Marginalized and Socially Integrated Groups of IDUs in Hungary: Potential Bridges of HIV Infection

Abstract

The discrepancy in HIV rates among Eastern and Central European injecting drug users (IDUs) suggests that, in addition to risk behaviors, social contact patterns also play an important role. We identify two groups of IDUs in Budapest, Hungary, marginalized IDUs (M-IDUs) and socially integrated IDUs (SI-IDUs), and compare their HIV/HBV/HCV social and risk network characteristics, risk behaviors, and travel patterns. Between 05/2003 and 01/2004, 29 non-treatmentrecruited young IDUs in Budapest participated in ethnographic interviews and focus groups. The mean age was 23.6 years (SD=3.6); eight were female and two Roma/Gypsy. Most injected heroin (n=23) and/or amphetamines (n=10) in the past 30 days. M-IDUs had no legal employment, injected heroin and sniffed glue, and stopped using drugs in treatment/prison. SI-IDUs had regular jobs or were students, injected heroin and sniffed cocaine, and stopped using drugs before exams/tests. Both M-IDUs and SI-IDUs shared injecting equipment on occasion and used condoms rarely. M-IDUs had a large social network of "buddies" and a small risk network of "friends". SI-IDUs had two separate large social networks of "buddies": a M-IDU and a non-IDU network; and a small risk network of "friends". Both groups reported monogamous sexual relationships. M-IDUs traveled within Hungary whereas SI-IDUs traveled to Western Europe. If an HIV epidemic among IDUs in Hungary is not prevented, SI-IDUs may form a potential "bridge" of HIV infection between highrisk IDU populations and the low-risk, general population, while M-IDUs may become cores of infection. Different approaches may be appropriate for M-IDUs and SI-IDUs to prevent HIV.

Strong HIV and hepatitis disclosure norms and frequent risk behaviors among Hungarian drug injectors

“…Young IDUs were recruited in Budapest, Hungary between May 2003 and January 2004 from non-treatment settings using a combination of targeted sampling, street outreach and chain referral methods as part of a pilot study exploring HIV risk among Hungarian IDUs (Heckathorn, 1997;Gyarmathy and Neaigus, 2005). Sample recruitment was from the needle exchange program, areas in the city where drug use was common, and through referral by participants in the study.…”

“…All interviews were voice recorded using a digital voice recorder. Interviews were transcribed and data were extracted based on a priori questions of interest (Kelly et al 2004;Gyarmathy and Neaigus, 2005). Data summaries were analyzed to identify key themes.…”

Analysis of duration of risk behaviour for key populations: a literature review

“…[121][122][123] Based on that information, the mean turnover for IDU was estimated to be 8.9 years. ▸ Thirty-two datasets [124][125][126][127][128][129][130][131][132][133][134][135][136][137][138][139][140][141][142] described the mean duration of injecting career up to the moment of the interview. It varied from 1.3 to 14.3 years, leading to a mean and a median of 8.6 years.…”

Individual and Social Factors Associated With Participation in Treatment Programs for Drug Users

“…Hence the results of this analysis may not generalize to all drug users; for example, those drug users who are more socially integrated may be underrepresented in our sample (Gyarmathy and Neaigus, 2005). Background characteristics collected about participants were limited to those necessary to understand factors related to the aims of the SHIELD study, and no data was collected about other descriptive information about participants, such as personal and other resources, coping strategies, and other psycho-social characteristics.…”