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

      Affiliations

    • 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 InformationCorresponding 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

      Affiliations

    • Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, SE-106 91 Stockholm, Sweden
  • ,
  • Katri Abel-Ollo

      Affiliations

    • Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia
  • ,
  • Kristi Rüütel

      Affiliations

    • 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

      Affiliations

    • 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

      Affiliations

    • Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  • ,
  • Lucy Platt

      Affiliations

    • Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
  • ,
  • Natalia Bobrova

      Affiliations

    • Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK
  • ,
  • Anneli Uusküla

      Affiliations

    • 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 ,Revised 10 February 2009 ,Accepted 27 February 2009.

References 

  1. Abel K, Talu A, Ahven A, Neuman A, Laastik L. Estonia. Drug situation, 2004 national report to the EMCDDA by the Reitox National Focal Point. New developments, trends and in-depth Information on selected issues. Tallinn: National Institute for Health Development; 2004;
  2. Abel K, Talu A, Neuman A, Ahven A, Denissov G, Laastik L. Estonia. Drug situation, 2005 national report to the EMCDDA by the Reitox National Focal Point. New developments, trends and in-depth information on selected issues. Tallinn: National Institute for Health Development; 2005;
  3. Abel-Ollo, K., Talu, A., Vals K., Vorobjov, S., Paimre, M., Ahven, A., et al. (2007). National Report (2006 data) to the EMCDDA by the REITOX National Focal Point. Estonia. New developments and trends and in-depth information on selected issues. Retrieved October 31, 2008, from http://eusk.tai.ee/failid/ESTONIA_2007_NATIONAL_REPORTING_Final.pdf.
  4. Atlani L, Caraël M, Brunet J-B, Frasca T, Chaika N. Social change and HIV in the former USSR: The making of a new epidemic. Social Science & Medicine. 2000;50(11):1547–1556
  5. Ball AL. HIV, injecting drug use and harm reduction: A public health response. Addiction. 2007;102(5):684–690
  6. Berens AI, Voets AJ, Demedts P. Illicit fentanyl in Europe. Lancet. 1996;347(9011):1334–1335
  7. Braine N, Des Jarlais DC, Goldblatt C, Zadoretzky C, Turner C. HIV risk behavior among amphetamine injectors at U.S. syringe exchange programs. AIDS Education and Prevention. 2005;17(6):515–524
  8. Booth RE, Lehman WEK, Kwiatowski CF, Brewster JT, Sinitsyna L, Dvoryak S. Stimulant injectors in Ukraine: The next wave of the epidemic. AIDS and Behavior. 2008;12(4):652–661
  9. Chaisson RE, Bacchetti P, Osmond D, Brodie B, Sande MA, Moss AR. Cocaine use and HIV infection in intravenous drug users in San Francisco. JAMA. 1989;261(4):561–565
  10. Cicero TJ, Inciardi JA, Muñoz A. Trends in abuse of Oxycontin and other opioid analgesics in the United States: 2002–2004. Journal of Pain. 2005;6(10):662–672
  11. Colfax G, Shoptow S. The methamphetamine epidemic: Implications for HIV prevention and treatment. Current HIV/AIDS Reports. 2005;2(4):194–199
  12. Connell JA, Parry JV, Mortimer PP, Duncan J. Novel assay for the detection of immunoglobulin G antihuman immunodeficiency virus in untreated saliva and urine. Journal of Medical Virology. 1993;41(2):159–164
  13. Darke S. Self-report among injecting drug users: A review. Drug and Alcohol Dependence. 1998;51(3):253–263
  14. Dehne KL, Khadokevich L, Hamers FF, Schwartländer B. The HIV/AIDS epidemic in Eastern Europe: Recent patterns and trends and their implication for policy-making. AIDS. 1999;13(7):741–749
  15. Denton SJ, Donaghue ER, McReynolds J, Kalelkar MB. An epidemic of illicit fentanyl deaths in Cook Country, Illinois: September 2005–April 2007. Journal of Forensic Sciences. 2008;53(2):452–454
  16. Des Jarlais DC, Friedman SR, Sotheran JL, Wenston J, Carballo M, Choopanya K, et al. Reliability and validity in cross-national research on AIDS risk behavior among injecting drug users. HIV epidemiology: Models and methods. In:  Nicolosi IA editors. HIV epidemiology: Models and methods. New York: Raven Press; 1994;p. 65–75
  17. European Monitoring Centre for Drugs and Drug Addiction (2004). Annual report 2004: the state of the drugs problem in the European Union and Norway. Luxembourg.
  18. European Monitoring Centre for Drugs and Drug Addiction. (2006). Annual report 2006: the state of the drugs problem in Europe. Luxembourg.
  19. European Centre for the Epidemiological Monitoring of HIV and AIDS. (2007). HIV/AIDS surveillance in Europe. End-year report 2006, 75. Retrieved, October 31, 2008, from http://www.eurohiv.org/reports/report_75/pdf/report_eurohiv_75.pdf.
  20. Fuller CM, Vlahov D, Latkin CA, Ompad DC, Celentano DD, Strathedee SA. Social circumstances of initiation of injection drug use and early shooting gallery attendance: Implications for HIV intervention among adolescent and young adult injection drug users. Journal of Acquired Immune Deficiency Syndromes. 2003;32(1):86–93
  21. Hagan H, Des Jarlais D. HIV and HCV Infection among Injecting Drug Users. Mount Sinai Journal of Medicine. 2000;67(5–6):423–428
  22. Hagan H, Thiede H, Des Jarlais DC. HIV/hepatitis C virus co-infection in drug users: Risk behaviour and prevention. AIDS. 2005;19(Suppl. 3):199–207
  23. Hamers FF, Downs AM. HIV in Central and Eastern Europe. Lancet. 2003;361(9362):1035–1044
  24. Heckathorn DD. Respondent-driven sampling: A new approach to the study of hidden populations. Social Problems. 1997;44(2):174–199
  25. Heckathorn DD. Respondent-driven sampling II: Deriving valid population estimates from chain-referral samples of hidden populations. Social Problems. 2002;49(1):11–34
  26. Heckathorn DD. RDSAT, version 5.6. Ithaca, New York: Cornell University; 2006;available at: http://www.respondentdrivensampling.org/
  27. Henderson GL. Fentanyl-related deaths: Demographics, circumstances, and toxicology of 112 cases. Journal of Forensic Sciences. 1991;36(2):422–433
  28. Hien NT, Giang LT, Binh PN, Devillé W, Van Ameijden EJ, Wolffers I. Risk factors of HIV infection and needle sharing among injecting drug users in Ho Chi Minh City, Vietnam. Journal of Substance Abuse. 2001;13(1–2):45–58
  29. Hull MJ, Juhascok M, Mazur F, Flomenbaum MA, Behonick GS. Fatalities associated with fentanyl and co-administered cocaine or opiates. Journal of Forensic Science. 2007;52(6):1383–1388
  30. Jönsson AK, Holmgren P, Druid H, Ahlner J. Cause of death and drug use pattern in deceased drug addicts in Sweden, 2002–2003. Forensic Science International. 2007;169(2–3):101–107
  31. Kelly JA, Amirkhanian YA. The newest epidemic: A review of HIV/AIDS in Central and Eastern Europe. International Journal of STD & AIDS. 2003;14(6):361–371
  32. Kronstrand R, Druid H, Holmgern P, Rajs JA. Cluster of fentanyl-related deaths among drug addicts in Sweden. Forensic Science International. 1997;88(3):185–195
  33. Lõhmus, L., & Trummal, A. (2007). Süstlavahetusteenuse külastajate HIV/AIDS-iga seotud riskikäitumine ja teadmised. Esmas- ja korduvklientide võrdlev analüüs 2006. Tervise Arengu Instituut, Tallinn [Risk behaviour related with HIV/AIDS of the visitors of syringe exchange services. Comparative analysis of primary and repeated visitors, National institute for Health Development, Tallinn]. Retrieved October 3, 2008, from http://www2.tai.ee/teated/GF/Systlavahetuse_kylastajad_2006.pdf.
  34. Magis-Rodríguez C, Brouwer KC, Morales S, Gayet C, Lozada R, Ortis-Monderagón R, et al. HIV prevalence and correlates of receptive needle sharing among injection drug users in the Mexican-U.S. border city of Tijuana. Journal of Psychoactive Drugs. 2005;37(3):333–339
  35. Marks G, Crepez N, Senterfitt JV, Janssen RS. Meta-analysis of high-risk sexual behavior in persons aware and unaware they are infected With HIV in the United States: Implications for HIV prevention programs. Journal of Acquired Immune Deficiency Syndromes. 2005;39(4):446–453
  36. Molitor F, Ruiz JD, Flynn N, Mikanda JN, Sun RK, Anderson R. Methamphetamine use and sexual and injection risk behaviors among out-of-treatment injection drug users. American Journal of Drug and Alcohol Abuse. 1999;25(3):475–493
  37. Molitor F, Truax SR, Ruiz JD, Sun RK. Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. Western Journal of Medicine. 1998;168(2):93–97
  38. Ojanperä I, Gergov M, Rasanen I, Lunetta P, Toivonen S, Tianen E, et al. Blood levels of 3-methylfentanyl in 3 fatal poisoning cases. American Journal of Forensic Medicine and Pathology. 2006;27(4):328–331
  39. Ojanperä I, Gergov M, Liiv M, Riikoja A, Vuori E. An epidemic of fatal 3-methylfentanyl poisoning in Estonia. International Journal of Legal Medicine. 2008;122(5):395–400
  40. Oole, K., Talu, A., Vals, K., Paimre, M., Ahven, A., & Neuman, A., et al. (2006). National Report (2005 data) to the EMCDDA by the REITOX National Focal Point. Estonia. New developments and trends and in-depth information on selected issues. 2006. Retrieved October, 31, 2008, from http://eusk.tai.ee/failid/Report_Drug_situation_in_Estonia_2006.pdf.
  41. Parry JV, Connell JA, Reinbott P, Garcia AB, Avillez F, Mortimer PP. GACPAT HIV 1+2: A simple, inexpensive assay to screen for, and discriminate between, anti-HIV 1 and anti-HIV 2. Journal of Medical Virology. 1995;45(1):10–16
  42. Platt L, Bobrova N, Rhodes T, Uusküla A, Parry JV, Rüütel K, et al. High HIV prevalence of HIV among injecting drug users in Estonia: Implication for understanding the risk environment. AIDS. 2006;20(1):2103–2120
  43. Politseiamet (2005). Narkosüüteod ja nende mõju kuritegevusele Eestis 1999–2004. Tallinn. [Police Board (2005). Drug-related crime and its impact to crime in Estonia 1999–2004. Tallinn]. Retrieved October 31, 2008 from http://www.pol.ee/failid/Narko_analyys_internet.pdf.
  44. Pollini RA, Brouwer KC, Lozada RM, Ramos R, Cruz MF, Magis-Rodríguez C, et al. Syringe possession arrests are associated with receptive syringe sharing in two Mexico–US border cities. Addiction. 2008;103(1):101–108
  45. Riiklik tervishoiuprogramm . Eesti riiklik HIV ja AIDSi strateegia aastateks 2006–2015 [National health care programme Estonian national HIV and AIDS strategy for the year 2006–2015]. Riigi Teataja. 2005;117:1856
  46. Rhodes T, Lowndes C, Judd A, Mikhailova LA, Sarang A, Rylkov A, et al. Explosive spread and high prevalence of HIV infection among injecting drug users in Togliatti City, Russia. AIDS. 2002;16(13):F25–F31
  47. Rhodes T, Mikhailova L, Sarang A, Lowndes CM, Rylkov A, Khutorskoy M, et al. Situational factors influencing drug injecting, risk reduction and syringe exchange in Togliatti City, Russian Federation: A qualitative study of micro risk environment. Social Science & Medicine. 2003;57(1):39–54
  48. Rhodes T, Judd A, Mikhailova L, Sarang A, Khutorskoy M, Platt L, et al. Injecting equipment sharing among injecting drug users in Togliatti city, Russian Federation: Maximizing the protective effects of syringe distribution. Journal of Acquired Immune Deficiency Syndromes. 2004;35(3):293–300
  49. Rhodes T, Singer M, Bourgois P, Friedman SF, Strathedee SA. The social production of HIV risk among injecting drug users. Social Science & Medicine. 2005;61(5):1026–1044
  50. Rosenblum A, Parrino M, Schnoll SH, Fong C, Maxwell C, Cleland CM, et al. Prescription opioid abuse among enrollees into methadone maintenance treatment. Drug and Alcohol Dependence. 2007;90(1):64–71
  51. Talu A, Abel K, Ahven A, Denissov G, Kutsar K, Neuman A, et al. Estonia Drug Situation 2003. Annual report to the European Monitoring Centre for Drugs and Drug Addiction. Tallinn: National Institute for Health Development; 2003;
  52. Talu, A., Abel-Ollo, K., Vals, K., & Ahven, A. (2008). 2008 National Report (2007 data) to the EMCDDA by the Reitox National Focal Point. “Estonia”. New Development, trends and in-depth information on selected issues. Retrieved January 20, 2009, from http://eusk.tai.ee/failid/report_2008_english_ESTONIAN.pdf.
  53. Tyndall MW, Currie S, Spittal P, Li K, Wood E, O'Shaughnessy MV, et al. Intensive injection cocaine use as the primary risk factor in the Vancouver HIV-1 epidemic. AIDS. 2003;17(6):887–893
  54. UNAIDS/WHO. (2006). AIDS epidemic update: December 2006. Retrieved October 31, 2008, from http://www.unaids.org/en/KnowledgeCentre/HIVData/EpiUpdate/EpiUpdArchive/2006/Default.asp.
  55. UNODC. World drug report. (2005). Retrieved September 3, 2008, from http://www.unodc.org/pdf/WDR_2005/volume_1_web.pdf.
  56. Uusküla A, Heimer R, Dehovitz J, Fischer K, McNutt LA. Surveillance of HIV, hepatitis B virus, and hepatitis C virus in an Estonian injection drug-using population: Sensitivity and specificity of testing syringes for public health surveillance. Journal of Infectious Diseases. 2006;193(3):455–457
  57. Uusküla A, Kals M, Rajaleid K, Abel K, Talu A, Rüütel K, et al. HIV infection among new injecting drug users in Estonia: Need for large scale prevention programes. Journal of Public Health (Oxford, England). 2008;30(2):119–125
  58. Uusküla A, McNutt LA, Dehovitz J, Fischer K, Heimer R. High prevalence of blood-borne virus infections and high-risk behaviour among injecting drug users in Tallinn, Estonia. International Journal of STD & AIDS. 2007;18(1):41–46
  59. Uusküla A, Rajaleid K, Talu A, Abel K, Rüütel K, Hay G. Estimating injection drug use prevalence using state wide administrative data sources: Estonia 2004. Addiction Research and Theory. 2007;15(4):411–424
  60. Vallejo R, de Leon-Casasola O, Benyamin R. Opioid therapy and immunosuppression: A review. American Journal of Therapeutics. 2004;11(5):354–365
  61. Victora CG, Huttly SR, Fuchs SC, Olinto MT. The role of conceptual frameworks in epidemiological analysis: A hierarchical approach. International Journal of Epidemiology. 1997;26(1):224–227
  62. Wang J, Carlson RG, Falck RS, Siegel HA, Rahman A, Li L. Respondent-driven sampling to recruit MDMA users: A methodological assessment. Drug and Alcohol Dependence. 2005;78(2):147–157
  63. Wei G, Moss J, Yuan CS. Opioid-induced immunosuppression: Is it centrally mediated or peripherally mediated?. Biochemical Pharmacology. 2003;65(11):1666–1761
  64. Werb D, Kerr T, Small W, Li K, Montaner J, Wood E. HIV risks associated with incarceration among injection drug users: Implications for prison-based public health strategies. Journal of Public Health (Oxford, England). 2008;30(2):126–132
  65. Wilson TE, Sharma A, Zilmer K, Kalikova N, Uusküla A. The HIV prevention needs of injection drug users in Estonia. International Journal of STD & AIDS. 2007;18(6):389–391
  66. Wong SC, Curtis JA, Wingert WE. Concurrent detection of heroin, fentanyl, and xylaxzine in seven drug-related deaths reported from the Philadelphia Medical Examiner's Office. Journal of Forensic Sciences. 2008;53(2):495–498
  67. Wood E, Li K, Small W, Montaner JS, Schester MT, Kerr T. Recent incarceration independently associated with syringe sharing by injection drug users. Public Health Reports. 2005;120(2):150–156

PII: S0955-3959(09)00055-3

doi: 10.1016/j.drugpo.2009.02.007

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