Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom.
Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada.
Int J Drug Policy. 2018 Mar;53:96-105. doi: 10.1016/j.drugpo.2017.11.010. Epub 2018 Jan 5.
People who inject drugs (PWID) account for over half of new HIV infections in Eastern Europe and central Asia, where opioids continue to be the dominant illicit drugs injected. Stimulants including amphetamines (ATS) have been associated with HIV infection risk in several settings. We sought to examine whether primary ATS injection was associated with greater HIV risk, compared to opioid injection in two European locales with significant HIV epidemics.
PWID in Kohtla-Järve and St. Petersburg were recruited using respondent-driven sampling in 2012-2013. Survey data on demographic characteristics, service use, injecting and sexual risk behaviours and HIV-status (and HCV in Kohtla-Järve) were compared between primary opioid and ATS injectors using logistic regression models.
Of 591 injectors recruited in Kohtla-Järve and 811 in St. Petersburg, 195 (33%) and 27 (4%) primarily injected ATS in each city. In both cities, ATS injectors were younger than opioid injectors, initiated injection later, injected less frequently and were more likely to have been paid for sex. In both cities, PWID had high levels of multiple sex partners. In Kohtla-Järve, ATS-injectors had lower odds of back-loading and greater odds of polydrug use than opioid-injectors. In St. Petersburg, where over half of PWID reported unsafe sharing practices, ATS-injectors were less likely to report these practices. ATS-injection was negatively associated with being HIV positive in Kohtla-Järve (aOR = 0.6; 95%CI: 0.5-0.8) and St. Petersburg (aOR = 0.3; 95%CI: 0.1-0.7). ATS-injection was negatively associated with HCV-reactivity in Kohtla-Järve (aOR = 0.5; 95%CI: 0.3-0.6).
In both locations, primary ATS injection was associated with lower injecting risk behaviours, lower odds of HIV and being paid for sex compared to opioid injection. Interventions targeting the characteristics and needs of ATS injectors are needed to increase contact with services and reduce sexual and injecting risk. Harm reduction services, including sexual risk reduction, need to be expanded for all PWID in St. Petersburg.
在东欧和中亚，注射吸毒者（PWID）占新感染 HIV 人数的一半以上，而阿片类药物继续是注射的主要非法药物。在一些情况下，兴奋剂包括苯丙胺类兴奋剂（ATS）与 HIV 感染风险有关。我们试图研究在两个 HIV 流行严重的欧洲地点，与阿片类药物注射相比，原发性 ATS 注射是否与更大的 HIV 风险相关。
2012-2013 年，使用 respondent-driven sampling 在科特卡-耶尔韦和圣彼得堡招募 PWID。使用逻辑回归模型比较科特卡-耶尔韦和圣彼得堡的主要阿片类药物和 ATS 注射者之间的人口统计学特征、服务使用、注射和性行为风险行为以及 HIV 状况（以及 HCV 在科特卡-耶尔韦）的调查数据。
在科特卡-耶尔韦招募的 591 名注射者和圣彼得堡招募的 811 名注射者中，分别有 195 名（33%）和 27 名（4%）主要注射 ATS。在这两个城市，ATS 注射者比阿片类药物注射者年轻，注射时间晚，注射频率低，更有可能因性交易而获得报酬。在这两个城市，PWID 都有很高的多个性伴侣。在科特卡-耶尔韦，ATS 注射者的背载可能性较低，多药使用的可能性较高。在圣彼得堡，超过一半的 PWID 报告不安全的共享行为，ATS 注射者报告这些行为的可能性较小。在科特卡-耶尔韦，ATS 注射与 HIV 阳性呈负相关（aOR=0.6；95%CI：0.5-0.8），在圣彼得堡，ATS 注射与 HIV 阳性呈负相关（aOR=0.3；95%CI：0.1-0.7）。在科特卡-耶尔韦，ATS 注射与 HCV 反应呈负相关（aOR=0.5；95%CI：0.3-0.6）。
在这两个地点，与阿片类药物注射相比，原发性 ATS 注射与较低的注射风险行为、较低的 HIV 感染率和性交易报酬相关。需要针对 ATS 注射者的特征和需求开展干预措施，以增加与服务的接触，减少性传播和注射风险。需要扩大圣彼得堡所有 PWID 的减少伤害服务，包括减少性传播风险。
