits. Results: Most participants (68.9%) completed at least one post-release study visit but few (18.6%) completed all 12. HHRP-M was associated with a 13.5% (95% confidence interval (CI): 3.8%, 23.2%) increased probability of completing at least one post-release study visit. Although not associated with initial linkage, methadone treatment was associated with an 11% (95% CI: 2.0%, 20.6%) increased probability of completing all twelve post-release study visits. Being subject to forced relocation outside Kuala Lumpur after prison release decreased retention by 43.3% (95% CI: -51.9%, -34.8%). Conclusion: Retaining study participants in HIV clinical trials following prison release is challenging and potentially related to the broader challenges that participants experience during community reentry. Researchers conducting clinical trials with this population may want to consider methadone and HHRP as means to improve post-release retention, even in clinical trials where these interventions are not being directly evaluated.
    Matched MeSH terms: Prisons/statistics & numerical data
  16. Science, 2014 Jul 11;345(6193):164-5.
    PMID: 25013064 DOI: 10.1126/science.345.6193.164
    Matched MeSH terms: Prisons
  17. Mohammad Rahim, K., Nadiah Syariani, M.S., Azizah, O., Geshina Ayu, M.S.
    MyJurnal
    Introduction: Cognitive distortion seems to be a potential force in shaping criminals and antisocial behaviour within an individual. Unfortunately there is no valid Malay psychometric instrument available to measure cognitive distortion in Malaysian settings, especially in prisons. There is an urgent need to have a valid and reliable Malay psychometric instrument to assess the cognitive distortion among Malaysians. Therefore, the present study aimed to validate “How I Think” Questionnaire into the Malay language (henceforth, HIT-M). Methods: A cross-sectional study was conducted among inmates (n= 150) incarcerated within two prisons in Peninsular Malaysia. The validation study commenced with Forward-Backward translations and was followed by content and face validities. Later, construct validity was
    performed via Exploratory Factor Analysis using Principal Component Analysis. Varimax rotation was applied in order to optimize the factor loadings on the extracted component. Finally, reliability testing was
    performed to determine the internal consistency of the items which was done using Cronbach Alpha coefficient method (α). Findings: Initial factor loadings resulted in 11 factors with a total variance of 74.1%. Next, factor analysis was repeated by extracting the items into a four factor structure parallel to the theoretical construct. Items with factor loadings above 0.40 were retained as acceptable factor loadings. After considering factor loadings, item correlation and content of items, the final version of HIT-M consisted of 24 items. The internal consistency of HIT-M was 0.90 which was considered good. Conclusion: HIT-M is a valid and reliable psychometric instrument to measure and assess cognitive distortion among Malaysians.
    Matched MeSH terms: Prisons
  18. Norliza, C., Salina, A.A., Hatta, M.S., Mohaad Adam, B.
    MyJurnal
    Objective: The aim of this study is to determine the risk factors for sex offenders. Methods: This is a cross sectional study comparing two groups using a combination of survey methodology and personal interviews. The data was collected over a period of six months from January 2004 until June 2004. All convicted sex offenders in respective prisons who are available until July 2004 was included in the study. A control group of non-sex offenders were chosen from the same prisons. The non-sex offenders were matched to the sex offenders group in term of the length of their sentence. Data was gathered using the self generated questionnaire, Structured Clinical Interview for DSM III-R, SCID and Personality Diagnostic Questionnaires. Results: Religion, education level, history of physical abuse and no history of substance abuse and dependence towards sex offenders. Conclusion: Offenders who only committed sexual offences have some characteristics which differ from other sex offenders who committed non sexual offences as well. Low or no formal education, had history of physical abuse were associated with sex offenders. No history of substance abuse and dependence were associated with no sex offenders.
    Matched MeSH terms: Prisons
  19. Azbel L, Rozanova J, Michels I, Altice FL, Stöver H
    Harm Reduct J, 2017 07 10;14(1):43.
    PMID: 28693573 DOI: 10.1186/s12954-017-0168-8
    BACKGROUND: Kyrgyzstan, where HIV is concentrated in prisons and driven by injection drug use, provides a prison-based methadone maintenance therapy program as well as abstinence-oriented therapeutic community based on the 12-step model called the "Clean Zone." We aimed to qualitatively assess how prisoners navigate between these treatment options to understand the persistence of the Clean Zone despite a lack of evidence to support its effectiveness in treating opioid use disorders.

    METHODS: We conducted an analysis of policy documents and over 60 h of participant observation in February 2016, which included focus groups with a convenience sample of 20 therapeutic community staff members, 110 prisoners across three male and one female prisons, and qualitative interviews with two former Clean Zone participants. Field notes containing verbatim quotes from participants were analyzed through iterative reading and discussion to understand how participants generally perceive the program, barriers to entry and retention, and implications for future treatment within prisons.

    RESULTS: Our analyses discerned three themes: pride in the mission of the Clean Zone, idealism regarding addiction treatment outcomes against all odds, and the demonization of methadone.

    CONCLUSION: Despite low enrollment and lack of an evidence base, the therapeutic community is buttressed by the strong support of the prison administration and its clients as an "ordered" alternative to what is seen as chaotic life outside of the Clean Zone. The lack of services for Clean Zone patients after release likely contributes to high rates of relapse to drug use. The Clean Zone would benefit from integration of stabilized methadone patients combined with a post-release program.

    Matched MeSH terms: Prisons
  20. Bick J, Culbert G, Al-Darraji HA, Koh C, Pillai V, Kamarulzaman A, et al.
    Int J Prison Health, 2016 12 19;12(4):253-269.
    PMID: 27921633 DOI: 10.1108/IJPH-06-2016-0017
    Purpose Criminalization of drug use in Malaysia has concentrated people who inject drugs (PWID) and people living with HIV into prisons where health services are minimal and HIV-related mortality is high. Few studies have comprehensively assessed the complex health needs of this population. The paper aims to discuss these issues. Design/methodology/approach From October 2012 through March 2013, 221 sequentially selected HIV-infected male prisoners underwent a comprehensive health assessment that included a structured history, physical examination, and clinically indicated diagnostic studies. Findings Participants were mostly PWID (83.7 percent) and diagnosed with HIV while incarcerated (66.9 percent). Prevalence of hepatitis C virus (90.4 percent), untreated syphilis (8.1 percent), active (13.1 percent), and latent (81.2 percent) tuberculosis infection was several fold higher than non-prisoner Malaysian adults, as was tobacco use (71.9 percent) and heavy drinking (30.8 percent). Most (89.5 percent) were aware of their HIV status before the current incarceration, yet few had been engaged previously in HIV care, including pre-incarceration CD4 monitoring (24.7 percent) or prescribed antiretroviral therapy (ART) (16.7 percent). Despite most (73.7 percent) meeting Malaysia's criteria for ART (CD4 <350 cells/ μL), less than half (48.4 percent) ultimately received it. Nearly one-quarter (22.8 percent) of those with AIDS (<200 cells/ μL) did not receive ART. Originality/value Drug addiction and communicable disease comorbidity, which interact negatively and synergistically with HIV and pose serious public health threats, are highly prevalent in HIV-infected prisoners. Interventions to address the critical shortage of healthcare providers and large gaps in treatment for HIV and other co-morbid conditions are urgently needed to meet the health needs of HIV-infected Malaysian prisoners, most of whom will soon transition to the community.
    Matched MeSH terms: Prisons/statistics & numerical data*
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