Illicit drug use and its health consequences in Belarus, Russian Federation and Ukraine: impact of transition

The Effect of the Non-compressed Oxygen Therapy and Hyperbaric Oxygenation in Combination With Standardized Drug Therapy on the Blood Acid-Base State Biomarkers in Alcohol Withdrawal Syndrome, an Experimental Study

In alcohol withdrawal syndrome (AWS), pathophysiological mechanisms cover acid-base disturbances that affect the clinical picture of this state. An earlier study found that oxygen therapy methods in combination with pharmacotherapy improved the cognitive state in persons suffering from AWS. As impairments in the acid-base state influence the general health, timely and effective correction of these acid-base disturbances could result in a potential improvement in the treatment of the alcohol withdrawal symptoms. Therefore, the aim of this study was to evaluate the effectiveness of non-compressed oxygen therapy (NOT) and hyperbaric oxygenation (HBO) in combination with standard drug therapy (SDT), based on the dynamics of the acid-base state (ABS) in blood during AWS. HBO is the use of oxygen under pressure, whereas NOT uses oxygen without pressure. A comparative assessment of the acid-base state biomarkers was made in 160 patients with a moderate alcohol withdrawal state (3 groups), namely, in patients who underwent SDT only (control group/CG; n = 42) and two comparison groups who underwent SDT in combination with NOT (SG1 group; n = 56) and HBO (SG2 group; n = 62). The use of both oxygen therapy methods (i.e., NOT and HBO) in combination with SDT corrected the ABS in a shorter time and more effectively, which was due to the better restoration of the carbonate buffer system. Although we did not find proof that novel oxygen-related therapeutic procedures such as NOT and HBO in combination with SDT improved the alcohol withdrawal symptoms, it helped with the faster restoration of the acid-base state.

``Now it is mostly done through stashes, to do it in person one has to trust you'': Understanding the retail injection drug market in Dnipro, Ukraine

Little research has been conducted in Ukraine since the 1990s to understand the organization of drug market and its implications for people who inject drugs (PWID). In this study, we explore how PWID perceive the retail drug market in a large Ukrainian city. Qualitative data were obtained during in-depth interviews and analyses included open coding, coding tree development and revision, axial coding, and identification of higher-level domains. Participants' narratives focused on types and forms of drugs available, perceptions about drug quality, methods of buying drugs, and the relationships that are formed and maintained by participating in the drug economy. The described technical organization of the drug market, with multiple contingent combinations of drug types, forms and means of obtaining drugs (hand-to-hand vs stash-based) resulted from diversification and digitalization of the retail injection drug market. The social organization of the drug market in the form of relationships with sellers and drug use partners represented the response to the fundamental problem of uncertainty. The lens of ``transaction cost'' helps explain strategies PWID used to manage uncertainties, including finding reliable and suitable sellers, sending money and picking up the stash under the threat of being stiffed or caught by the police, choosing the product itself, using the intermediaries to outsource risky operations and forming groups to procure and inject together. Our results indicate that the technical and social organization of drug distribution in Ukraine stimulates formation and continuation of relationships and impacts the choices of what, how, and when to inject beyond individual preferences. The policy and practice implications include the need to monitor and understand the retail drug market to develop and deliver more efficient and client-oriented services, incorporate and leverage social networks structure for information sharing and behavior change, pilot and implement drug testing services to assist with management of uncertainties.

Evolution of illicit opioid use among people with HIV infection in St Petersburg, Russia, in the period 2004-2015

OBJECTIVES

In the late 1990s, when the current Russian opioid epidemic began, illicit opioids used in Russia consisted almost exclusively of heroin. The type of opioids used has evolved in the early 21st Century. The objective of this study was to describe the evolution of illicit opioid use among people living with HIV (PLWH) reporting recent opioid use in St Petersburg, Russia.

METHODS

We examined baseline data from four research studies conducted in the period 2004-2015 that included PLWH who used opioids [Partnership to Reduce the Epidemic Via Engagement in Narcology Treatment (PREVENT; 2004-2005; n = 17), HIV Evolution in Russia-Mitigating Infection Transmission and Alcoholism in a Growing Epidemic (HERMITAGE; 2007-2010; n = 281), Linking Infectious and Narcology Care (LINC; 2013-2014; n = 119) and Russia Alcohol Research Collaboration on HIV/AIDS (Russia ARCH; 2012-2015; n = 121)] and reported recent use of heroin and other opioids.

RESULTS

Although these studies spanned more than a decade, the participants represented similar birth cohorts; the mean age was 24.5 years in 2004 and 33.3 years in 2014. The use of opioid types, however, evolved across cohorts, with the use of any illicit drug other than heroin increasing from 6% [95% confidence interval (CI) 000.2, 29%] in PREVENT (2004-2005) to 30% (95% CI 25, 36%) in HERMITAGE (2007-2010) to 70% (95% CI 61, 78%) in LINC (2013-2014) to 77% (95% CI 68, 84%) in ARCH (2012-2015). Any heroin use consistently decreased over the 10-year period in the cohorts, from 100% (95% CI 80, 100%) in 2004-2005 to 54% (95% CI 44, 63%) in 2012-2015.

CONCLUSIONS

Among PLWH who use opioids in St Petersburg, Russia, illicit use of opioids other than heroin appears to be more common than heroin use.

Computerized intervention to prevent drug use among at-risk adolescents in Central Asia: Preliminary family-level findings from a pilot mixed methods trial

BACKGROUND

The rapidly growing rates of HIV infection in Kazakhstan are largely driven by injection drug use. The study adapts a family-focused evidence-based HIV and substance use prevention intervention for at-risk adolescents from communities in Almaty that have been greatly affected by heroin trade and use.

METHODS

This NIDA-funded pilot feasibility trial included 181 at-risk adolescents (ages 14-17) recruited through local schools and 181 of their parents or other adult family members. To be eligible, youth had to reside in city areas with high drug exposure and have at least one personal or family risk factor (e.g., substance-using family members or friends, parental criminal history). In addition to the standard school-based health education program on drug use and HIV, intervention arm adolescent-caregiver dyads received three pilot computerized sessions focused on caregiver-adolescent communication, support and monitoring. Adolescents and caregivers completed ACASI surveys in Russian at baseline, 3- and 6-month follow-ups and a subsample from the treatment group (n = 24 dyads) also participated in post-intervention focus group interviews.

RESULTS

At 6-month follow-up, small effect sizes were detected for parenting practices as the key theoretical mediating variable. Intervention arm participants reported a reduction in harsh discipline practices (Cohen's d= -.35, p = .026), an increase in positive and supportive parenting (d = 0.26, p = .042), and a decline in poor monitoring (according to caregivers d = -0.23, p = .137 and adolescents d = -0.25, p = .113). Post-intervention focus groups provided examples of how the intervention content allowed caregivers to reconnect with their children and get more involved in each other's lives.

CONCLUSION

In middle-income countries like Kazakhstan, interventions that integrate family involvement approaches and utilize interactive technologies may represent an engaging and potentially effective tool with high fidelity and easy scalability to reduce substance use and other risk-taking behaviors among at-risk youth.

In Their Own Voices: Breaking the Vicious Cycle of Addiction, Treatment and Criminal Justice Among People who Inject Drugs in Ukraine

AIMS

To understand how perceived law enforcement policies and practices contribute to the low rates of utilization of opioid agonist therapies (OAT) among people who inject drugs (PWIDs) in Ukraine.

METHODS

Qualitative data from 25 focus groups (FGs) with 199 opioid-dependent PWIDs in Ukraine examined domains related to lived or learned experiences with OAT, police, arrest, incarceration, and criminal activity were analyzed using grounded theory principles.

FINDINGS

Most participants were male (66%), in their late 30s, and previously incarcerated (85%) mainly for drug-related activities. When imprisoned, PWIDs perceived themselves as being "addiction-free". After prison-release, the confluence of police surveillance, societal stress contributed to participants' drug use relapse, perpetuating a cycle of searching for money and drugs, followed by re-arrest and re-incarceration. Fear of police and arrest both facilitated OAT entry and simultaneously contributed to avoiding OAT since system-level requirements identified OAT clients as targets for police harassment. OAT represents an evidence-based option to 'break the cycle', however, law enforcement practices still thwart OAT capacity to improve individual and public health.

CONCLUSION

In the absence of structural changes in law enforcement policies and practices in Ukraine, PWIDs will continue to avoid OAT and perpetuate the addiction cycle with high imprisonment rates.

Chapter 5. Russian media narratives about young drug users

Since the 1960s, the media in Western Europe and the United States has been one important actor in the public understanding of the drug phenomenon. In Russia, however, it is only since the 1980s that illegal drugs have been discussed in the media and this discussion remains on-going today. By using narrative analysis, this article focuses on how illegal drug use among young people is constructed in the Russian press. As a result of the narrative analysis, three main discourses were identified: a foreign problem discourse, a disease discourse, and a medical discourse.

Law enforcement practices associated with HIV infection among injection drug users in Odessa, Ukraine

Despite HIV prevention efforts over the past 10 years in Odessa, Ukraine, HIV rates among injection drug users (IDUs) remain high. We explored whether IDUs' experiences with the police and court system in Odessa were associated with HIV serostatus, after controlling for other factors. Qualitative methods, including semi-structured interviews with the police and members of court (N = 19), and focus groups with IDUs (N = 42), were employed to aid in developing a survey instrument for a larger quantitative phase and to assist in interpreting the findings from the quantitative phase, which included 200 participants who were interviewed and tested for HIV. Overall, 55 % tested positive for HIV. Negative experiences with the police were noted by 86 % and included having preloaded syringes taken (66 %), rushed injections due to fear of the police (57 %), police planting drugs (18 %), paying police to avoid arrest (61 %) and threatened by the police to inform on other IDUs (23 %). HIV positive participants were more likely than those who were negative to report these experiences. In a multiple logistic regression, the most significant correlate of HIV infection was rushed injections due to fear of the police. Police actions in Odessa may be contributing to the continued escalation of HIV among IDUs, underscoring the need for structural interventions.

Gender differences in alcohol choice among Russians: evidence from a quantitative study

AIMS

Qualitative studies find that men and women in Russia have different preferences for alcoholic beverages, but quantitative evidence for gender differences in beverage type choice remains scarce. The purpose of this article is to test numerically whether and to what extent men and women in Russia differ in terms of preferences for type of drink, such as vodka, wine and beer.

METHODS

Results are based on multinomial logistic regression and ordinary least squares regression analyses of the Russian Longitudinal Monitoring Survey-Higher School of Economics 2008 data.

RESULTS

We observed significant gender differences in preferences for alcoholic beverages. Men have strong preferences for vodka, and they drink it in much larger amounts in comparison with women. Women are more likely to either refrain from drinking or drink mild types of alcoholic beverages, such as wine and beer. Gender differences remain statistically significant even when sociodemographic factors are well accounted for.

CONCLUSIONS

The present study confirms the previous research findings about gender differences in drinking practices among Russians. Our results provide quantitative evidence of the pronounced differences in beverage types consumed by men and women.

Individual and network interventions with injection drug users in 5 Ukraine cities

OBJECTIVES

We evaluated the effects of an individual intervention versus a network intervention on HIV-related injection and sexual risk behaviors among street-recruited opiate injection drug users in 5 Ukraine cities.

METHODS

Between 2004 and 2006, 722 opiate injection drug users were recruited to participate in interventions that were either individually based or based on a social network model in which peer educators intervened with their network members. Audio computer-assisted self-interview techniques were used to interview participants at baseline and follow-up.

RESULTS

Multiple logistic analyses controlling for baseline injection and sexual risks revealed that both peer educators and network members in the network intervention reduced injection-related risk behaviors significantly more than did those in the individually based intervention and that peer educators increased condom use significantly more than did those in the individual intervention. Individual intervention participants, however, showed significantly greater improvements than did network members with respect to reductions in sexual risk behaviors.

CONCLUSIONS

Social network interventions may be more effective than individually based interventions in changing injection risk behaviors among both peer educators and network members. The effectiveness of network interventions in changing sexual risk behaviors is less clear, probably owing to network composition and inhibitions regarding discussing sexual risk behaviors.

Hepatitis C virus infection among drug injectors in St Petersburg, Russia: social and molecular epidemiology of an endemic infection

AIMS

To understand the epidemiology and transmission patterns of hepatitis C virus (HCV), the predominant blood borne-pathogen infecting injection drug users (IDUs), in a part of the former Soviet Union.

DESIGN

Cross-sectional respondent-driven sample of IDUs.

SETTING

St Petersburg, Russia.

PARTICIPANTS

A total of 387 IDUs were recruited in late 2005 and throughout 2006.

MEASUREMENTS

Participants were surveyed to collect demographic, medical and both general and dyad-specific drug injection and sexual behaviors. A blood sample was collected to detect antibodies to hepatitis C and to amplify viral RNA for molecular analysis. The molecular data, including genotypes, were analyzed spatially and linkage patterns were compared to the social linkages obtained by respondent-driven sampling (RDS) for chains of respondents and among the injection dyads.

FINDINGS

HCV infection was all but ubiquitous: 94.6% of IDUs were HCV-seropositive. Among the 209 viral sequences amplified, genotype 3a predominated (n = 119, 56.9%), followed by 1b (n = 61, 29.2%) and 1a (n = 25, 11.9%). There was no significant clustering of genotypes spatially. Neither genotypes nor closely related sequences were clustered within RDS chains. Analysis of HCV sequences from dyads failed to find associations of genotype or sequence homology within pairs.

CONCLUSIONS

Genotyping reveals that there have been at least five unique introductions of HCV genotypes into the IDU community in St Petersburg. Analysis of prevalent infections does not appear to correlate with the social networks of IDUs, suggesting that simple approaches to link these networks to prevalent infections, rather than incident transmission, will not prove meaningful. On a more positive note, the majority of IDUs are infected with 3a genotype that is associated with sustained virological response to antiviral therapy.

Interventions with injection drug users in Ukraine

AIMS

To assess the effectiveness of a brief human immunodeficiency virus (HIV) testing and counseling intervention compared to a more time-consuming and expensive street-based intervention with injection drug users (IDUs).

DESIGN

Cross-over experimental design in which 900 IDUs were recruited, followed by a 'wash-out' period with no recruitment, a reversal of intervention assignment areas and an additional recruitment of 900 IDUs with baseline and 6-month follow-up assessments.

SETTING

Kiev, Odessa and Makeevka/Donesk Ukraine.

PARTICIPANTS

A total of 1798 IDUs.

MEASUREMENTS

HIV testing and audio computer-assisted self-interview (ACASI) data on socio-demographics, drug use and injection and sex-related risk behaviors.

FINDINGS

Participants in both conditions reduced their injection and sex risks significantly; however, there was little difference in outcomes between conditions. IDUs who knew they were HIV-infected at baseline were significantly more likely to practice safe sex than those unaware or HIV-negative; those who first learned that they were infected at baseline changed their safe sex practices significantly more than those who already knew that they were infected at baseline and those who were HIV-negative. Younger IDUs and those injecting for a shorter period of time reported higher injection and sex risk behaviors following interventions.

CONCLUSIONS

Awareness of HIV infection by street-recruited drug injectors is associated with reduced sex risks. Additional interventions are required for younger IDUs and those injecting for shorter periods of time.

HIV and hepatitis C virus infections among hanka injection drug users in central Ukraine: a cross-sectional survey

BACKGROUND

Ukraine has experienced an increase in injection drug use since the 1990s. An increase in HIV and hepatitis C virus infections has followed, but not measures of prevalence and risk factors. The purposes of this study are to estimate the prevalence of HIV, HCV, and co-infection among injection drug users (IDUs) in central Ukraine and to describe risk factors for HIV and HCV.

METHODS

A sample of 315 IDUs was recruited using snowball sampling for a structured risk interview and HIV/HCV testing (81.9% male, 42% single, average age 28.9 years [range = 18 to 55]).

RESULTS

HIV and HCV antibodies were detected in 14.0% and 73.0%, respectively, and 12.1% were seropositive for both infections. The most commonly used drug was hanka, home-made from poppy straw and often mixed with other substances including dimedrol, diazepines, and hypnotics. The average period of injecting was 8.5 years; 62.5% reported past-year sharing needles or injection equipment, and 8.0% shared with a known HIV-positive person. More than half (51.1%) reported multiple sexual partners, 12.9% buying or selling sex, and 10.5% exchanging sex and drugs in the past year. Those who shared with HIV positive partners were 3.4 times more likely to be HIV positive than those who did not. Those who front- or back-loaded were 4 times more likely to be HCV positive than those who did not.

CONCLUSION

Harm reduction, addiction treatment and HIV prevention programs should address risk factors to stop further spread of both HIV and HCV among IDUs and to the general population in central Ukraine.

HIV/AIDS epidemic in Eastern Europe: recent developments in the Russian Federation and Ukraine among women

BACKGROUND

The Russian Federation and the Ukraine are among the Eastern European countries with the fastest growing number of cases of HIV. According to data from the Joint United Nations Program on HIV/AIDS, nearly 90% of newly reported HIV diagnoses in Eastern Europe in 2006 were from the Russian Federation (66%) and the Ukraine (21%). A growing number of women are infected with HIV. The impact of gender on HIV/AIDS is an important factor in understanding the development and evolution of the HIV/AIDS epidemic in Eastern Europe.

OBJECTIVE

The aim of this study was to assess the importance of integrating gender consideration into the creation of HIV programs and to examine the effect of gender on HIV/AIDS.

METHODS

Reported HIV/AIDS cases from the official epidemiological register of the Ukrainian Centre for AIDS Prevention alongside data from the Russian Federal AIDS Center were analyzed. Joint United Nations Program on HIV/AIDS country fact sheets were reviewed and analyzed, and this information was supplemented with published HIV prevalence and sexually transmitted disease case reporting information, unpublished reports, and expert evaluations.

RESULTS

Of the newly registered cases of HIV, the proportion of women rose from 13.0% in 1995 to 44.0% in 2006 in the Russian Federation, and from 37.2% in 1995 to 41.9% in 2006 in the Ukraine. There has also been a considerable increase in mother-to-child transmission of HIV since 1995. Between 1987 and 1994, the proportion of children among the people newly infected with HIV in the Ukraine was 2.2%; in 2006 it was 17.6%. In 2006, 16,078 new HIV cases were registered in the Ukraine and 39,652 new HIV cases in the Russian Federation. Large increases in the number of HIV-infected women were reported from both countries.

CONCLUSIONS

The data examined in this study suggest subregional differences in the magnitude of the HIV/AIDS epidemic in the Russian Federation and the Ukraine and the importance of the impact of gender on the rapid spread of the HIV/AIDS epidemic among women and women of child-bearing age. To protect women from HIV infection, it is important to find ways to empower them by implementing policies and specific prevention measures that increase their access to knowledge about HIV/AIDS; the empowerment of women is vital to reversing the HIV/AIDS epidemic.

Use of a Peer Leader Intervention Model to Reduce Needle-Related Risk Behaviors among Drug Injectors in Ukraine

This study was designed to assess change in needle-related risks following interventions with injection drug users (IDUs) in the Crimea. Participants were recruited through street outreach by former IDUs in the cities of Simferopol and Nikolayev, Ukraine. The intervention was based on a social network model in which peer leaders were recruited and asked to bring in up to three members of their injecting network. Findings supported the feasibility of the intervention: peer leaders recruited an average of 2.4 network members; two-thirds attended at least four of the five training sessions; and a positive relationship was observed between greater session attendance by peer leaders and increased communication with network members about HIV prevention. Moreover, leaders who did not engage in high-risk behaviors at follow-up were much more likely to have had network members who did not engage in high-risk activities compared to leaders who continued high-risk behaviors.

Stimulant injectors in Ukraine: the next wave of the epidemic?

This study was designed to assess differences in drug and sex-related risk behaviors between injectors of opiates only, opiate/sedative mix only and stimulants only. Participants were current out-of-treatment injection drug users (IDUs), unaware of their HIV status, recruited through street outreach in Kiev, Odessa and Makeevka/Donetsk, Ukraine. Overall, 22% tested positive for HIV, including 39% among opiate/sedative injectors, 19% among opiate injectors and 17% among stimulant injectors. Despite these differences, stimulant injectors were at higher risk than other IDUs in sharing a used needle/syringe, always injecting with others, injecting a drug solution drawn from a common container, having an IDU sex partner, not using condoms during vaginal or anal sex and on composite measures of injection and sex risks. After controlling for age differences, stimulant injectors remained at higher risk in their needle and sex risk behaviors. Without intervention, it is likely that HIV will increase among stimulant injectors.

Alcohol and other drug related deaths among young people in CIS countries: proximal and distal causes and implications for policy

BACKGROUND

Although the mortality crisis that followed the break-up of the Soviet Union in 1992 has been well researched, most attention has been paid to mortality among middle-aged men. There has been relatively little analysis of death rates among young people, many of which appear related to alcohol and other drug (AOD) use. Death rates ranged from exceedingly high in some countries (e.g. Russia) to very low in others (e.g. Armenia). This divergence among Commonwealth of Independent States (CIS) countries increased considerably over the 1990s. What caused this divergence in youth deaths and what policy response is needed?

METHOD

An ecological study of country-level data was used to explore the relationships between risk factors, AOD use and youth deaths across time and between countries. Qualitative research literature was used to supplement the statistical data.

RESULTS

AOD abuse risk factors were divided into 'proximal causes' (e.g. AOD availability) and 'distal causes' (e.g. social cohesion, welfare, culture). Proximal risk factors appeared to explain some of the AOD use and death data, but they did not explain all of the country differences. Analysis of distal risk factors suggested that family and community strength are important factors in the trends in AOD abuse and youth mortality.

CONCLUSIONS

The policy response to AOD abuse and mortality among young people needs to attend to both proximal and distal factors. An exclusive focus on proximal risk factors is unlikely to provide a satisfactory solution. Rather, the social determinants of child and youth development need to be considered. More research is needed on the relationship between AOD abuse and youth mortality, and on the influence of family and community strength on both these outcomes in the region. Useful lessons may be learned from countries such as Armenia, where both AOD abuse and youth mortality have remained low.

Predictors of risky needle use following interventions with injection drug users in Ukraine

This study was designed to assess factors associated with change in needle-related risk behaviors as well as predictors of continued high-risk behavior following intervention efforts among injection drug users (IDUs) in Ukraine. In each of three locations--Kiev, Odessa, and Makeevka/Donesk--100 IDUs were recruited using modified targeted sampling methods. Following a baseline interview, participants were offered free HIV testing and, over the course of the next 5 months, individualized interventions focusing on reducing HIV-related risk behaviors. Former IDUs conducted interventions through street outreach. The intervention model was based on the Indigenous Leader Outreach Model (ILOM) and stressed assessing an individual's unique risks and developing strategies by which to minimize those risks. Follow-up assessments showed significant reductions in every risk behavior measured. Following the intervention, however, approximately one of four participants reported front- or backloading, using drugs obtained from a common container or injecting with a used needle/syringe. Although the sample as a whole averaged only 28 years of age, those who were younger were significantly more likely to engage in each of these behaviors than those who were older. In light of the overall young age of the Ukrainian IDUs observed in this study, the consistent finding that younger IDUs were at highest risk foreshadows a worsening HIV epidemic in Ukraine.

A situational picture of HIV/AIDS and injection drug use in Vinnitsya, Ukraine

BACKGROUND

New and explosive HIV epidemics are being witnessed in certain countries of Eastern Europe, including Ukraine, as well as a rapid and dramatic increase in the supply, use, and negative public health consequences of illicit drugs. A majority of registered HIV cases in Ukraine occur among injection drug users (IDUs), large numbers of whom report HIV risk behaviors such as needle sharing. The purpose of this study was to apply the World Health Organization's Rapid Assessment and Response on Injection Drug Use (IDU-RAR) guide to create a situational picture in the Vinnitsya Oblast, Ukraine, a region with very scarce information about the HIV/AIDS and injection drug use (IDU) epidemics.

METHODS

The IDU-RAR uses a combination of qualitative data collection techniques commonly employed in social science and evaluation research to quickly depict the extent and nature of the given health problem and propose locally relevant recommendations for improvement. The investigators focused their assessment on the contextual factors, drug use, and intervention and policy components of the IDU-RAR. A combination of network and block sampling techniques was used. Data collection methods included direct observation, review of existing data, structured and unstructured interviews, and focus group discussions. Key informants and locations were visited until no new information was being generated.

RESULTS

The number of registered HIV cases in Vinnitsya has increased from 3 (1987-1995) to 860 (1999-10/2004), 57 of whom have already died. Ten percent of annual admissions to the area's Regional Narcological Dispensary were for opiate disorders, and the number of registered IDUs rose by 20% from 1999 to 2000. The level of HIV/AIDS awareness is generally poor among the general population but high among high-risk populations. Both HIV/AIDS and injection drug use carry a strong stigma in the community, even among medical professionals. There was very little evidence of primary HIV/AIDS prevention efforts, and IDU prevention efforts focused on promotion of anti-drug messages in the schools.

CONCLUSION

Given that Ukraine has sparse resources to be devoted to this problem, action recommendations should be prioritized, realistic, and initially targeted to persons in greatest need. The following action recommendations are prioritized by the following categories: First priority: Voluntary Counseling and Testing; Second Priority: Prevention and Education; and Third Priority: Harm Reduction and Treatment. They are provided in this sequence based on what response can realistically be implemented first with limited additional resources and can make the greatest immediate impact. The persons at greatest risk, HIV positive persons and IDUs, should be attended to first.

Epidemiology of heavy alcohol use in Ukraine: findings from the world mental health survey

AIMS

To describe the epidemiology of heavy alcohol use in Ukraine, using data from the world mental health (WMH) survey in Ukraine.

METHODS

The WMH composite international diagnostic interview was administered in 2002 to a national probability sample of Ukrainian adults (n=4725). An algorithm for classifying heavy use in the past year was developed from self-reports about the quantity and frequency of drinking, and its convergent validity was demonstrated. Prevalence rates and socio-demographic risk factors were examined separately for men and women.

RESULTS

The 12-month rates of heavy alcohol use were 38.7% in men and 8.5% in women (22.0% overall). Among heavy alcohol users, 92% of men and 52% of women consumed at least 80 g of ethanol in a typical drinking day on a monthly basis in the year before the interview. The most significant risk factors in men and women were age (26-54 years for men; 18-25 years for women), living in the Southeast region, being in the labour force whether employed or unemployed, and for men, low education and being the father of a young child. A highly significant linear relationship of number of risk factors with heavy alcohol use was found for both sexes.

CONCLUSIONS

The rates for men were similar to those reported in a Russian national survey with the exception of Southeast Ukraine where the rate was >10% higher. The highest rates were among men who were middle-aged, fathers and unemployed. Future prospective studies are needed to assess the impact of heavy alcohol use on Ukrainian health, mental health and occupational and social functioning.

Drug injectors and dealers in Odessa, Ukraine

This article reports on the results observed in a series of focus groups and in-depth interviews with injection drug users (IDUs) and drug dealers in Odessa, Ukraine. Ukraine has the highest rate of HIV infection in Eastern as well as Western Europe, and Odessa ranks among the cities in that country with the highest seroprevalence. The epidemic is largely concentrated among IDUs, although heterosexual transmission is increasing. The purpose of this study was to further understand the context in which HIV-related risk behaviors occur in order to recommend intervention strategies that might reduce the rate of new infections. The drug users who participated in the research were impoverished and severely addicted. Findings revealed that there were two sources for drugs in Odessa: either from gypsies in preloaded syringes, or from drug dealers also in a liquid form. The most common drug injected was liquid poppy straw, a weak opiate known as "hemia." Results showed widespread victimization of drug users by police officials, leading to increased risk-taking to avoid arrest or harassment. Needle/syringe sharing was common and users rarely had time to disinfect their works. The most common product used to clean was urine, believed to be an antiseptic. When asked to recommend prevention strategies to reduce the rising rate of HIV, the most common response by the users and dealers was to legalize drugs. The drug and HIV epidemics in Odessa, as well as all of Ukraine, call for urgent public health measures to impact and improve the health of its citizens.

Predictors of Self-Reported HIV Infection Among Drug Injectors in Ukraine

OBJECTIVE

To identify characteristics, including current high-risk drug and sex behaviors, associated with self-reported HIV infection among injection drug users (IDUs) in Ukraine.

DESIGN

Targeted sampling of IDUs from Kiev, Odessa, and Makeevka/Donetsk, Ukraine.

METHODS

From June through August 2002, 100 IDUs from each site were recruited through street outreach, including 212 who had previously been tested for HIV and knew their serostatus. Subjects were administered a standardized computer-assisted interview assessing HIV-related drug and sex risk behaviors and history of HIV testing.

RESULTS

Twenty six percent of the 212 participants reported they were HIV-positive. Univariate followed by multiple logistic regression analyses were used to identify factors associated with HIV infection. In the 30-day period before their interview, HIV-infected IDUs were significantly more likely to have injected with a needle previously used by another injector without disinfecting, frontloaded and/or backloaded, and shared the drug solution from a common container. In addition, they had higher prevalence rates for hepatitis B virus and hepatitis C virus than those not infected with HIV. On the other hand, they were more likely to have reported no sex partners and, if sexually active, more likely to have used a condom.

CONCLUSION

The high HIV seroprevalence among IDUs in Ukraine, combined with their continued engagement in needle-related risk behaviors, assures the continuance of the epidemic in this region, a region that is the epicenter of HIV in Europe.