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Prevalence of HIV among injection drug users in Georgia
– Reported, January 20, 2012
Injection drug use remains a major risk factor for HIV transmission in Georgia. The study aims to characterize the prevalence of HIV among injection drug users in Georgia.
A cross-sectional, anonymous bio-behavioural survey to assess knowledge and behaviour in injection drug users in combination with laboratory testing on HIV status was conducted in five Georgian cities (Tbilisi, Gori, Telavi, Zugdidi and Batumi) in 2009. A snowball sample of 1127 eligible injection drug user participants was investigated.
Odds of HIV exposure were increased for injection drug users of greater age, with greater duration of drug use and with a history of imprisonment or detainment (p < 0.05).
More research is required to analyze the determinants of HIV risk in Georgian injection drug users. The imprisoned population and young injection drug users may be appropriate target groups for programmes aimed at preventing HIV transmission.
Injection drug use is the primary route of HIV transmission in Eastern Europe. An exceptionally high HIV prevalence among injection drug users (IDUs) is well documented in Ukraine and Russia. The Baltic States, which experienced a rapid increase in HIV among IDUs in 2001-02, have recently reported declines in this high-risk group. In contrast, Georgia and other countries in the region are reporting increasing cases of HIV among IDUs .
Georgia is categorized as a low-HIV-prevalence country . The estimated prevalence among the adult population is 0.1% . According to the national HIV registry data, there has been a sharp increase in newly diagnosed cases since 2004, with a steady increase since 2008. Annually, almost half of the newly diagnosed cases are revealed at the AIDS stage of disease. There is regional heterogeneity in HIV prevalence with higher rates in the capital (Tbilisi), regions bordering Turkey, and in the conflict zone of Abkhazia . Injection drug use remains a major risk factor for HIV transmission. In 2009, more than 70% of new HIV infections were attributed to injection drug use or sexual contact with an injection drug user .
Drug abuse and its related health and social consequences are critical challenges facing Georgia. As a bridge between Europe and Asia, Georgia and other south Caucasian countries serve as a drug trafficking route into Russia and Europe. The conflict regions may also have conditions that support drug trafficking. No reliable estimates on the extent of drug use in Georgia currently exist .
Over the past few years, Georgia’s government, together with international donor organizations, has been strengthening HIV surveillance and preventive efforts among high-risk groups. Second-generation surveillance has been initiated in IDUs since 2002 . Several rounds of bio-behavioural surveillance surveys (Bio-BSS) have been conducted in the capital and other cities. This paper reports on the findings of Bio-BSS that were conducted in five cities in Georgia in 2008-09 using a respondent-driven sampling (RDS) methodology as part of a Global Fund-supported project, and aims to identify HIV risk determinants among IDUs.
Five cross-sectional, anonymous surveys of IDUs were conducted in Tbilisi, Batumi, Zugdidi, Gori and Telavi in 2009. Participants were recruited by using RDS methodology. RDS is a variant of chain-referral sampling used to reach hidden populations . RDS provides a probabilistic sample of a researched sub-population in a given location, and a specially developed software package (RDSAT) generates sample weights that account for network sizes and the degree of homophily. In the current analyses, a non-weighted combined dataset from all five studies was used. Therefore, the sample should be considered as a standard snowball.
The median age of study participants was 35 years. The majority of participants were ethnically Georgian males. Ethnic distribution of the sample corresponds to the Georgian population’s ethnic composition, where 84% are Georgians ; however, it is questionable whether the gender composition of participants is representative of the true IDU population. In total, 49.7% of respondents were married. The median age for starting any type of drug use was 17 years, and for injecting drugs, the median age at first use was 19 years. All IDUs across all five survey locations had heard about HIV/AIDS, and almost 50% knew a person who has been infected, became ill or died of AIDS. The majority of IDUs had knowledge about how HIV is transmitted and how its transmission can be prevented. Most (99.4%) knew that sharing syringes increases the risk for contracting HIV; 97% reported that they could get new, unused syringes when needed; and 94.9% mentioned drug store as a prime source of syringes.
Our analysis raises a number of interesting issues for discussion. The prevalence of HIV among IDUs in the neighbouring countries of Turkey (1.5%) and Armenia (6.8%) is similar to that of Georgia, ranging between 2.5% and 4.5% . In other nearby former Soviet Union countries, the rate is higher: 10.3% prevalence in Azerbaijan , 30.1% in the capital city of the Russian Federation, and 22.9% in Ukraine.
It is interesting to note that the HIV prevalence, while low, is increasing in Georgia , and the highest prevalence of HIV was noted in a major urban area (Tbilisi) and/or geographically near the border of the country (Batumi). Previous Bio-BSS among IDUs carried out in these locations in 2004 revealed an HIV prevalence of 0.4% in Tbilisi and 2.1% in Batumi . Comparison with our study findings demonstrates increases in HIV prevalence in both locations, with a statistically significant change for Tbilisi IDUs (p < 0.05). This may be important for the identification of potential entry points for HIV prevention programming.
No association was found between high-risk injection behaviour at last injection (use of shared syringe, use of potentially contaminated syringe, and joint use of injecting paraphernalia) and HIV positivity. It is not likely that IDUs underreport engagement in unsafe injecting practices as there is general consensus that IDUs do reliably report such behaviours in studies of this type [15]. However, we measured injecting behaviour at last injection, which may substantially differ from behaviour during previous injections.
The alarmingly high prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) among IDUs in Georgia is an indicator of unsafe injecting practice, which IDUs may have engaged in during their injecting career. In all, 64.6% of IDUs tested in Tbilisi in 2006 were infected with HCV . In a 2000-01 study, a prevalence of 55.2% of HBV-positive cases was identified . This corresponds to the finding of our study that 59.1% of IDUs have ever used a shared syringe. It is notable that a comparison of syringe sharing at last injection with the 2002-04 Bio-BSS results showed a reduction in this behaviour among Tbilisi and Batumi IDUs, with a statistically significant reduction among the Tbilisi sample (from 15.3% in 2002 to 3.4% in 2009, p < 0.05) . Prevalence of other risk factors, such as joint use of injecting paraphernalia remains high (46.4%).
The existing coverage of HIV prevention programmes in Georgia to the IDU population is less than 20% [3], and this study demonstrates that coverage remains at an unsatisfactory level. Therefore behaviour changes, as well as structural and systems improvements, will be required to implement gains in HIV prevention. More research is required to analyze the determinants of HIV risk in Georgian IDUs. The imprisoned population and young IDUs may be appropriate target groups for programmes aimed at preventing HIV transmission.
Credits:Ivdity Chikovani, Ketevan Goguadze,Sudit Ranade, Mollie Wertlieb, Natia Rukhadze and George Gotsadze
More information at: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3050784/?tool=pubmed
– WF Team
