Drug choice, spatial distribution, HIV risk, and HIV prevalence among injection drug users in St. Petersburg, Russia

Abstract

Background: The HIV epidemic in Russia has been driven by the unsafe injection of drugs, predominantly heroin and the ephedrine derived psychostimulants. Understanding differences in HIV risk behaviors among injectors associated with different substances has important implications for prevention programs.

Methods: We examined behaviors associated with HIV risk among 900 IDUs who inject heroin, psychostimulants, or multiple substances in 2002. Study participants completed screening questionnaires that provided data on sociodemographics, drug use, place of residence and injection- and sex-related HIV risk behaviors. HIV testing was performed and prevalence was modeled using general estimating equation (GEE) analysis. Individuals were clustered by neighborhood and disaggregated into three drug use categories: Heroin Only Users, Stimulant Only Users, and Mixed Drug Users.

Results: Among Heroin Only Users, younger age, front/backloading of syringes, sharing cotton and cookers were all significant predictors of HIV infection. In contrast, sharing needles and rinse water were significant among the Stimulant Only Users. The Mixed Drug Use group was similar to the Heroin Only Users with age, front/back loading, and sharing cotton significantly associated with HIV infection. These differences became apparent only when neighborhood of residence was included in models run using GEE.

Conclusion: The type of drug injected was associated with distinct behavioral risks. Risks specific to Stimulant Only Users appeared related to direct syringe sharing. The risks specific to the other two groups are common to the process of sharing drugs in preparation to injecting. Across the board, IDUs could profit from prevention education that emphasizes both access to clean syringes and preparing and apportioning drug with these clean syringes. However, attention to neighborhood differences might improve the intervention impact for injectors who favor different drugs.

Figure 1

Spatial Distribution of HIV Cases and Injection Drugs within the City of St. Petersburg. Data from 899 participating injection drug users screened at baseline were sorted by district of residence. For each district, the number of participants, the HIV prevalence, and the percentage of injectors who injected only heroin, only amphetamine-type psychostimulants (ATS), or both within the 30 days prior to entering the study are included on the embedded table. The maps display HIV prevalence (A) and type of drug injected (B) with the size of the pie charts proportional to the number of participants who resided in each of the 13 neighborhoods within the city limits of St. Petersburg. For HIV prevalence, the dark part of the pies represents the seropositive cases. For drug injected, the open part of the pies represents heroin only injectors, the dark part represents ATS only injectors, and the striped part represents injectors of both kinds of drug.