Explosive spread and high prevalence of HIV infection among injecting drug users in Togliatti City, Russia.

OBJECTIVE: To establish the prevalence of antibodies to HIV (anti-HIV) and associated risk factors among injecting drug users (IDU) in Togliatti City, Samara Oblast, Russian Federation. DESIGN: An unlinked anonymous cross-sectional community recruited survey with oral fluid sample collection. METHODS: Between September and October 2001, 426 IDU were recruited by trained fieldworkers. Participants completed an interviewer administered questionnaire, and oral fluid samples were tested for anti-HIV. Univariate and multivariate analyses compared potential risk factors for anti-HIV. RESULTS: Anti-HIV prevalence was 56% (234/418). Three-quarters of anti-HIV-positive IDU (74%) were unaware of their positive status. In an adjusted model, the odds of HIV infection were higher among IDU who had ever injected home-produced drugs, who reported injecting with used needles and syringes in the past 4 weeks, and who were living in one particular district of the city (Komsomolksii). CONCLUSION: The high prevalence of HIV, and a recent increase in HIV detected through routine screening tests since 2000, suggests that an explosive epidemic has occurred among IDU in Togliatti City. In the face of currently inadequate HIV prevention coverage among IDU, this has urgent implications for maximizing the distribution of sterile injecting equipment as well as for enhancing sexual risk reduction. Recognizing that it is likely that similar explosive epidemics are taking place in other Russian cities, we recommend community-wide HIV prevention coverage supported by city and state policies oriented to harm reduction.

The prevalence of injecting drug use in a Russian city: implications for harm reduction and coverage.

AIM: This study sought to estimate the prevalence of injecting drug users (IDU) in Togliatti city and to examine the implications of these estimates for HIV prevalence and harm reduction. DESIGN: Routine data sources of IDUs were identified. Covariate capture-recapture techniques were used on the individuals identified on the three data sources and used to estimate the number of IDU 'not observed' by the data sources, and thereby estimate the prevalence of IDU. SETTING: Togliatti City, Samara Oblast, Russian Federation. PARTICIPANTS: IDUs recorded on three data sources (narcology records, HIV positive test results and police arrest data) during 2001. MEASUREMENTS: Poisson regression models were fitted to the observed data, with interactions between data sources fitted to replicate 'dependencies' between those data sources. To select the best model the goodness of fit was approximated by chi2 distribution and the best-fitting model was selected on the basis of standard information criteria and log likelihood ratio tests. FINDINGS: The total estimated population of IDUs is 20 226 [95% confidence interval (CI): 16 971-24 749] giving a population prevalence of 5.4% (95% CI: 4.5-6.6%) of the registered population and 2.7% (95% CI: 2.4-3.5%) of the population (including migrants) aged 15-44 years. For every one IDU in contact with a service there were three out of contact. CONCLUSIONS: There is a high prevalence of IDU which, in the context of a fast-emerging IDU-associated HIV epidemic, will have serious public health implications.