The prevalence of the intravenous use of psychoactive preparations in Nizhegorod Province and the possible ways to prevent HIV infection among the users

The number of users of intravenous drugs (UID), altogether from 35,000 to 25,000 persons, was determined by the method of coefficients. The analysis of 130 anonymous questionnaires, including 75 street questionnaires (61%) and 51 questionnaires (39%) distributed among UID in narcological and infectious hospitals showed that out of 130 respondents 60% underwent hospital treatment. The study revealed that most of the questioned users used crudely made opiates, 48 (37%) out of 130 persons made injections with used syringes and needles (in younger age groups the proportion of such UID amounted to 63%). 70% of the respondents used individual injection instruments (in a group of persons older than 25 years they amounted to 90%). The conclusion was made on the necessity of introducing a school program on the healthy mode of life and information programs on the prevention of the spread of infection among UID with due regard to different age groups, as well as training outreach workers for disseminating information on the prophylaxis of HIV infection among UID.     

The determinants of the spread of HIV among injection drug addicts in Ukraine

The main tendencies in the development of drug addiction in the Ukraine, the dynamics of the spread of HIV among drug addicts introducing drugs intravenously, epidemiological data on HIV, AIDS and drug addiction, as well as prognoses on the development of HIV infection are presented. Since 1995 the number of HIV-infected persons grew 34-fold, the number of cases of HIV infection resulting from the intravenous use drugs rose to 70% simultaneously with the rise (about 34-fold) of the number of persons infected with HIV through sexual contacts (about 13 fold). In 1996-1997 such tendency increased. On the whole, the proportion of drug addicts introducing drugs by intravenous injection was 83% in the Ukraine. By April 1, 1998, official registration covered 18,800 HIV-infected persons, including 270 foreign nationals, as well as 499 AIDS patients, including 487 Ukrainian citizens, among them 28 children. Out of 18,800 HIV-infected persons, 78.3% were drug addicts, most of them young people aged 15-30 years; about 18% were young people under 20 years of age, 80% being males. According to the model the rapid spread of HIV from the group of drug addicts to the heterosexual population, the total number of HIV-infected persons reaching 1,500,000 is expected in the country by 2014.     

A questionnaire survey of intravenous drug addicts (Moscow, May 1997-January 1998)

Questionnaires were distributed among users of intravenous drugs (UID) on the basis of Narcological Hospital No. 17 in Moscow and in the streets of the city (altogether, respondents filled in 298 questionnaires in the hospital and 126 questionnaires in the streets). The average age of the respondents was 21-22 years. The sufficiently wide spread of the joint use of injection instruments was noted (35-41%), the ensuing risk could be consciously evaluated by 38% of the respondents in the hospital and 20% in the streets. According to the observation diaries, HIV was not a priority for many UID. Their priorities included the problems of the treatment of hepatitis, abscesses, overdosage/poisoning, etc. Among the hospital respondents and selected street respondents the spread of hepatitis B and C was noted by 30% and 34% respectively. Under hospital conditions testing for HIV gave negative results in 58% and positive results in 5% of the respondents, while 37% of the respondents stated than they had never been tested. Among street respondents, 62% stated that they had negative results of testing and 39% stated that they had never been tested. The conclusion has been made that the realization of prophylactic programs may augment the level of knowledge concerning risks linked with the intravenous use of drugs, thus giving motivation to UID either to stop their use or to avoid contamination of the blood with HIV while using them.     

An analysis of the situation with injection narcotic usage in the city of Voronezh during the development of the HIV infection epidemic in Russia

The medico-demographic situation in Voronezh, characterized by a decrease in the birth rate, a rise in the mortality rate, the prevalence of pensioners (38%) in the structure of the population, is presented. The negative influence of the deterioration of socio-economic conditions on the social health of the population, especially on the situation with drug addiction, is pointed out. The extent of the misuse of narcotic and toxic substances among adolescents essentially increased. The rapid assessment of the situation with the intravenous use of drugs in Voronezh was carried out, following the WHO methodology. The conclusion was made concerning the necessity of complex sociological monitoring with a view to obtaining more reliable data on the number of drug addicts. The calculation of the supposed number of users in Voronezh among persons aged 15-30 years, made by three modules of assessment, revealed this number reached 61,374 persons, i.e. every fifth or sixth young person used some narcotic substances. The necessity of taking drastic measures on the primary prophylaxis of HIV infection among injecting drug users by creating conditions for the realization of the programs "Harm Reduction" and "Equal Helps Equal" which proved to be effective in other regions of the Russian Federation.     

The HIV infection epidemic in the city of Irkutsk under the conditions of drug abuse prevalence

The data on the spread of HIV infection in Irkutsk and Irkutsk Province, starting from March 9, 1999, are presented. The simultaneous appearance of 17 multiple morbidity foci of HIV infection, involving 2,227 persons into the epidemic, within the period of 8 months was noted. The age structure of the epidemic process was represented by 1,846 adults aged 18-50 years (83%), 256 adolescents aged 16-17 years (12.9%), 78 children aged 10-15 years (3.5%) and 17 persons of other ages (0.53%). The leading role in the age structure of the epidemic process belonged to young people aged 10-29 years (90.4% of cases). The epidemiological analysis made it possible to establish the fact that the epidemic was linked with the intravenous injection of heroin. The viral contamination of the drug is not excluded also in the process of its preparation for injection.     

Clinical symptoms associated with seroconversion for HIV-1 among misusers of intravenous drugs: comparison with homosexual seroconverters and infected and non-infected intravenous drug misusers.

OBJECTIVE--To study the clinical symptoms associated with seroconversion for HIV-1 among misusers of intravenous drugs. DESIGN--Case-control study in cohorts of drug misusers and homosexual men. SETTING--Outpatient clinic, Municipal Health Service, Amsterdam. SUBJECTS--Misusers of intravenous drugs from our prospective cohort who seroconverted for HIV. Controls were drug users positive for HIV, drug users negative for HIV, and homosexual men who had seroconverted. RESULTS--Five out of 18 (28%) drug users were admitted to hospital with bacterial pneumonia in the four to six months between their last visit at which they were HIV negative and their first visit when they were HIV positive. For comparison none of the 27 homosexual men who seroconverted for HIV, three out of 177 (2%) drug users negative for HIV, and 10 out of 112 (9%) drug users positive for HIV reported bacterial pneumonia. One out of the 18 drug users who seroconverted suffered from oesophageal candidiasis at the time of seroconversion. Other clinical symptoms did not differ between drug users who seroconverted and those who remained negative for HIV, probably due to the high background morbidity among the drug users. CONCLUSIONS--Seroconversion to HIV-1 among intravenous drug misusers is associated with bacterial pneumonia. Those drug users with previously negative test results for HIV who are admitted to hospital for bacterial pneumonia should be tested to detect primary infection with HIV-1.     

A decrease in harm: a new concept for Russian public health

The main principles of the concept of the "decrease of harm", realized in many countries of the world, are presented and the expediency of using this concept in Russia is substantiated. The beginning of the realization of the Project "Decrease of Harm: the Russian Federation", aimed at training specialists capable of carrying out prophylactic work among users of intravenous drugs (UID), is demonstrated. The principles of the selection of the groups of trainees are shown: the groups are made up of physicians working at AIDS centres, specialists in narcology and representatives of non-governmental organizations. The course of training provides the basic information on the strategy of the prophylaxis of HIV infection among UID, including evaluation and study, outreach, change of syringes and needles, replacement therapy, the program of the treatment of drug addiction. At the present moment 46 specialists from 18 regions of Russia are taking the course of training.     

An analysis of an outbreak of HIV infection in the city of Svetlogorsk, the Republic of Byelarus, among persons using injected narcotics

The examination of all persons suspected in the use narcotics (including suppliers and vendors of drugs) in Svetlogorsk (Belarus) for the presence of antibodies to HIV revealed 811 cases of HIV infection, i.e. 1% of the whole population was found to be infected by HIV. More than 90% of all HIV-infected persons were drug addicts introducing narcotic intravenously; young people aged 18 to 29 years constituted 81% (of these, 76% were males and 24% were females). The rapid spread of HIV was caused by the use of a ready-made HIV-infected drug which had been supplied for sale and could have been infected in the process of manufacture or packing.     

Prevention and control of HIV infection in the Osh region of the Kyrgyz Republic

A total of 178 cases of HIV infection were diagnosed in the Osh region of the Kyrgyz Republic for January 1, 2003, the intensity of the prevalence of HIV infection being 14.5 per 100,000 of the population with this figure for the whole republic being equal to 5.9. In the dynamics of the HIV infection epidemic two periods were detected. During the first 3 years (1998-2000) a few individual imported cases of HIV infection were registered in the region. During the last 2 years (2001-2002) 98.8% of all cases of HIV infection registered in the region, as well as the presence of an epidemic outbreak among injection drug users (IDU), were detected. The risk factors of getting HIV infection were the intravenous use of drugs and a low level of information among young people concerning the routes of transmission of this infection and means of protection from HIV/AIDS: the promotion of healthy life style among young people, the introduction of the programs of "harm reduction" among IDU and the rules of safe sex.     

Development of HIV infection epidemic among intravenous drug users in the Sverdlovsky region

The Sverdlovsky region takes the fourth place among the 89 subjects of the Russian Federation by the number of registered cases of HIV infection. Drug addiction has reached an excessive scale in this region: according to the data of express evaluation carried out by the Regional Narcological Hospital and the Regional AIDS Center, not less than 7-8% of persons aged 15-30 years constantly use injection drugs. The large-scale epidemic of injection drug addiction has led to the rapid spread of HIV among addicts. The first penetration of HIV into this population took place in 1996 and, starting from the year 2000, rapid, development of the epidemic began, taking the character of an avalanche. The peak of new cases of HIV infection fell on 2001 (9,230 cases were registered). The concentrated stage of the epidemic development is observed in the region at present, the prevalence of HIV infection among drug addicts being 13.8%. Children born from HIV-infected drug addicted mothers now represent a new risk group due to great difficulties in the prophylaxis of the vertical virus transmission.     

The road will be mastered by the walker

Anonymous questioning by the distribution of questionnaires among 1,600 young people (68.9% of them were city dwellers, 31.1% were villagers) was carried out. The questioning covered 1,079 adolescents aged 12-16 years (67.3%), 501 young people aged 16-19 years (31.3%) and 20 respondents aged 19-23 years (1.4%). The analysis of answers to questionnaires indicated that all respondents had the same level of knowledge on the subject, but the information they possessed was not duly analyzed and had no influence on their own behavior. It should be pointed out that 1% of persons aged 12-19 years took drugs by intravenous injection. These data, as well as other materials, gave grounds for the development of a new educational program on the prophylaxis of HIV/AIDS/STD and its introduction in 1997. The program is intended for a school course of 6 years (forms 6-11) and must provide adolescents with reliable and comprehensible information, conductive to the formation of a healthy mode of life.     

The epidemic of human immunodeficiency virus-caused infection among users of psychotropic preparations in Russia

The development of the epidemic of HIV infection among the intravenous injecting users of psychotropic substances in Russia in 1994-1999 is described on the basis of the data provided by territorial centers for the prevention and control of AIDS. In addition, the results of the screening in individual groups of the population of Russia for antibodies to HIV, carried out at the period of 1994 to the first half of 1999, are presented. In 1999 a considerable rise in the number of newly detected cases of HIV infection, mainly among persons injecting psychotropic drugs intravenously for non-medical purposes, was noted. The conclusion was made that the spread of HIV among drug addicts led to its passage to other groups of the population, mainly by heterosexual transmission.     

Strategic problems in counteracting the spread of HIV infection in the Altai Territory

The Altai Territory belongs at present to regions with the insignificant level of the spread of HIV infection. By December 1, 1999, the Altai Territory had 31 registered cases of HIV infection, which constituted 1.33 per 10,000 of the population (the corresponding figure for the whole of Russia being 14.92). But the situation with HIV/AIDS showed the general tendency to the development of the epidemic of HIV infection due to steady growth and the wide involvement of injecting drug users in the epidemic process. Before 1999 all cases of HIV infection registered in the Altai Territory were imported. Out of 31 HIV infected persons detected in the territory, 18 were injecting drug users. In 1999 local foci of HIV infection were formed among drug users in two big cities of the Altai Territory, which was indicative of the gradual transition of HIV infection from the phase of the registration of individual cases to the phase of the formation of local foci among some groups of the population.     

The behavioral risk factors for contracting HIV infection in the intravenous administration of narcotics in abusers of psychoactive substances in the city of Rostov-on-Don

150 persons (drug users) who had applied to the department of psycho-social consultations and voluntary tests for the presence of HIV infection and STD of the Regional AIDS Control Center, as well as partners of HIV-infected addicts in the intravenous use of drugs, were examined. Out of 150 examined persons 63 were found to be positive for HIV infection. Among dangerous behavioral patterns, characteristic of drug addicts introducing drugs intravenously, the practice of repeated aspiration of the drug into syringes from the dose of the drug solution, common for the whole group of addicts, was noted as the most widespread habit.     

The strategy for the control of the spread of HIV infection in the city of Novorossiysk

The results of the work of the center for controlling the spread of HIV infection are discussed. The analysis of the epidemiological situation and the work on the projects, envisaging preventive measures among intravenous drug users permitted the realization of educational and behavior-changing programs in the city in 1999. The results of this work demonstrate the effect of various preventive measures, manifested by a decrease in the rate of the spread of HIV infection in the city not only among drug users, but also among other groups of the population.     

Prevalence of HBV and HCV markers in patients of specialized medical institutions

240 medical histories of patients admitted to Moscow clinical narcological hospital No. 17 with "opium addiction" diagnosis in 2000 and 2003 (120 histories for each year) were analyzed. From 1997 to 2003 4220 patients registered in narcological dispensary of Cherepovets city (Vologda region) were tested for HBsAg and anti-HCV. It has been shown that in new injection opiate drug users young patients (15 - 19 y.o.) predominated (41.7%). Tendency to development of drug addiction in younger age was revealed - in 2003 compared to 2001 percent of new injection drug users aged 11 - 14 years admitted to hospital raised in 1.5 times. In 2000 and 2003 in Moscow markers of HIV and/or HBV/HCV infection were detected in 84.2 and 91.7% of injection drug users respectively. Maximal rates of HBV and HCV infection in injection drug users in Cherepovets city were detected in 2001 - 11.7 and 83.1% respectively. Leading role of injection drug users in maintenance of HBVand HCV epidemic process activity in Russia was established.     

We rely on the common sense of young people

The principles of the primary prophylaxis, analogous to the program "Harm Reduction", are presented. The basis for placing this work on broad footing was the rapid assessment of the situation with the use of narcotic drugs in the city (the number of users exceeded 10,000 per 238,000 inhabitants) with a tendency towards a sharp decrease of the age of the users (9-13 years). The experience of work on the training of medical personnel, directly contacting with blood and thus considered to be a risk group, taking into account risky professional behavior (potentially dangerous), was accumulated. The training activities among students of medical schools proved to be effective. They became the best volunteers and leaders among young people. Adolescents aged 14-18 years were enlisted as volunteers: they worked in different places usually attended by young people and invited drug addicts to the anonymous examination room. The role of local mass media in educating the public on of the problems of the prevention of HIV infection is discussed. As a result, the activation of the youth movement in support of the program "Anti-AIDS" and an increase in the number of people in target groups coming to the anonymous examination room are noted.     

英德市吸毒人群艾滋病知识知晓情况及影响因素分析

目的了解英德市吸毒人群艾滋病知识知晓率及其影响因素,为制定吸毒人群行为干预措施提供科学依据。方法对英德市强制戒毒所内的吸毒者进行面对面问卷调查。结果吸毒者以男性为主,占94.88%;年龄以20～39岁为主,占76.36%;文化程度(初中及以下)为主,占90.58%,静脉注射吸毒者占69.09%,其中33.73%吸毒时共用注射器;3.86%与固定性伴发生性行为时每次均用安全套;28.93%发生过商业性行为,27.43%发生商业性行为时每次均用安全套;艾滋病知识知晓率为75.87%,文化程度初中及其以下、年龄20～39岁、同居和接受过艾滋病知识教育是影响吸毒人群艾滋病知识知晓率的主要因素。结论英德市吸毒人群对艾滋病防治知识知晓率较低,高危行为发生较严重,应在吸毒人群中开展艾滋病知识的健康教育和行为干预,遏制艾滋病在该人群的传播或由该人群向一般人群扩散。     

Specific features of the HIV infection epidemic in Moscow

Retrospective analysis of the epidemic of HIV infection in Moscow allowed to mark out two periods: the first--from 1987 to 1993 and the second one--from 1994 to 2000. The characteristic feature of the first period of the epidemic was the sexual transmission of the agent mainly among homosexuals; the most affected group were persons aged 20-39 years and the number of AIDS patient decreased with a simultaneous growth in lethality. During the second stage of the HIV infection epidemic changes in the prevailing transmission routes of the agent occurred: injection drug addicts took the leading role. Changes in the ratio of HIV-infected men and women took place along with active involvement of persons aged 13-18 years into the epidemic process. The established changes in the epidemiological situation require corrections in the strategy and tactics of epidemic control and prophylactic measures.     

The HIV/AIDS epidemic and the trends in the behavior of people using injection narcotics (IDU)

The degree of risk of the spread of HIV infection among drug addicts in Zhitomir has been prognosticated. As revealed in this study, narcotic drugs are mostly introduced by individual dispensable syringes or by individual reusable syringes. But such factors as the repeated use of needles (47%), obtaining drug solution from different persons (49%), the injection of drugs under unsanitary conditions (62%), with-drawing drug solution into the syringe by some other person (32%), unavailability of the means of disinfection (64%), absence of knowledge and practice in disinfection (91%), the presence HIV-infected persons among IDU (41%), a low level of sanitary and hygienic culture (41%), lack of sexual restraint (93%), concubinage with IDU (44%), unemployment (66%), etc. have been found to increase the possibility of getting HIV infection twofold. The results of this sociological study have demonstrated new trends in the study of the behavior of IDU, necessary for the creation of the module for preventive work both in Zhitomir and the Zhitomir region.