Explorative study on risk factors contributing to HIV infection in intravenous drug users population in Yerevan, Armenia

Abstract

Introduction: Despite overall declines in AIDS incidence and mortality in several developed countries, HIV incidence continues to rise in many marginalized populations, such as intravenous drug users (IDU). Although IDU account for only 5-10 % of the cumulative adult HIV infections worldwide, diffusion of injection drug use and HIV has occurred on every continent. According to the National Center for AIDS Prevention, in Armenia, 30% of the 102 HIV cases registered by October 1, 1999 constitutes intravenous drug users. For the recognition of public health significance of HIV infection among IDU understanding of the links between HIV and substance abuse is essential. Since little is known on this issue, an ethnographic study was conducted with the goals of contacting and understanding the IDU population. Research was intended to explore drug using patterns and general characteristics of intravenous drug users in Yerevan and to find possible connections between those characteristics and infection with HIV. Methods: Qualitative research techniques such as semi-structured in-depth interviews and key informant interviews were used. Injecting drug users were recruited through adaptive, multisite snowball sampling. A total of 22 ethnographic interviews were conducted during the period from June through September 1999 in Yerevan among intravenous drug users to explore direct patterns of drug use and other specific IDU behavior practices in greater depth. In addition, two key informants were chosen to gain understanding of injecting patterns in Yerevan: the Deputy Director of Republican Narcologic Center of the Ministry of Health and the Deputy Head of Department on Combat Against Illicit Drug Trafficking of the Ministry of Interior Affairs. Obtained data were analyzed using ATLAS/ti, computer software package for analysis of qualitative data. Results: Data suggest that IDU in Yerevan seem to be at risk of HIV acquisition due to their personal, behavioral, social, and drug use characteristics. The majority of IDU started to inject drugs under the influence of their peers/pushers and continue it due to developed addiction. IDU have a rather incomplete and hypothetical knowledge about HIV/AIDS and perceive the problem as an abstract one that “could touch everybody but not themselves”. IDU behaviors were far from being safe and healthy. Most often they reported sharing of needles and syringes with their close friends, do not clean used needles and syringes, and do not use condoms with both primary and casual partners. Recommendations: Further research with the employment of social network samples of active drug users is needed to identify the natural context of drug use profiles, such as needle sharing, sexual relationships, preferences, and habits that might influence HIV acquisition and transmission. The use of mass media is suggested to increase awareness of the general population on drug and HIV-related issues.