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Public health
Original research
Exploratory qualitative study examining acceptability of strategies to improve access to substance use treatment and HIV prevention services for young adults on probation in Ukraine
  1. Emily Dauria1,
  2. Halyna Skipalska2,
  3. Lakshmi Gopalakrishnan3,
  4. Oksana Savenko2,
  5. Liudmyla Sabadash2,
  6. Marina Tolou-Shams3,
  7. Timothy Flanigan4,
  8. Peter Navario5,6,
  9. Theresa P Castillo5,6
  1. 1Behavioral and Community Health Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
  2. 2HealthRight International, Kyiv, Ukraine
  3. 3Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, California, USA
  4. 4Brown University, Providence, Rhode Island, USA
  5. 5School of Public Health, New York University, New York, New York, USA
  6. 6HealthRight International, New York, New York, USA
  1. Correspondence to Dr Emily Dauria; efd16{at}pitt.edu

Abstract

Objective Adults <30 years’ of age experience elevated HIV-rates in Ukraine. Young adults (YA) involved in the criminal justice system (CJS) are at an increased HIV-risk given elevated rates of substance use, engagement in high-risk sexual behaviour and insufficient healthcare access. The objective of this exploratory study was to investigate the acceptability of strategies to refer and link CJS-involved YA to HIV-prevention and substance use treatment services from CJS settings.

Design We conducted qualitative individual interviews with CJS-involved YA (18–24 years), and CJS stakeholders. Interviews were guided by the Social Ecological Model. Interviews with YA explored substance use and sexual behaviour, and acceptability of strategies to link YA to HIV-prevention and substance use treatment services from CJS. Stakeholder interviews explored system practices addressing HIV-prevention and substance use and addiction. Data were analysed using Inductive Thematic Analysis.

Setting Data were collected in three locales, prior to the 2022 Russian–Ukrainian conflict.

Participants Thirty YA and 20 stakeholders.

Results Most YA were men, reported recent injection drug use and were Mage=23 years. YA were receptive to linkage to HIV-prevention services from CJS; this was shaped by self-perceived HIV-risk and lack of access to HIV-prevention services. YA were less receptive to being referred to substance use treatment services, citing a lack of self-perceived need and mistrust in treatment efficacy. Stakeholders identified multilevel contextual factors shaping acceptability of HIV-prevention and substance use treatment from CJS (eg, stigma).

Conclusions Findings should be reviewed as a historical record of the pre-conflict context. In that context, we identified strategies that may have been used to help curtail the transmission of HIV in a population most-at-risk, including CJS-involved YA. This study demonstrates that improving access to substance use treatment and HIV-prevention services via CJS linkage were acceptable if provided in the right conditions (eg, low or no-cost, confidential).

  • Public health
  • HIV & AIDS
  • QUALITATIVE RESEARCH
  • Substance misuse

Data availability statement

Data are available upon reasonable request.

http://creativecommons.org/licenses/by-nc/4.0/

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2022-061909

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    Data availability statement

    Data are available upon reasonable request.

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    Footnotes

    • Contributors ED, TF, HS, PN and MT-S contributed to the design of the study. OS and LS collect the data with support from HS, TPC and ED. ED, LG, TPC and HS analysed the study data. ED wrote the first draft. All authors contributed to interpretation of the findings and reviewed the full draft of the paper. All authors approved the final manuscript; ED is the guarantor.

    • Funding This work was supported by the National Institute on Drug Abuse (Grants R25DA037190 (principal investigator (PI): Beckwith), and T32DA013911 (PI: TF)). ED’s time was also supported by NIDA (R34DA050480 (PI: ED)). The views expressed in this publication are those of the authors and not necessarily those of the funding agencies.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

    • Provenance and peer review Not commissioned; externally peer reviewed.