HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: Implications for intervention

Talu, Ave; Rajaleid, Kristiina; Abel-Ollo, Katri; Rüütel, Kristi; Rahu, Mati; Rhodes, Tim; Platt, Lucy; Bobrova, Natalia; Uusküla, Anneli

doi:10.1016/j.drugpo.2009.02.007

« Previous Next »International Journal of Drug Policy
Volume 21, Issue 1 , Pages 56-63, January 2010

HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: Implications for intervention

Ave Talu
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
- Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
- Corresponding author at: Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia. Tel.: +372 6 593 997; fax: +372 6 593 998.
Kristiina Rajaleid
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, SE-106 91 Stockholm, Sweden
Katri Abel-Ollo
- Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
Kristi Rüütel
- Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
- Department of Infectious Diseases and Drug Prevention, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
Mati Rahu
- Department of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
- Estonian Centre of Behavioural and Health Sciences, Tartu-Tallinn, Estonia
Tim Rhodes
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
Lucy Platt
- Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
Natalia Bobrova
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
Anneli Uusküla
- Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
- Estonian Centre of Behavioural and Health Sciences, Tartu-Tallinn, Estonia

Received 1 November 2008; received in revised form 10 February 2009; accepted 27 February 2009. published online 23 April 2009.

Abstract

Background

Following a heroin shortage, fentanyl and 3-methylfentanyl, known as “China White” and “White Persian”, have become the most widely used drugs, along with amphetamine, among injecting drug users (IDUs) in Tallinn, Estonia.

Methods

In order to assess the relationships between the injection of fentanyl and amphetamine, and levels of HIV prevalence and risk behaviour, 350 current IDUs were recruited using respondent-driven sampling for an interviewer-administered unlinked cross-sectional survey and HIV testing. IDUs were categorised into groups based on self-report of the main drug used within the last 28 days.

Results

77% (256/331) of participants reported fentanyl and 23% (75/331) amphetamine as their main drug of injection. HIV prevalence was 27% (95% confidence interval [CI]: 18.45–35.51) and 62% (95% CI: 56.97–67.03) among amphetamine and fentanyl injectors, respectively. After adjustment, fentanyl injectors had three times the odds of being HIV positive (adjusted odds ratio [AOR]=2.89; 95% CI: 1.55–5.39). They also had higher odds for injecting in the street with a previously used needle/syringe (AOR=2.39; 95% CI: 1.14–5.04) and sharing a needle/syringe with somebody known to have HIV (AOR=3.00, 95% CI: 1.33–6.79). Fentanyl injectors also had higher odds for lifetime overdose (AOR=3.02, 95% CI: 1.65–5.54).

Conclusion

The injection of fentanyl is associated with elevated injecting risk behaviour derived from injection practice and situational risk factors, and needs urgently targeted interventions.

Keywords: Injecting drug use, HIV, Fentanyl, Amphetamine, 3-Methylfentanyl, Risk behaviour