High-risk behaviors after release from incarceration among people who inject drugs in St. Petersburg, Russia

• Russia has high rates of injection drug use, infectious disease, and incarceration.
• We modeled time to opioid relapse and unsterile syringe use after release from prison.
• Unemployment, previous diagnosis of HCV and HBV were associated with relapsing sooner.
• Being unemployed was also associated with unsterile syringe use at relapse.
• Linkage from prison to health care and social services must be strengthened in Russia.

BackgroundInjection drug use, infectious disease, and incarceration are inextricably linked in Russia. We aimed to identify factors associated with time to relapse (first opioid injection after release from prison) and using a non-sterile, previously used syringe at relapse in a sample of people who inject drugs in St. Petersburg.MethodsWe collected data on time from release to relapse among individuals with a history of incarceration, a subsample of a larger study among people who inject drugs. Proportional hazards and logistic regression were used to identify factors associated with time to relapse and injection with a non-sterile previously used syringe at relapse, respectively.ResultsThe median time to relapse after release was 30 days. Factors that were independently associated with relapsing sooner were being a native of St. Petersburg compared to not being native (AHR: 1.64; 95% CI 1.15–2.33), unemployed at relapse compared to employed (AHR: 4.49; 95% CI 2.96–6.82) and receiving a previous diagnosis of HBV and HCV compared to no previous diagnosis (AHR: 1.49; 95% CI 1.03–2.14). Unemployment at relapse was also significant in modeling injection with a non-sterile, previously used syringe at relapse compared to those who were employed (AOR: 6.80; 95% CI 1.96–23.59).ConclusionsUnemployment was an important correlate for both resuming opioid injection after release and using a non-sterile previously used syringe at relapse. Linkage to medical, harm reduction, and employment services should be developed for incarcerated Russian people who inject drugs prior to release.