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Self-reported testing, HIV status and associated risk behaviours among people who inject drugs in Europe: important differences between East and West

Uusküla, Annelia; Raag, Maita; Folch, Cintac; Prasad, Leonid; Karnite, Andae; van Veen, Maaike G.f; Eritsyan, Kseniag; Rosinska, Magdalenah; Des Jarlais, Don C.b; Wiessing, Lucasi

doi: 10.1097/QAD.0000000000000299
Epidemiology and Social

Aims: To describe HIV-related risk behaviours, HIV testing and HIV status among people who inject drugs (PWIDs) in the 2000 in European countries with high-prevalence HIV epidemics among PWID.

Methods: Data from 12 cross-sectional studies among PWID from seven countries were used. Meta-analysis was used to synthesize the data and meta-regression to explain heterogeneity [in addition to deriving adjusted odds ratios (AORmeta)].

Results: Data on 1791 PWID from western (the West) and 3537 from central and eastern (the East) European countries were available. The mean age of participating PWIDs was 30.6 years (SD 7.9), 75% were men, and 36% [95% confidence interval 34–37%) were HIV-infected (30% West, 38% East); 22% had not previously been tested for HIV. The prevalence of reported high-risk behaviour was significantly higher among PWID from the East. Comparison of HIV-infected and uninfected PWID within countries yielded similar results across all countries: HIV-infected PWID were less likely to be sexually active [AORmeta 0.69 (0.58–0.81)], reported less unprotected sex [AORmeta 0.59 (0.40–0.83)], but reported more syringe sharing [AORmeta 1.70 (1.30–2.00)] and more frequent injecting [AORmeta 1.40 (1.20–1.70)] than their HIV-uninfected counterparts.

Conclusion: Despite the absolute differences in reported risk behaviours among PWID in western and eastern Europe, the associations of risk behaviours with HIV status were similar across the sites and regions. There is a substantial potential for further HIV transmission and acquisition based on the continuous risk behaviours reported. HIV prevention and harm reduction interventions targeting PWID should be evaluated.

aDepartment of Public Health, University of Tartu, Tartu, Estonia

bThe Baron Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center New York, USA

cCentre d’Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Institut català d’Oncologia (ICO), Agència Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Badalona, Spain

dInstitute of Public Health of the University of Porto, Porto, Portugal

eRiga Stradins University, Department of Public Health and Epidemiology, Riga, Latvia

fPublic Health Service Amsterdam, Amsterdam, The Netherlands

gNGO Stellit, Saint-Petersburg State University, St Petersburg, Russian Federation

hNational Institute of Public Health – National Institute of Hygiene, Warsaw, Poland

iEuropean Monitoring Centre for Drugs and Drug Addiction (EMCDDA), Lisbon, Portugal.

Correspondence to Anneli Uuskula, MD, MS, PhD, University of Tartu, Tartu, Estonia. E-mail:

Received 23 September, 2013

Revised 3 April, 2014

Accepted 3 April, 2014

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© 2014 Lippincott Williams & Wilkins, Inc.