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Initiation into injecting drug use in ukraine
 

Initiation into injecting drug use in ukraine

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    Initiation into injecting drug use in ukraine Initiation into injecting drug use in ukraine Presentation Transcript

    • Initiation Into Injecting Drug Use In Ukraine: Results From a Respondent Driven Sampling Study Among Young IDUs and Non-IDU Peers Jean-Paul Grund, Olga Balakireva, Olena Sakovich, Yuliya Rubanets, Marina Ryabova, Cas Barendregt, Nataliya Levchuk, Tatyana Bondar
    • Project Data • Project Title: Preventing Initiation of Injecting Drug Use amongst Vulnerable Adolescents and Youth in Ukraine • Implemented by: - Ukrainian Institute for Social Research (Olga Balakireva (PI), Yuliya Rubanets, Marina Ryabova, Nataliya Levchuk, Tatyana Bondar); - DV8 Research, Training & Development, Rotterdam, the Netherlands (Jean-Paul Grund (co-PI)); - Addiction Research Institute (IVO) Rotterdam, the Netherlands (Cas Barendregt)
    • Acknowledgement • Funding: UNAIDS/UNICEF (PAF) • Project Officer: Olena Sakovich, UNICEF, Kiev
    • BACKGROUND: A TWIN EPIDEMIC OF IDU AND HIV (i) • Registered drug users in Ukraine: – 1990 43.2 per 100K pop. – 2005 179.2 per 100K pop. (Ministry of Health of Ukraine. 2006) • Number of IDUs in Ukraine: – 560.000 (Social Monitoring Center, 2002) – 424.700 (consensus estimate of national HIV/AIDS specialists, 2005)
    • BACKGROUND: A TWIN EPIDEMIC OF IDU AND HIV (ii) • Injecting drug use remains main mode of HIV transmission: – 2005: 45.5% of PLWHA infected through IDU (Ukrainian AIDS Center, 2006) BUT… – Existing HIV testing and HIV case registration system seriously underestimates actual number of HIV-positive IDUs (UAC /UNAIDS, 2002) – Local Sentinel Surveillance studies suggest HIV prevalence among IDUs between 10% and 59%, with IDUs aged 15 to 19 at highest risk. – IDU population keeps growing in number
    • STUDY OBJECTIVES • Present prevention approaches either tend to emphasize targeted interventions aimed at established drug injectors or public information campaigns, aiming at informing the general public in a ‘broadcast’ fashion. • Importance of needle exchange, Substitution treatment and other harm reduction interventions, but… • Is it possible to “Break the Cycle” of initiation into IDU? – Little scientific information is available on the determinants of initiation into injecting drug use among youth. From Ukraine and other post Soviet countries none whatsoever. Study aims: • Provide data on the process of initiation into injecting drug use • Serve as foundation for prevention activities seeking to reduce the incidence & prevalence of IDU
    • Study Design • Literature review on (prevention of) initiation of injecting drug use among youth and support services for young/novice injecting drug users (IDUs); • In-depth interviews with young/recent IDUs; • Quantitative survey of young/recent IDUs and their non-injecting friends in four cities (Kyiv, Odesa, Poltava and Pavlograd); • Each phase informed the following
    • Survey Methodology • Respondent Driven Sampling (Heckathorn, 1997, 2002) in four cities: Kyiv, Odesa, Poltava and Pavlohrad; • Target Populations: 1. Injecting drug users (IDUs) up to 23 years of age, having injected at least once in the last 3 months); not in treatment for drug addiction and not involved in rehabilitation programs at the time of interview. 2. IDUs’ friends who do not inject drugs (non-IDUs) up to 23 years of age (thus including non-users (NUs) and users of non-injected drugs (NIDUs))
    • IDU 1 recruits 4 freinds: 3 IDUs and 1 non-IDU IDU 1 IDU 1.1 IDU 1.2 IDU 1.3 The same scheme as for IDU-1 IDU 1.1.1 IDU 1.1.2 Non-IDU Non-IDU respondents do not recruit! Non-IDU IDU 1.1.3 The same scheme as for IDU-1 IDU 20 IDU 20.1 IDU 20.2 IDU 20.3 Non-IDU The same scheme as for IDU-1 Seeds: IDU 1 ...... IDU20 RDS Recruitment Scheme
    • The Resulting Sample Non-injecting friends (non-IDUs), N=802 Kyiv Odesa Pavlograd Poltava Kyiv Odesa Pavlograd Poltava Injecting drug users (IDUs), N=808 25% 25% 25% 25% 25% 25% 25% 25% 205 201 199 203 199 201 Use drugs non-injectingly (NIDUs), N=476 200 201 Do not use any illegal drugs (NU), N=326
    • Demographics IDUs Non-IDUs Gender: M. F. 78,5% 21,5% 63,3% 36,7% Mean Age: 20 yrs. 19 yrs. Employed: 35% 40%
    • Drugs of first injection by city of residence (% ) Among all IDUs 25 60 Pavlograd 5 55 35 0 Poltava 11 77 Odesa 2 12 68 Kyiv 9 23 59 0% 10 20% Poppy straw extract 9 40% 60% Amphtamines 80% Heroin 10 11 11 9 100% Others
    • Social Setting of the First Hit “Who was present at your first injection?”* Company % Friends or good acquaintances 80 Person I did not know very well 20 Sexual partner 17 Stranger 7 Alone 5 * More than one answer was possible.
    • Social Setting of the First Hit “Who gave you the first injection?” by gender (%) 64 Friend, acquantance 55 67 13 Self-made 4 15 8 Sexual partner 32 3 6 Drug dealer 2 7 5 Running body 4 5 1 O ther persons 3 3 0 10 20 Men 30 40 Women 50 60 All 70 80
    • Social Setting of the First Hit Average age of first injection: 17.7 years Average age of “Initiator”: 22.8 years Initiator is usually an IDU friend First drug of injection is usually obtained from a close friend, free of charge Most common location of IDU initiation: A friend‘s apartment
    • Behavioral risks associated with the first injection (i) • “At my initiation other people used the same drug.” • Obtained first drug injected as liquid in syringe • “Each in the group had his/her own syringe” 80% 75% 21%
    • Behavioral risks associated with the first injection (ii) • didn’t know / unsure whether syringe was used by someone before or not 33% – Associated with Age: Younger at initiation  increasing incertainty; – Associated with length of Non-IDU use: 2 Years 4 Years 32% 21% • 50% was high on AOD “At the time of my first injection I was under the influence of alcohol and marijuana.” (Poltava, female, 19 years).
    • Behavioral risks associated with the first injection (iii) “Did you use a sterile needle during the first injection?" by other drug use (%) % 80 70 60 50 40 30 20 10 0 73 62 38 56 49 43 51 26 Had not used any stuff Non-injecting drugs Do not know/unsure whether the syringe was new Alcohol Alcohol and non-injecting drugs Sure, it was a new syringe
    • Behavioral risks associated with the first injection (iv) Other drug use during the first injection by gender (%) % 60 50 55 44 38 Men Women 40 25 30 14 20 11 5 10 6 0 Had not used any stuff Non-injecting drugs Alcohol Syringe sharing at the first injection: Men: Women Alcohol and noninjecting drugs 29% 51%
    • The reproduction of injecting drug use • 167 IDUs (21%) initiated 605 Novice IDUs  Reproduction Rate: 3.6 per initiator or 0.7 for whole sample – Males: 22%, RR 3.83 – Females: 16%, RR 2.61 “Did you ever initiate a novice?” % Yes, I did 21 No. of times: 7 twice 6 tree or more No, I didn’t once 8 79
    • Initiation into IDU: Planned or Spontaneous? Planning the first and the second injection, by gender (%) 100 % 90 80 70 60 50 40 30 20 10 0 100 % 90 80 70 60 50 60 44 40 30 20 10 First injection Men Second injection 45 28 0 First injection Women Second injection
    • Did you ever want to try an injecting drug? (%) of the NIDUs and NUs NIDUs NUs No, never 56 80 Yes, a couple of times 37 17 Yes, quite often 5 1 Yes, I really would like to try an injecting drug 2 2
    • Self-Assessment of the probability of initiating IDU among NIDUs and NUs (%) 5 Sure they will try one day 10 Not going to try injecting drugs so far, but don’t know how the things will be going later on 30 34 65 Sure they will never try injecting drugs 56 0 NIDUs 10 20 30 40 50 60 70 NUs 80 90 100
    • First injection: Summary • • • • Mostly home-produced opiate; Taken in a group of friends; At the apartment of a friend; Administered by a close friend or, in the case of women, a sexual partner; • Obtained from a close friend, free of charge; • Generally an unplanned event. Additional data on: – Motivations for & Barriers to initiation of drug injecting – Risk & Protective Factors
    • Peer-based interventions targeting (young) IDUs, Interventions targeting IDUs to prevent initiation of other, that is: - to not inject in the presence of non-injectors; - to not give other people their first injection; - inform non-injectors on the negative effects of injecting drug use. • XXXXX IDUs Non-IDUs aiming at changes in sub-cultural norms towards rejecting initiation of non-IDUs: •Do not give other people (e.g. non-IDUs friends) their first injection •Do not inject in the presence of non-IDUs •Honestly inform non-IDUs on the consequences of injecting drug use (health, habit) •Example: Break the Cycle (Hunt 1998) Proposed Strategy Peer-based interventions targeting NIDUs & experimental IDUs, aiming at Abstinence-based drug education: establishing sub-cultural norms favoring non-injecting modes of administration: interventions targeting non-IDUs to prevent initiation of injecting drug use. •Honest information on modes of administration; •Information on safer and effective non-IDU modes of administration
    • Reference: • Jean-Paul Grund, Olga Balakireva, Olena Sakovich, Yuliya Rubanets, Marina Ryabova, Cas Barendregt, Nataliya Levchuk, Tatyana Bondar. Initiation into Injecting Drug Use In Ukraine: Results From a Respondent Driven Sampling Study Among Young IDUs and Their Non-IDU Peers. Presented at the Seventeenth International Conference on the Reduction of Drug Related Harm, Vancouver, Canada, May 3, 2002 (Abs.No. We.07.1). J-P Grund