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HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn,Estonia: Implications for intervention
Authors:Ave Talu  Kristiina Rajaleid  Katri Abel-Ollo  Kristi Rüütel  Mati Rahu  Tim Rhodes  Lucy Platt  Natalia Bobrova  Anneli Uusküla
Institution:1. Department of Clinical and Health Psychology, University of Florida, United States;2. Department of Epidemiology, University of Florida, United States;3. Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center & Research Institute, United States
Abstract:BackgroundFollowing a heroin shortage, fentanyl and 3-methylfentanyl, known as “China White” and “White Persian”, have become the most widely used drugs, along with amphetamine, among injecting drug users (IDUs) in Tallinn, Estonia.MethodsIn order to assess the relationships between the injection of fentanyl and amphetamine, and levels of HIV prevalence and risk behaviour, 350 current IDUs were recruited using respondent-driven sampling for an interviewer-administered unlinked cross-sectional survey and HIV testing. IDUs were categorised into groups based on self-report of the main drug used within the last 28 days.Results77% (256/331) of participants reported fentanyl and 23% (75/331) amphetamine as their main drug of injection. HIV prevalence was 27% (95% confidence interval CI]: 18.45–35.51) and 62% (95% CI: 56.97–67.03) among amphetamine and fentanyl injectors, respectively. After adjustment, fentanyl injectors had three times the odds of being HIV positive (adjusted odds ratio AOR] = 2.89; 95% CI: 1.55–5.39). They also had higher odds for injecting in the street with a previously used needle/syringe (AOR = 2.39; 95% CI: 1.14–5.04) and sharing a needle/syringe with somebody known to have HIV (AOR = 3.00, 95% CI: 1.33–6.79). Fentanyl injectors also had higher odds for lifetime overdose (AOR = 3.02, 95% CI: 1.65–5.54).ConclusionThe injection of fentanyl is associated with elevated injecting risk behaviour derived from injection practice and situational risk factors, and needs urgently targeted interventions.
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