Unsafe Injection and Sexual Risk Behavior among Injecting Drug Users in Georgia

Abstract

Injection drug users (IDUs) are at risk for acquiring human immunodeficiency virus (HIV) through parenteral and sexual transmission. In this paper, we describe the prevalence and correlates of unsafe drug injecting and sexual behaviors among IDUs recruited across five cities in Georgia in 2009. IDUs were administered a questionnaire collecting information on demographics, drug use, sexual behaviors, and HIV testing behaviors. Correlates of risky injecting and sexual behaviors were determined using logistic regression. Of 1,127 IDUs, the majority (98.7%) were men, and the median duration of injecting drugs was 7 years. Unsafe injecting behavior at last injection was reported by 51.9% of IDUs, while 16.8% reported both unsafe injecting behavior and not using condoms with last occasional and/or commercial partner. In the multivariate analysis, independent correlates of unsafe injecting behavior at last injection were types of drugs injected [p=0.0096; (for ephedrine, adjusted odds ratio (aOR)=7.38; 95% CI, 1.50-36.26)] and not using condoms at last commercial sex (aOR =2.29, 1.22-4.32). The following variables were significantly associated with unsafe injecting behavior at last injection and not using condoms at last sex with commercial and/or occasional partners in the multivariate analysis: marital status [p = 0.0002; (for divorced, widowed, and separated aOR =2.62, 1.62-4.25; for single aOR =1.61, 1.08-2.39)], being a member of a regular injecting group (aOR=0.62, 0.44-0.88), types of drugs injected in the past month [p =0.0024; (for buprenorphine aOR =0.34, 0.18-0.63)], city of residence (p=0.0083), and not receiving information on HIV (aOR=1.82, 1.07-3.09). Though only ephedrine was injected by a smaller number of IDUs (9.1%), the vast majority of these (81.4%) reported unsafe injecting practices at last injection. High prevalence of unsafe injecting behaviors and diverse and at-risk sexual partnerships highlight the need to implement complex and targeted HIV interventions among IDUs in Georgia.

Methadone and buprenorphine-naloxone are effective in reducing illicit buprenorphine and other opioid use, and reducing HIV risk behavior—Outcomes of a randomized trial

“…Similar to other recent reports (Chikovani et al, 2011) direct needle sharing was not high among study participants (Table 3); the most common unsafe injection behavior at baseline was sharing a cooker and dividing the solution using one syringe. Buprenorphine injection in Georgia generally occurs in groups of 3–4 people who dissolve one 8 mg tablet in a water and then, using a large volume syringe, divide the solution by front- or back-loading into smaller individual syringes (Javakhishvili et al, 2011; Otiashvili et al, 2010).…”

Understanding the association between injecting and sexual risk behaviors of injecting drug users in Manipur and Nagaland, India

“…However, there is also a need to understand and address sexual transmission of HIV infection among IDUs and their sexual partners. While a few studies from Indonesia and United States of America (USA) have demonstrated no association between injecting and sexual risk behaviors [17,18], other international studies conducted in South Africa and USA have established this association [19-23]. Although some Indian studies have investigated the sexual risk behaviors of IDUs [2,4,6,24,25], none have attempted to analyze the associations between injecting and sexual risk behaviors of IDUs in Northeast India, where injecting drugs remains an important route of HIV transmission [13,15].…”

Policing, massive street drug testing and poly-substance use chaos in Georgia – a policy case study

“…This was related to either collection of money for expensive 8 mg buprenorphine tablet, to be later divided and injected by, usually, four individuals, or to predetermined division of functions/labor (money, procurement of precursors, cooking) among group members in case of preparation of home-made stimulants and opioids [11]. In all these instances injection happened within a group of 3–5 drug injectors with apparently little direct sharing, but frequent indirect sharing via common container, cotton filters, and large volume syringe for division (front or back loading) of the produced substance [9, 40]. …”