Breaking New Ground in HIV Research in Eastern Europe

A team led by Yale School of Medicine professor Frederick L. Altice, M.D., has received a five year, $4.2 million grant from the National Institutes on Drug Abuse (NIDA) to study ways of curbing the HIV epidemic in states of the former Soviet Union –Ukraine, Georgia and Kazakhstan. Altice and his partners will study interventions in the criminal justice system as a means of curbing what he calls an explosive HIV epidemic in the region, fueled by injection drug use and high-risk sexual behavior among this population. The initial focus will be in Ukraine where his team has been working since 2005. Their work to date has involved introducing medication-assisted treatments like buprenorphine and methadone and created integrated systems of care.

In many countries of Eastern Europe and Central Asia, high-risk sexual and injection drug behaviors among current and former prisoners have contributed greatly to expanding HIV epidemics. “In this region,” Altice said, “incarceration and drug use is among the highest in the world. As a result, there is a concentration of HIV, AIDS and other infectious diseases like tuberculosis within the criminal justice system. Research partnerships are desperately needed to address the interface of substance abuse, high-risk sex and HIV.”

“The epidemic of HIV among prisoners in overcrowded settings, compounded by high rates of tuberculosis and its drug-resistant forms, contributes profoundly to increased morbidity and mortality,” Altice said. The focus of the research is to identify ideal interventions within the criminal justice system in which HIV can be detected among drug users and their sexual partners, and where effective, evidence-based treatments can be implemented.

This project represents the first academic collaboration between the criminal justice system in Ukraine and American investigators.The research team seeks to expand its research through partnerships with colleagues in other states of the former Soviet Union, specifically Georgia and Kazakhstan. The collaboration will identify targets for intervention that include surveillance and intervention studies that aim to reduce HIV transmission both within prisons, but also focus on community transitions from prison. Other activities may focus on alternatives to incarceration to reduce HIV transmission among drug users and their partners.

Dr. Altice, who has been conducting research on infectious diseases, substance use disorders and the criminal justice system for more than 20 years, will collaborate with Dr. Sergey Dvoriak, lead investigator in Ukraine, Dr. David Otiashvilli in Georgia and Dr. Nina Kerimi in Kazakhstan. Domestically, Drs. Doug Bruce and Gerald Friedland from Yale School of Medicine, Drs. Michael Copenhaver and Linda Frisman from the University of Connecticut, Dr. Faye Taxman from George Mason University and Michael Lawlor from University of New Haven will round out the research team.