Injecting behaviour and service use among young injectors in Albania, Moldova, Romania and Serbia.

BACKGROUND: This study examines socio-demographic profiles, injecting risk and use of health services among young injectors (15-24) in Albania, Moldova, Romania and Serbia. The objective was to provide age-disaggregated data to identify differences between adolescents (<18) and youth (18-24), and help fill the gap in knowledge on the youngest injectors in this region. METHODS: Cross sectional surveys were conducted in each country using chain-referral sampling to reach diverse networks of people who use drugs (PWID). In Albania and Romania, surveys were conducted in the capitals, respectively, Bucharest and Tirana. Respondents were recruited from 3 cities in Moldova (Chisinau, Balti and Tiraspol) and Serbia (Belgrade, Novi Sad and Nis). Data were collected on risk behaviours, service use and contact with police and other authorities. Analysis focused on associations between unsafe injecting behaviour and key determinants including demographic background, source of needles/syringes, use of harm reduction services and interactions with law enforcement. RESULTS: Although drug use and health-seeking varied across settings, sources of injecting equipment were significantly associated with sharing needles and syringes in Moldova, Romania and Serbia. Obtaining equipment from formal sources (pharmacies, needle-exchange programmes) reduced likelihood of sharing significantly, while being stopped by the police or incarcerated increased it. Adolescents relied on pharmacies more than public sector services to obtain equipment. CONCLUSION: Adolescents comprise a small proportion of PWID in this region, but have poorer access to harm reduction services than older peers. Engaging young PWID through private and public sector outlets might reduce unsafe practices, while use of the justice system to address drug use complicates efforts to reach this population.

HIV/AIDS Monitoring and Evaluation Systems Strengthening for the National AIDS Program in Albania.

The Institute of Public Health (IPH) is the Principal Recipient (PR) of the Global Fund for AIDS, TB and Malaria Round 5 HIV/AIDS and TB grants. The GF HIV Grant is highly targeted, aimed at filling key gaps in the national response to HIV/AIDS. Albania is considered a low HIV prevalence country based on the number of reported cases. The work presented in this paper is carried out as part of the Monitoring and evaluation framework development in respect to the National AIDS strategy and Global Fund agreement. The performance framework consists of a range of indicators agreed by the PR (IPH in Albania), and specific targets to be met on an annual base. The PR must, therefore, be able to measure its performance against this framework in order to demonstrate that it is meeting its targets. To assist this process, the GFATM requires PRs to undertake an assessment of their capacity to monitor and evaluate the program, and put in place measures to strengthen any identified weaknesses. The Global Fund's M&E Systems Strengthening Tool, MESST, was used. The MESST is conducted via a participatory workshop involving the PR, SRs,(Subrecipients) some representatives of the Country Coordinating Mechanism (CCM), the donor community and other stakeholders or implementing partners relevant to the exercise. The proposed output for this exercise is an M&E Action Plan for the PR. A 2-day MESST workshop was held in Tirana, Albania. Participants at the workshop assessed the M&E capacity of the national HIV program, and its implementers, the IPH and the sub recipients (SRs), by looking at three elements of the M&E system. These are: The Monitoring and Evaluation Plan, The ability of collate and analyze data at the IPH, The reporting systems in the health facilities, the community and the laboratories, The result was identification of a range of strengths and weaknesses, and from these, the development of a list of key actions to address the weaknesses identified.

Behavioral risk factors and prevalence of HIV and other STIs among female sex workers in Tirana, Albania.

The paper presents the results of the research and a comparative analysis of findings on key indicators for the study population. The study instrument was a standardized behavior study questionnaire provided in the Family Health International published manual (Family Health International, 2000). The target group was female sex workers working in Tirana. The prevalence of biological infections was low. HIV was detected in one case. Syphilis and Hepatitis B rates resulted to be respectively 6.5% and 7.6%. The median age of the study participants is 28 years. Almost 38% of the participants were illiterate, and more than half belong to the Roma community. Almost 50% of the respondents had received money in exchange of sex for the first time 18 years earlier. Almost 65% of respondents reported two or more different sex partners in the last seven days, while almost 30% referred five or more. Condom use at last sex with a paying client was reported by almost 68%. Consistent condom use with paying clients in the last month was reported by almost 35% of the respondents.

An analysis of respondent driven sampling with Injection Drug Users (IDU) in Albania and the Russian Federation.

Injection drug users in Tirana, Albania and St. Petersburg, Russia were recruited into a study assessing HIV-related behaviors and HIV serostatus using Respondent Driven Sampling (RDS), a peer-driven recruitment sampling strategy that results in a probability sample. (Salganik M, Heckathorn DD. Sampling and estimation in hidden populations using respondent-driven sampling. Sociol Method. 2004;34:193-239). This paper presents a comparison of RDS implementation, findings on network and recruitment characteristics, and lessons learned. Initiated with 13 to 15 seeds, approximately 200 IDUs were recruited within 8 weeks. Information resulting from RDS indicates that social network patterns from the two studies differ greatly. Female IDUs in Tirana had smaller network sizes than male IDUs, unlike in St. Petersburg where female IDUs had larger network sizes than male IDUs. Recruitment patterns in each country also differed by demographic categories. Recruitment analyses indicate that IDUs form socially distinct groups by sex in Tirana, whereas there was a greater degree of gender mixing patterns in St. Petersburg. RDS proved to be an effective means of surveying these hard-to-reach populations.