HIV infection associated with drug injecting in the Newly Independent States, eastern Europe: The social and economic context of epidemics

Department of Social Science and Medicine, Imperial College School of Medicine, University of London, UK.
Addiction (Impact Factor: 4.74). 09/1999; 94(9):1323-36.
Source: PubMed


We review recent trends in HIV associated with injecting drug use (IDU) in the Newly Independent States (NIS) in eastern Europe, including Belarus, Moldova, Russia, Ukraine, and Kazakhstan in central Asia. We aim to draw attention to the social and economic "risk environments" in which rapid HIV spread among IDUs has occurred.
Findings draw on centrally registered HIV surveillance data, published research studies and assessment reports funded by international development agencies.
Since 1995, there is evidence of rapid HIV spread in Belarus, Kazakhstan, Moldova, Russia and Ukraine, with estimates suggesting between 50% and 90% of new HIV infections among IDUs. At the same time, there have been rapid increases in the incidence of syphilis and declines in health and welfare status, including outbreaks of diphtheria, tuberculosis and cholera. Findings emphasize the potential influence of the social and economic context in creating the "risk environments" conducive to HIV and epidemic spread. Key factors include: rapid diffusions in IDU; population migration and mixing; economic transition and decline; increasing unemployment and impoverishment; the growth of informal economies; modes of drug production, distribution and consumption; declines in public health revenue and infrastructure; and political, ideological and cultural transition.
An understanding of the social and economic contexts mediating HIV spread is a prerequiste to identifying the environmental "pre-conditions" of epidemic outbreaks, and thus also, for predicting and preventing HIV transmission. The "risk environment" may influence the efficacy of individual and community-level HIV prevention and highlights the concomitant urgency for interventions targeting social and environmental change.

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    • "Thus, the combination of sex work and IDU may particularly worsen HIV epidemics, increase discrimination and exploitation, and yield in negative social and health consequences. This view is supported by a study in Russia which estimated that 80% of HIV positive women were involved in both drug use and sex work (Rhodes et al., 1999). In the Central Eastern European region, IDU among sex workers varies greatly: In some cities, local harm reduction programs estimate 80-95% IDU among sex workers, while in other cities the rate is below 10% (CEEHRN, 2005, Table 8). "
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    ABSTRACT: Drug use and sex work are both controversial issues with multiple interesting connections. This article presents findings from the first-ever survey on drug use and sex work in Hungary. The study aimed to chart the prevalence, function, and problems of drug use among various groups of sex workers. Survey forms were collected from 510 participants (average age 29.5 years, 91% female) in and near Budapest over a period of six months. The results show that sex workers have manifold higher lifetime prevalence, 84.3%, of illicit drug use compared with the prevalence of the Hungarian general young adult population, 20.9%. In our sample, it was very rare to perform sex work for alcohol or drugs (5%) or for money to purchase alcohol or drugs (20%). Findings also indicate notable relationships between location-based sex work types and the drugs used. One-third of the street sex workers reported regular amphetamine use, but none reported regular cocaine use. On the contrary, no escorts reported regular amphetamine use, but 38% admitted to regular cocaine use. The location of sex work may pose an additional occupational health risk factor for substance use. Regular use of alcohol was twice as typical (64%) for sex workers who were employed in bars, in salons/parlors, or alone in rented apartments than it was for those working in other indoor locations (33-34%). Furthermore, 74% of street sex workers smoked tobacco compared with 17% of escorts. Problem drug use was roughly estimated by asking the participants about the main problem domains (medical, legal, social, etc.) from the Addiction Severity Index instrument. The most problematic drug was amphetamine, and the most frequent problem was prolonged or excessive drug use. These main findings may contribute to more focused planning of health intervention services, harm reduction measures, outreach programs, and specific treatments.
    Social Science [?] Medicine 09/2013; 93C:64-69. DOI:10.1016/j.socscimed.2013.06.004 · 2.89 Impact Factor
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    • "Injecting drug use has long played a prominent role in determining the unfolding of the HIV epidemic in various countries around the world.1–7 Drug use is very complex in Pakistan which is in close geographical proximity to some of the world's major drug production areas and is itself a large opiate producing area with a long history of drug use,8 with approximately 5 million drug users by some estimations.9 "
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    ABSTRACT: Objectives We describe the characteristics of injecting drug users (IDU) in Pakistan in 2006 and 2011, and assess the heterogeneity of IDU characteristics across different cities and years as well as factors associated with HIV infection. Methods Cross-sectional, integrated behavioural-biological surveys of IDU were conducted in 10 cities across Pakistan in 2006 and 2011. Univariate and multivariable analyses were used to describe the differences in HIV prevalence and risk behaviours between cities and over time. Results Large increases in HIV prevalence among injection drug users in Pakistan were observed, with overall HIV prevalence increasing from 16.2% in 2006 to 31.0% in 2011; an increase in HIV prevalence was also seen in all geographic areas except one. There was an increase in risk behaviours between 2006 and 2011, anecdotally related to a reduction in the availability of services for IDU. In 2011, larger proportions of IDU reported injecting several times a day and using professional injectors, and fewer reported always using clean syringes. An increase in the proportion living on the street was also observed and this was associated with HIV infection. Cities differ in terms of HIV prevalence, risk profiles, and healthcare seeking behaviours. Conclusions There is a high prevalence of HIV among injection drug users in Pakistan and considerable potential for further transmission through risk behaviours. HIV prevention programs may be improved through geographic targeting of services within a city and for involving groups that interact with IDU (such as pharmacy staff and professional injectors) in harm reduction initiatives.
    Sexually transmitted infections 01/2013; 89(Suppl 2). DOI:10.1136/sextrans-2012-050775 · 3.40 Impact Factor
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    • "Several countries in Eastern Europe have witnessed an explosive epidemic of injection drug use contributing to an HIV prevalence among adults (15–49 years) estimated to be over 1% (1.0% in Russia, 1.1% in Ukraine, and 1.2% in Estonia in 2009) (UNAIDS, 2010). In the 1990s, several newly independent states faced major socio-political and economic changes, which contributed to poor health outcomes, reductions in life expectancy, and the spread of injecting drug use among vulnerable social groups (Mathers et al., 2010; Rhodes et al., 1999; Uusküla, Kalikova, Zilmer, Tammai, & DeHovitz, 2002). There are approximately 14,000 IDUs in Estonia giving a prevalence of 2.4% of the adult population (aged 15–44) (Uusküla et al., 2007). "
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    ABSTRACT: Aim: To explore socio-demographic factors, health risks and harms associated with early initiation of injecting (before age 16) among injecting drug users (IDUs) in Tallinn, Estonia. Methods: IDUs were recruited using respondent driven sampling methods for two cross-sectional interviewer-administered surveys (in 2007 and 2009). Bivariate and multivariate logistic regression analysis was used to identify factors associated with early initiation versus later initiation. Results: A total of 672 current IDUs reported the age when they started to inject drugs; the mean was 18 years, and about a quarter of the sample (n = 156) reported early initiation into injecting drugs. Factors significantly associated in multivariate analysis with early initiation were being female, having a lower educational level, being unemployed, shorter time between first drug use and injecting, high-risk injecting (sharing syringes and paraphernalia, injecting more than once a day), involvement in syringe exchange attendance and getting syringes from outreach workers, and two-fold higher risk of HIV seropositivity. Conclusions: Our results document significant adverse health consequences (including higher risk behaviour and HIV seropositivity) associated with early initiation into drug injecting and emphasize the need for comprehensive prevention programs and early intervention efforts targeting youth at risk. Our findings suggest that interventions designed to delay the age of starting drug use, including injecting drug use, can contribute to reducing risk behaviour and HIV prevalence among IDUs.
    The International journal on drug policy 10/2012; 24(2). DOI:10.1016/j.drugpo.2012.08.003 · 2.54 Impact Factor
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