Strong HIV and hepatitis disclosure norms and frequent risk behaviors among Hungarian drug injectors

Abstract

Ethnographic interviews and focus groups were conducted (05/2003-01/2004) among injecting drug users (IDUs; n=29) in Budapest, Hungary to assess HIV, Hepatitis B and C (HBV and HCV) related knowledge, norms, attitudes and behaviors. Participants perceived themselves at low risk for infection with HIV but high risk for hepatitis through injection but not sexual exposure. They reported strong disclosure norms for HIV and hepatitis infections, while sexual and injecting risk behaviors were influenced by trust about partners' self-report of infection status. Injecting networks were small, with infrequent syringe sharing among a few close friends. Cookers and drug filters were often shared, and filters were re-used as a backup drug supply. Most sexual relationships were monogamous, where condoms were rarely used. Although participant norms supported HIV/HBV/HCV testing, the lack of available testing facilities was a barrier to getting tested. Strong norms for infection disclosure and for getting tested coexist with engaging in risk behaviors with injecting and sex partners who are close friends. Network interventions among IDUs in Hungary should build on disclosure norms and trust to reduce injecting and sex risk. Testing services should be expanded and access increased so that IDUs can act on and reinforce their norms for testing.

Unprotected Sex in Heterosexual Partnerships of Injecting Drug Users in St. Petersburg, Russia

“…While trust between sex partners who inject together has been pinpointed as a potential reason for this combined risk [30,31], in this study trust between sex partners was not significant in the multivariate analysis. The reason for this may be that among this population of IDUs, other, more “practical” factors, such as self-reported HIV concordance/discordance and social exposure to the sex partner, are more important.…”

Views and experiences of hepatitis C testing and diagnosis among people who inject drugs: Systematic review of qualitative research

“…Two studies included the views of health professionals involved in the care of PWIDs; one as the sole study participants (Perry & Chew-Graham, 2003) and one, in addition to the views and experiences of PWID (Munoz-Plaza, Strauss, Astone, Jarlms, & Hagan, 2004). Most studies specifically examined views and experiences in relation to HCV infection only, though two studies (Gyarmathy, Neaigus, Ujhelyi, Szabo, & Racz, 2006;Lally, Montstream-Quas, Tanaka, Tedeschi, & Morrow, 2008) explored viral hepatitis infection more broadly alongside sexually transmitted infections such as HIV (table 1). **INSERT TABLE 1 ABOUT HERE** The included studies covered testing and the impact of diagnosis, including barriers and facilitators to testing, experiences of testing, reactions to diagnosis, and the impact of diagnosis on behaviour, and stigma as a barrier to testing uptake and disclosure.…”

Liquid Drugs and High Dead Space Syringes May Keep HIV and HCV Prevalence High – A Comparison of Hungary and Lithuania

“…A further limitation is that the injection of drugs purchased in liquid form was not assessed in Hungary. This drug category was not included because preliminary ethnographic findings showed that while some reported using liquid opioids in the past [26], these drugs were no longer available in Hungary. However, the questionnaire for this study included a question asking whether they used any drugs other than the ones mentioned and what these drugs were, and not only did nobody in Hungary mention ‘kompót’, but participants also commented on how exhaustive the drug list was.…”