MANAGING THE QUALITY OF BEHAVIOR ON HIV AMONG INJECTING DRUG USERS IN PRISHTINA

Abstract

Although Kosovo is a country with low HIV prevalence, the exposure to HIV among injecting drug users (IDUs) may be considerably higher. To assess the quality behaviors of HIV, HBV, HCV and Syphilis, as well HIV-relevant behavioral risks, a bio-behavioral RDS study was carried out in this key population in Prishtina in 2011. The study was a part of the second wave of HIV surveillance among most-at-risk populations. (The first wave was completed in 2006.) In total, 205 IDUs (of whom five were seeds) were tested and interviewed in the July-August 2011 period. Age range in the sample was 19-54 (Mean age = 31.0; SD = 7.14). Most participants were men (179/200; EPP1 = 88.7%). In regard to education, the largest percentage of recruited IDUs had completed secondary education (EPP = 49.3%). Slightly less than a third of respondents have been married at the specific time the study have been carried on (EPP = 30.9%). Permanent employment was reported by 35.1% (EPP) of IDUs in the sample. No HIV+ cases were found. Four IDUs were infected with Syphilis (EPP = 2.0%; 95% CI = 0.3-4.3), 16 with HBV (EPP = 6.0%; 95% CI = 3.0-10.5) and 96 with HCV (EPP = 37.4%; 95% CI = 28.9-46.8). Of the HBV+ individuals, two were diagnosed as having an acute and nine as having chronic infection. A majority of IDUs were alone the last time they injected drugs (EPP = 63.0%). In the past week, 187 of 197 participants (EPP = 97.3%) did not share injecting equipment. A majority of IDUs (158/198; EPP = 83.8%) stated that they always use sterile injecting equipment. Slightly over a half of participants (EPP = 51.8%) were ever treated for drug abuse. In regard to sexual behaviors, a majority of recruited IDUs were sexually active in the month preceding the study (EPP = 74.1%), of which about a quarter had multiple sexual partners (EPP = 27.1%). A minority of participants had regular sexual partner who was also injecting drugs (EPP = 8.5%). Less than a third of the surveyed IDUs used condoms consistently in the past month (EPP = 30.3%). About one fifth of participants (EPP = 22.0%) answered correctly to all five standard UNGASS HIV knowledge indicators. Although the study met all basic requirements of RDS methodology (Johnston et al., 2009), generalizability of the findings should be approached with caution due to a relatively small sample size and the fact that a majority of recruited IDUs have used Labyrinth drop-in and needle-exchange services in the past. The findings point to low levels of injecting equipment sharing, although the prevalence of HCV infection suggests that this is a recent development. Relatively infrequent and inconsistent condom use, coupled with low HIV risk self-assessment, emphasizes a need for a stronger promotion of condom use in the population. Overall, the observed changes in the levels of risk-taking behaviors in this key population confirmed the importance of repeated high-quality bio-behavioral HIV surveys in this key population (Zaba et al., 2005; Brown, 2003).