Liquid drugs and high dead space syringes may keep HIV and HCV prevalence high - a comparison of Hungary and Lithuania

Abstract

Despitevery similar political, drug policy and HIV prevention backgrounds, HIV and HCV prevalence is considerably different in Hungary (low HIV and moderate HCV prevalence) and Lithuania (high HCV and moderate HIV prevalence). Wecompared the drug use profile of Hungarian (n = 215) and Lithuanian (n = 300) injecting drug users (IDUs). Overall, compared with IDUs in Hungary, IDUs in Lithuania often injected opiates purchased in liquid form ('shirka'), used and shared 2-piece syringes (vs. 1-piece syringes) disproportionately more often, were less likely to acquire their syringes from legal sources and had significantly more experience with injected and less experience with non-injected drugs. It may not be liquid drugs per se that contribute to a higher prevalence of HCV and/or HIV, but it is probably factors associated with the injecting of liquid drugs, such as the wide-spread use and sharing of potentially contaminated 2-piece syringes acquired often from non-legal sources, and syringe-mediated drug sharing with 2-piece syringes. Scaling up substitution therapy, especially heroin replacement, combined with reducing the supply of liquid drugs may decrease the prevalence of high-risk injecting behaviours related to the injecting of liquid drugs and drug injecting-related infections among IDUs in Lithuania.

Fig. 1

Non-injected drugs used daily by Lithuanian and Hungarian IDUs. Alc = Alcohol; Glu = glue or inhalants; Her = heroin; Klo = klonopin or rivotril (i.e. clonazepam); Mar = marijuana; Mot = methadone from sources other than treatment; Mtx = methadone from treatment; Pop = poppy tea; Tob = tobacco; Trn = tranquilizers; Xtc = ecstasy. ∗ p < 0.05, statistically significant difference between proportions.

Fig. 2

Drugs injected daily by Lithuanian and Hungarian IDUs. Amp = Amphetamines (purchased in powder form); Coc = cocaine; Her = heroin; Ket = ketamine; Klo = klonopin or rivotril (i.e. clonazepam); Lia = amphetamines purchased in liquid form; Lio = opiates purchased in liquid form; Mot = methadone from sources other than treatment; Mtx = methadone from treatment; Trn = tranquilizers. ∗ p < 0.05, statistically significant difference between proportions.