Injection stimulant use and HIV risk in Ukraine

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Injection stimulant useand HIV risk in Ukraine

• O. Zeziulin1, K. Dumchev1, J. Schumacher2
• 1Vinnitsya Regional Narcological Dispensary,
  Vinnitsya, Ukraine
• 2University of Alabama at Birmingham, Birmingham,
  AL,USA

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Conflict-of-interest disclosure

• This research was sponsored by ICOHRTA-Ukraine
  program (Fogarty International Center, NIH)
• The authors have no financial relationships that
  related to the topic of this presentation.

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Injection drug use continues to drive the HIV
epidemic in Ukraine, the most affected country in
Europe.
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Background

• Ukraine is the most affected country in Eastern
  Europe (180,000-520,000 cases, or 1.4)
• Majority of prevalent HIV cases are among IDUs
  (60)
• Prevalence of HIV among IDUs from 8.7 to 51
• UNAIDS (2005)

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Local description

• Vinnitsya mid-size city in central Ukraine
  (population 380,000)
• Mostly agricultural region
• Main drug of abuse home-made opioid extracted
  from poppy straw (hanka or shirka) and
  stimulants made from over-the-counter
  medications (vint, jeff, mulka)

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Context and objectives

• This is a secondary analysis of the data from a
  cross-sectional study investigating HIV and HCV
  prevalence among opiate IDUs, risk factors and
  drug use patterns
• The purpose of todays presentation is to
  describe stimulant use among opiate IDUs and its
  relation to HIV risk

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Instruments

• HIV and HCV rapid tests
• Questionnaires
• Demographics and Health Questionnaire
• Risk Assessment Battery (RAB)
• Form 90 (lifetime and past 30 days)
• Unstructured interviews were used to collect
  qualitative data on peculiarities of drug
  preparation and use

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Injection stimulants Source

• Easily prepared from over-the-counter medications
  like Effect, Coldact, Trifed
• Precursors include phenylpropanolamine,
  ephedrine, norephedrine, theophedrine
• Pure ephedrine is now illegal and almost
  impossible to get
• Acting substances ephedrone, catinone,
  methamphetamine

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Injection stimulants Preparation

• Two major ways of preparation
• More complex, involving harder-to-get components
• Resulting solution is longer-acting (up to 8
  hours)
• Easier (as quick as 20 minutes)
• Resulting solution is short-acting (less than an
  hour)
• Components include red phosphorus, iodide,
  vinegar, potassium permanganate
• Permanganate is known to cause severe brain
  damage (Parkinson syndrome)

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Results (1)

• St ever used injection stimulants
• St never used injection stimulants

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Results (2)

• St ever used injection stimulants
• St never used injection stimulants

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Results (3)

• St ever used injection stimulants
• St never used injection stimulants

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CONCLUSIONS

• Intravenous stimulant use is common in Ukraine.
  Differences in injection practices between
  stimulants and opiates have implications for HIV
  risk. Ease of preparation and low cost contribute
  to rapid expansion of stimulant use in Ukraine
  and should be considered for prevention efforts.

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Thank you for attention!