Changing drug use and HIV prevalence among injecting drug users in Ukraine: evidence from biobehavioral surveys

BACKGROUND: Integrated biobehavioral surveys (IBBS) have been used to evaluate the impact of HIV prevention efforts among most-at-risk groups in Ukraine since 2007. Harm reduction program coverage among injecting-drug users (IDUs) increased substantially from 96,000 in 2008 to 170,000 in 2010 with support from the Global Fund, and IBBS have shown declining HIV prevalence. Aim of the study was to examine the changes in HIV prevalence, drug use patterns and risky behaviors in IDUs on national and city level.METHODS: For this analysis, three IDU-IBBS datasets were combined – 2008 (N=3711), 2009 (N=3962), and 2011 (N=9069). The analysis included 25 cities that participated in either 2008 or 2009, and 2011. Changes in HIV prevalence, drug use, and risk behaviors were compared between 2008/9 and 2011.RESULTS: The surveyed IDU population in 2011 was older than in 2008/9 (31.0 vs. 32.8 years; p<.0001), and included more females (23.5% vs. 25.5%; p=.0038), with substantial variation across cities.Overall HIV prevalence in the sample declined slightly (22.9% to 21.6%; p=.05). In eight cities, HIV prevalence decreased significantly (-5% to -18%), while significant increases were seen in five cities (8% to 15%). Prevalence among IDUs younger than 25 years declined (9.9% to 7.2%; p=.0078).The combined dataset showed no difference in opioid or stimulant past-30-day use, with variation at city level. Clean needle/syringe use during last injection increased significantly (88.8% to 97.0%; p<.0001), with no opposing trend in any city. Three cities had an increase in past-30-day needle/syringe sharing; nine – in container sharing; twelve – in use of preloaded syringes. Changes in condom use were not significant (54.1% to 54.9%, p=.32).CONCLUSIONS: IDUs in Ukraine are ageing and HIV seroprevalence among IDUs continues to decline, especially among young IDUs. However, prevention programming needs to respond to significant regional variations in risk behaviors and HIV transmission.