Yale expert advances AIDS research at global conference in Durban, South Africa

At the AIDS 2016 international conference in Durban, South Africa, Frederick L. Altice, professor of medicine, epidemiology, and public health, presented research published in a special theme issue of The Lancet. Altice’s work focused on incarceration as a key contributor to rising rates of HIV, hepatitis C virus, and tuberculosis in Eastern Europe and Central Asia.

Incarceration rates in Eastern Europe and Central Asia (EECA) are among the highest in the world, in part due to criminal justice policies targeting people who use drugs. These policies markedly contribute to heightened levels of HIV, as well as Hepatitis C and tuberculosis, in the region, according to the research.

For the paper presented on Tuesday, July 19 — titled “The perfect storm” — Altice collaborated with an international team of investigators. The research team reviewed and analyzed published reports on the treatment and prevention of addiction, HIV, hepatitis C, and tuberculosis in the criminal justice systems of 15 EECA nations. They found that in the Ukraine alone, incarceration may contribute to up to half of all new HIV infections and 75% of all new tuberculosis infections among people who inject drugs (PWID). HIV infections in PWID could be reduced by over 50%, however, if prisons scaled up treatment with methadone or buprenorphine (which curb cravings for opioids) and maintained patients on treatment after release, the team reported.

“The HIV epidemic in EECA in people who inject drugs is volatile, and a large percentage PWID eventually becoming incarcerated,” said Altice. The lack of HIV prevention strategies — such as opioid agonist therapies with methadone or buprenorphine to treat addiction, and needle and syringe programs — undermines HIV prevention efforts, he noted. “For such interventions to be most effective, they would need to be scaled up within prison and continued post release.”

To address the issue, the Lancet paper described strategies such as scaling up treatment for opioid addiction in prisons and communities; reducing incarceration of drug users; and improving screening, treatment, and care for prisoners with tuberculosis.

Altice is also senior author on three other papers presented in this series, which can be read in full here. A podcast interview featuring Altice is available on the upper-righthand side of this page.