A decline in the prevalence of injecting drug users in Estonia, 2005–2009

Abstract

Aims and setting Descriptions of behavioural epidemics have received little attention compared with infectious disease epidemics in Eastern Europe. Here we report a study aimed at estimating trends in the prevalence of injection drug use between 2005 and 2009 in Estonia. Design and methods The number of injection drug users (IDUs) aged 15–44 each year between 2005 and 2009 was estimated using capture-recapture methodology based on 4 data sources (2 treatment data bases: drug abuse and non-fatal overdose treatment; criminal justice (drug related offences) and mortality (injection drug use related deaths) data). Poisson log-linear regression models were applied to the matched data, with interactions between data sources fitted to replicate the dependencies between the data sources. Linear regression was used to estimate average change over time. Findings there were 24305, 12292, 238, 545 records and 8100, 1655, 155, 545 individual IDUs identified in the four capture sources (Police, drug treatment, overdose, and death registry, accordingly) over the period 2005 – 2009. The estimated prevalence of IDUs among the population aged 15–44 declined from 2.7% (1.8–7.9%) in 2005 to 2.0% (1.4–5.0%) in 2008, and 0.9% (0.7–1.7%) in 2009. Regression analysis indicated an average reduction of over 1700 injectors per year. Conclusion While the capture-recapture method has known limitations, the results are consistent with other data from Estonia. Identifying the drivers of change in the prevalence of injection drug use warrants further research.

Preventing Injection Drug use Initiation: State of the Evidence and Opportunities for the Future

“…Concurrently, there is widespread lack of coverage for basic HIV prevention interventions such as MAT [53]; as a result, in certain regions (i.e., Russian Federation), the elevated incidence of HIV and other blood-borne disease transmission among PWID is likely to continue [2]. The lack of education and experience with the harmful consequences of injecting drugs among at-risk populations in Eastern Europe may have contributed to the expansion of these syndemics, though it is likely that a more stable economic climate and a Bcommunity learningê ffect may be contributing to a recent increase in the resilience of these populations in avoiding injecting [54]. While studies from the region document some decreases in the proportion of new injectors among PWID populations [54], HIV and HCV prevalence among new injectors remains high [53].…”

Combined prevention for persons who inject drugs in the HIV epidemic in a transitional country: the case of Tallinn, Estonia

“…Studies conducted among PWID in Estonia have found very high HIV prevalence rates (40–90%) (Platt L et al, 2006; Wilson, Sharma, Zilmer, Kalikova & Uusküla, 2007). In Tallinn, Estonia's capital and largest city, approximately 50% of the city's 5,000 - 7,000 PWIDs are already infected with HIV (Uusküla, Rajaleid, Talu, Abel-Ollo & Des Jarlais, 2013a). …”

Critical remarks on strategies aiming to reduce drug related harm: substance misuse and HIV/AIDS in a world in turmoil

“…Even in some places where injection was especially prevalent and had been one of the key drivers of HIV and HCV spread, such as in Estonia, Eastern Europe, injection has becoming a less frequent habit in recent years 11 .…”