Stimulant Injectors in Ukraine: The Next Wave of the Epidemic?

Booth, Robert E.; Lehman, Wayne E. K.; Kwiatkowski, Carol F.; Brewster, John T.; Sinitsyna, Larisa; Dvoryak, Sergey

doi:10.1007/s10461-008-9359-3

Cited by 36 publications

(30 citation statements)

References 27 publications

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“…13 Our finding that IDUs practicing higher injection-related risk behavior are more likely to be practicing higher sexual risk behavior is consistent with other research findings. [14][15][16][17][18][19] There is some evidence from other studies in line with our results that those injecting buprenorphine might have lower HIV-related risky injection practices. [20][21] A study carried out recently by Otiashvili et al among IDUs in Georgian needle exchange programs found that two thirds of IDUs injected buprenorphine in the past month and approximately a half of these used it to cope with the symptoms of withdrawal.…”

Section: Discussionsupporting

confidence: 90%

Unsafe Injection and Sexual Risk Behavior among Injecting Drug Users in Georgia

Chikovani

Božičević²,

Goguadze

et al. 2011

J Urban Health

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Injection drug users (IDUs) are at risk for acquiring human immunodeficiency virus (HIV) through parenteral and sexual transmission. In this paper, we describe the prevalence and correlates of unsafe drug injecting and sexual behaviors among IDUs recruited across five cities in Georgia in 2009. IDUs were administered a questionnaire collecting information on demographics, drug use, sexual behaviors, and HIV testing behaviors. Correlates of risky injecting and sexual behaviors were determined using logistic regression. Of 1,127 IDUs, the majority (98.7%) were men, and the median duration of injecting drugs was 7 years. Unsafe injecting behavior at last injection was reported by 51.9% of IDUs, while 16.8% reported both unsafe injecting behavior and not using condoms with last occasional and/or commercial partner. In the multivariate analysis, independent correlates of unsafe injecting behavior at last injection were types of drugs injected [p=0.0096; (for ephedrine, adjusted odds ratio (aOR)=7.38; 95% CI, 1.50-36.26)] and not using condoms at last commercial sex (aOR =2.29, 1.22-4.32). The following variables were significantly associated with unsafe injecting behavior at last injection and not using condoms at last sex with commercial and/or occasional partners in the multivariate analysis: marital status [p = 0.0002; (for divorced, widowed, and separated aOR =2.62, 1.62-4.25; for single aOR =1.61, 1.08-2.39)], being a member of a regular injecting group (aOR=0.62, 0.44-0.88), types of drugs injected in the past month [p =0.0024; (for buprenorphine aOR =0.34, 0.18-0.63)], city of residence (p=0.0083), and not receiving information on HIV (aOR=1.82, 1.07-3.09). Though only ephedrine was injected by a smaller number of IDUs (9.1%), the vast majority of these (81.4%) reported unsafe injecting practices at last injection. High prevalence of unsafe injecting behaviors and diverse and at-risk sexual partnerships highlight the need to implement complex and targeted HIV interventions among IDUs in Georgia.

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Section: Discussionsupporting

confidence: 90%

Unsafe Injection and Sexual Risk Behavior among Injecting Drug Users in Georgia

Chikovani

Božičević²,

Goguadze

et al. 2011

J Urban Health

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“…In addition to the concurrent use of benzodiazepines, the use of other opiates and home-made stimulants was common in our sample. Even if poly-drug use is a well-known phenomenon in the region and is confirmed by other authors [53,54] , our findings indicate a scenario of even more chaotic drug use in the study sample. The reasons for unsystematic (unstructured) poly-drug use (mixing together buprenorphine with other sedatives and with pseudo/ephedrine-based stimulants at the same time) might be the fluctuating availability of particular substances, the high price of all illegal drugs on the Georgian black market compared to local income levels, and users' attempts to combine different drugs in order to increase the euphoric effects, potency and duration of effect of the preparation.…”

Section: Dosage Of Injected Buprenorphinesupporting

confidence: 86%

“…In 2007, IDUs comprised 60.4% of registered HIV cases [60] . This dangerous situation might be further aggravated by the recent significant increase in the use of home-made stimulants, its frequent concurrent use with buprenorphine [35,37,40] and the existing evidence of increased risky injections and sexual behaviours on the part of amphetamine-type stimulant users [53,54,61,62] . An increase in amphetamine-type stimulant injection in Georgia has been identified in some earlier studies [35,37,41] .…”

Section: Public Health and Illegal Buprenorphine Injecting: The Emergmentioning

confidence: 99%

Why Do the Clients of Georgian Needle Exchange Programmes Inject Buprenorphine?

Otiashvili

Zábranský²,

Kirtadze

et al. 2009

Eur Addict Res

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Aim: The aim of the study was to understand the prevalence and patterns of the non-medical injecting use of buprenorphine among drug injectors in Georgia. Method: A self-administered questionnaire was distributed among injecting drug users enrolled in Georgian needle exchange programmes. The questions covered topics related to drug use career, patterns (frequency, history, dosage) and reasons for the use of buprenorphine. Results: Pharmaceutical buprenorphine in the form of Subutex® was the most commonly injected drug in terms of lifetime (95.5%) and last-month (75%) prevalence of use. 48% of those study participants who had injected Subutex at some point reported having used it to cope with withdrawal or to give up other opioids. 90.5% of Subutex injectors used 1–2 mg as a single dose, and the mean frequency of its injection was 6 times per month. 75% of Subutex injectors had used 3 or more types of illegal drugs during the last 30 days. Conclusion: While widely misused by Georgian drug injectors, Subutex is neither the principal nor the favourite drug, and it is rather used as self-treatment. The authors consider the introduction of buprenorphine maintenance treatment to be a promising effective measure to decrease its non-medical and illegal use.

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“…Qualitative research indicates that IDUs inject a variety of mostly homemade drugs using easily accessible over-the-counter ingredients such as cold medicines and household chemicals. Commonly used drugs include the opiate-based ''hanka'' or ''hemia'' (liquid poppy straw or latex involving a lengthy preparation process of mixing chemicals, cooking and straining) and amphetamine-based ''shirka'', ''vint'' or ''jeff'' (ephedrine, methamphetamine, or methcathernone involving a lengthy preparation process of mixing chemicals, cooking and straining) or ''baltushka'' (ephedrine based involving a cold-shaking process to separate tablets from liquid) [8,[10][11][12]. Economic, political and social instability, misinformation and incorrect beliefs about drug injection risks and HIV transmission, social stigmatization, police policies towards IDUs, gender differences in drug use practices are suggested contributors to the rise of HIV among IDUs [8,13].…”

Section: Introductionmentioning

confidence: 99%

Correlates of HIV Risk Among Injecting Drug Users in Sixteen Ukrainian Cities

Taran¹,

Johnston

Pohorila

et al. 2010

AIDS Behav

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We present findings from a HIV survey using respondent driven sampling among 3,711 injecting drug users (IDUs) in 16 cities in Ukraine in 2008. Eligible participants were males and females who injected drugs in the past 1 month, ≥ 16 years and lived/worked in their respective interview area. The impact of injecting and sexual risk behaviors on HIV-infection were analyzed using four logistic models. Overall HIV prevalence was 32%. In the sexual risk model, paying for sex in the past 3 months and condom use during last sex increased the odds of HIV infection. Being female, having greater than 3 years of injection drug use, always sharing equipment and using alcohol with drugs in the past month remained significant in all four models. These findings indicate the urgent need to scale up peer education, needle exchange and methadone substitution programs for IDUs with specific programs targeting the needs of female injectors.

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Stimulant Injectors in Ukraine: The Next Wave of the Epidemic?

Cited by 36 publications

References 27 publications

Unsafe Injection and Sexual Risk Behavior among Injecting Drug Users in Georgia

Unsafe Injection and Sexual Risk Behavior among Injecting Drug Users in Georgia

Why Do the Clients of Georgian Needle Exchange Programmes Inject Buprenorphine?

Correlates of HIV Risk Among Injecting Drug Users in Sixteen Ukrainian Cities

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