Explosive spread and high prevalence of HIV infection among injecting drug users in Togliatti City, Russia

Department of Social Science and Medicine, Imperial College Faculty of Medicine, University of London, London, UK.
AIDS (Impact Factor: 5.55). 10/2002; 16(13):F25-31. DOI: 10.1097/00002030-200209060-00002
Source: PubMed


To establish the prevalence of antibodies to HIV (anti-HIV) and associated risk factors among injecting drug users (IDU) in Togliatti City, Samara Oblast, Russian Federation.
An unlinked anonymous cross-sectional community recruited survey with oral fluid sample collection.
Between September and October 2001, 426 IDU were recruited by trained fieldworkers. Participants completed an interviewer administered questionnaire, and oral fluid samples were tested for anti-HIV. Univariate and multivariate analyses compared potential risk factors for anti-HIV.
Anti-HIV prevalence was 56% (234/418). Three-quarters of anti-HIV-positive IDU (74%) were unaware of their positive status. In an adjusted model, the odds of HIV infection were higher among IDU who had ever injected home-produced drugs, who reported injecting with used needles and syringes in the past 4 weeks, and who were living in one particular district of the city (Komsomolksii).
The high prevalence of HIV, and a recent increase in HIV detected through routine screening tests since 2000, suggests that an explosive epidemic has occurred among IDU in Togliatti City. In the face of currently inadequate HIV prevention coverage among IDU, this has urgent implications for maximizing the distribution of sterile injecting equipment as well as for enhancing sexual risk reduction. Recognizing that it is likely that similar explosive epidemics are taking place in other Russian cities, we recommend community-wide HIV prevention coverage supported by city and state policies oriented to harm reduction.

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    • "All biological parameters were given point values and the HCV epidemic was assumed to start 20 years before the HIV epidemic (Magiorkinis et al., 2009). The HIV epidemic was assumed to run for 10–40 years to portray the likely range of epidemic durations associated with our dataset, with 10 years being suitable for some Asian settings and the former Soviet Union (Rhodes et al., 2002) and 40 years being suitable for many western settings. To evaluate whether incorporating sexual HIV transmission improved the model's agreement with observed trends, the uncertainty analyses were undertaken with and without sexual HIV transmission included. "
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    ABSTRACT: BACKGROUND: Amongst injecting drug users (IDUs), HIV is transmitted sexually and parenterally, but HCV is transmitted primarily parenterally. We assess and model the antibody prevalence of HCV amongst HIV-infected IDUs (denoted as HCV-HIV co-infection prevalence) and consider whether it proxies the degree of sexual HIV transmission amongst IDUs. METHODS: HIV, HCV and HCV-HIV co-infection prevalence data amongst IDU was reviewed. An HIV/HCV transmission model was adapted. Multivariate model uncertainty analyses determined whether the model's ability to replicate observed data trends required the inclusion of sexual HIV transmission. The correlation between the model's HCV-HIV co-infection prevalence and estimated proportion of HIV infections due to injecting was evaluated. RESULTS: The median HCV-HIV co-infection prevalence (prevalence of HCV amongst HIV-infected IDUs) was 90% across 195 estimates from 43 countries. High HCV-HIV co-infection prevalences (>80%) occur in most (75%) settings, but can be lower in settings with low HIV prevalence (<10%) or high HIV/HCV prevalence ratios (HIV prevalence divided by HCV prevalence>0.75). The model without sexual HIV transmission reproduced some data trends but could not reproduce any epidemics with high HIV/HCV prevalence ratios (>0.85) or low HCV-HIV co-infection prevalence (<60%) when HIV prevalence>10%. The model with sexual HIV transmission reproduced data trends more closely. The proportion of HIV infections due to injecting correlated with HCV-HIV co-infection prevalence; suggesting that up to 80/60/<20% of HIV infections could be sexually transmitted in settings with HCV-HIV co-infection prevalence between 50-60/70-80/>90%. CONCLUSION: Substantial sexual HIV transmission may occur in many IDU populations; HCV-HIV co-infection prevalence could signify its importance.
    Full-text · Article · Feb 2013 · Drug and Alcohol Dependence
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    • "In 2007 and 2009 the questionnaire was based on the WHO Drug Injecting Study Phase II survey (version 2b(rev.2)) [29], and in 2005, the questionnaire was adapted from several studies in resource-constrained and developed countries, including the Russian Federation [30,31]. Both instruments were originally developed to collect risk behavior data from IDUs, and therefore contained similar measures on key behavior characteristics (age, gender, age at injection initiation, injection frequency, main drug injected, receptive sharing within last 4 weeks, SEP utilization [ever, and in the last 4 weeks], number of sexual partners within last 12 months). "
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    ABSTRACT: Estonia has experienced an HIV epidemic among intravenous drug users (IDUs) with the highest per capita HIV prevalence in Eastern Europe. We assessed the effects of expanded syringe exchange programs (SEP) in the capital city, Tallinn, which has an estimated 10,000 IDUs. SEP implementation was monitored with data from the Estonian National Institute for Health Development. Respondent driven sampling (RDS) interview surveys with HIV testing were conducted in Tallinn in 2005, 2007 and 2009 (involving 350, 350 and 327 IDUs respectively). HIV incidence among new injectors (those injecting for < = 3 years) was estimated by assuming (1) new injectors were HIV seronegative when they began injecting, and (2) HIV infection occurred at the midpoint between first injection and time of interview. SEP increased from 230,000 syringes exchanged in 2005 to 440,000 in 2007 and 770,000 in 2009. In all three surveys, IDUs were predominantly male (80%), ethnic Russians (>80%), and young adults (mean ages 24 to 27 years). The proportion of new injectors decreased significantly over the years (from 21% in 2005 to 12% in 2009, p = 0.005). HIV prevalence among all respondents stabilized at slightly over 50% (54% in 2005, 55% in 2007, 51% in 2009), and decreased among new injectors (34% in 2005, 16% in 2009, p = 0.046). Estimated HIV incidence among new injectors decreased significantly from 18/100 person-years in 2005 and 21/100 person-years in 2007 to 9/100 person-years in 2009 (p = 0.026). In Estonia, a transitional country, a decrease in the HIV prevalence among new injectors and in the numbers of people initiating injection drug use coincided with implementation of large-scale SEPs. Further reductions in HIV transmission among IDUs are still required. Provision of 70 or more syringes per IDU per year may be needed before significant reductions in HIV incidence occur.
    Full-text · Article · Jun 2011 · BMC Public Health
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    • "Policing practices can exert strong influences on IDU behaviors in their micro-social environment [1]. Police practices that negatively affect the IDU risk environment are those that lead to increased harm for IDUs and an elevated risk of acquiring HIV and other blood borne infections [8-10,14]. The effects of police practices can be direct-for example, by confiscating syringes or causing IDUs to rush injections-or indirect, such as harassment that discourages IDUs from attending needle exchange or drug treatment programs [11,12]. "
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    ABSTRACT: To assess factors associated with drug-related harms related to policing among injection drug users (IDUs) in Tijuana, Mexico. IDUs who were over 18 years old and had injected drugs within the last six months were recruited via respondent-driven sampling and underwent questionnaires and testing for HIV (human immunodeficiency virus), syphilis and TB (tuberculosis). Random effects logistic regression was used to simultaneously model factors associated with five drug-related harms related to policing practices in the prior six months (i.e., police led them to rush injections; affected where they bought drugs; affected locations where they used drugs; feared that police will interfere with their drug use; receptive syringe sharing). Of 727 IDUs, 85% were male; median age was 38 years. Within the last 6 months, 231 (32%) of IDUs reported that police had led them to rush injections, affected where they bought or used drugs or were very afraid police would interfere with their drug use, or shared syringes. Factors independently associated with drug-related harms related to policing within the last six months included: recent arrest, homelessness, higher frequencies of drug injection, use of methamphetamine, using the local needle exchange program and perceiving a decrease in the purity of at least one drug. IDUs who experienced drug-related harms related to policing were those who were most affected by other micro and macro influences in the physical risk environment. Police education programs are needed to ensure that policing practices do not exacerbate risky behaviors or discourage protective behaviors such as needle exchange program use, which undermines the right to health for people who inject drugs.
    Full-text · Article · Apr 2011 · Harm Reduction Journal
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