Changes in HIV Prevalence and Risk Among New Injecting Drug Users in a Russian City of High HIV Prevalence

Platt, Lucy PhD*; Rhodes, Tim PhD*; Hickman, Matthew PhD†; Mikhailova, Larissa PhD‡; Lisetsky, Konstantin PhD§; Sarang, Anya∥; Lewis, Kim MSc¶; Parry, John PhD¶

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e318165dbf7
Epidemiology and Social Science

Objective: To measure HIV prevalence and associated risk factors among recent initiates into drug injecting in 2001 and 2004 in Togliatti City, Russian Federation.

Design: Two unlinked, anonymous, cross-sectional, community-recruited surveys of injecting drug users (IDUs) with oral fluid samples for anti-HIV testing.

Methods: IDUs completed an interviewer-administered questionnaire, and oral fluid samples were tested for antibodies to HIV. Demographic characteristics and injecting risk behaviors were compared between subsamples of IDUs who reported injecting for 3 years or less in each of the survey years, 2001 (n = 138) and 2004 (n = 96). Univariable and multivariable analyses explored risk factors with anti-HIV among these new injectors.

Results: Among IDUs overall, although HIV prevalence was high, a lower prevalence was found in 2004 (38.5%, 95% confidence interval [CI]: 34.1 to 42.9) than in 2001 (56%, 95% CI: 51.2 to 60.8). A significantly lower prevalence of HIV was found among new injectors in 2004 (11.5%, 95% CI: 5.0 to 17.9) than in 2001 (55.2%, 95% CI: 46.7 to 63.8). Proportionally, fewer new injectors reported injecting daily, injecting with used needles/syringes, and frontloading in 2004 compared with 2001. Decreased odds of anti-HIV were associated with being recruited in 2004 and with a history of drug treatment. Increased odds of HIV were associated with exchanging sex, duration of injection, and frontloading.

Conclusions: Findings indicate a decrease in HIV prevalence among new injectors between 2001 and 2004 and emphasize the role of provision of needle/syringes through pharmacies and providing access to voluntary HIV testing. These findings have implications for other cities in which explosive HIV outbreaks have occurred.

Author Information

From the *Centre for Research on Drugs and Health Behaviour, Public and Environmental Health Research Unit, Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom; †Department of Social Medicine, University of Bristol, Bristol, United Kingdom; ‡City Narcological Services and NGO Parents Against Drugs, Togliatti City, Samara Oblast, Russian Federation; §Samara State University, Samara Oblast, Russian Federation; ∥Russian Harm Reduction Network, Ilimskaya Street 4-1-38, 127576 Moscow, Russia; and the ¶Health Protection Agency and Department of Public Health and Policy London School of Hygiene and Tropical Medicine, London, United Kingdom.

Received for publication August 17, 2007; accepted December 19, 2007.

Funded by the Department for International Development.

Correspondence to: Lucy Platt, PhD, Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom (e-mail:

© 2008 Lippincott Williams & Wilkins, Inc.