Risk for Heterosexual HIV Transmission Among Non-Injecting Female Partners of Injection Drug Users in Estonia

Abstract

The HIV epidemic in Estonia, as with other eastern European countries, is currently concentrated among injection drug users (IDUs). Non-IDUs who have IDU sex partners could serve as a potential bridge in an expanding epidemic. We applied HIV transmission modelling to data collected from non-IDU/IDU heterosexual couples in Kohtla-Järve, Estonia to estimate HIV risk from IDUs to their sex partners based on self-reported sexual behaviors shared by the couple. IDUs and their current main non-injecting sex partners were recruited for an interviewer-administered survey and HIV testing. Bernoulli modelling techniques were applied to estimate the risk of HIV transmission (incidence) among HIV negative non-injecting female partners of male IDUs. The estimated HIV incidence in this population of non-injecting women with only main sexual partners in the last 6 months ranged from 3.24 to 4.94 HIV seroconversions per 100 person years depending on the value used in the models for the per act transmission rate during acute stage infection. Non-IDUs who have IDU sex partners are at high risk for HIV and could serve as a potential bridge to a more generalized epidemic. Whether this might lead to an expansion of the HIV epidemic beyond core groups in Estonia or other Eastern European countries warrants closer study.

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

“…As most of the sexual transmission is likely to be from PWID to non-injecting sexual partners (Uusküla et al, 2013b), sexual transmission to PWID is not likely to be substantial.…”

Design and baseline findings of a large-scale rapid response to an HIV outbreak in people who inject drugs in Athens, Greece: the ARISTOTLE programme

“…The median (25th, 75th) size of their injection network—i.e. of PWIDs they knew and had met in the past month—was 30 people.…”

“…In the Athens outbreak, apart from increasing the coverage of NSP and OST, it is necessary to address cocaine and speedball use as well as homelessness, which affects mainly migrant PWIDs, and to tackle the increased sexual transmission risk of HIV among female PWIDs. Prevention programmes should also take into account non‐injecting sexual partners of PWIDs, who could serve as a ‘bridging population’ for transmission to the wider heterosexual population . The implementation of ARISTOTLE suggests that repeat RDS sampling may be an effective way to reach high coverage of interventions in the hard‐to‐reach population of PWIDs within a short period of time.…”

Changes in high-risk sexual behaviour among Estonian adults between 1996 and 2006

“…Characteristics of the sexual networks of IDUs/their main sexual partners, and sexual behaviour of the general population, will probably determine the further generalisation of the HIV epidemics 9. However, data on sexual behaviour among the general population and, therefore, indications of any changes from these countries is scant.…”