HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: Implications for intervention
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.
aEstonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
bDepartment of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
cCentre for Health Equity Studies, Stockholm University/Karolinska Institutet, SE-106 91 Stockholm, Sweden
dDepartment of Infectious Diseases and Drug Prevention, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
eDepartment of Epidemiology and Biostatistics, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
fEstonian Centre of Behavioural and Health Sciences, Tartu-Tallinn, Estonia
gCentre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
hDepartment of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
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.
ABSTRACT