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Estonia's HIV Epidemic Expanding Rapidly Due to New Injectors of Illegal Drugs

March - April, 2008  |  Volume 7, Issue 2

Estonia's HIV epidemic is rapidly expanding due to new injectors of illegal drugs, according to a Fogarty-supported study. Estonia's rate of new HIV infections was 467 per million inhabitants in 2005, the highest per capita rate in Eastern Europe and almost twice as high as Russia, which had the second highest rate.

An Estonian man leaning against a tree
Photo: LHIL, Jad Davenport

As many as half of Estonia's drug users are infected with HIV.

Dr. Anneli Uuskula of the University of Tartu and her colleagues conducted two HIV risk behavior and HIV infection studies among drug injectors in Tallinn, Estonia, in 2004 and 2005. Their findings, published in the Journal of Public Health, reveal that HIV prevalence was just as high for new injectors - those injecting less than three years--as for long-term injectors. In the first study, half of the new injectors were infected. In the first, the rate was 34 percent.

The research revealed that injection and sexual risk behaviors were similar among new and long-term injectors, with about one third sharing needles and syringes within the first three months and about half having had more than one sexual partner in the previous year.

It is of "utmost importance" that interventions to prevent HIV and discourage drug injection be scaled up in Estonia, the authors urge. In many settings, younger and new injectors may have less access to HIV prevention and other services. Peer education that could provide new injectors with risk-reduction skills could also be effective, suggest the authors.

Finally, the team recommends implementation of programs known to reduce HIV risk behavior among injecting drug users such as community outreach, needle and syringe access programs, treatment for drug addiction, and methadone maintenance treatment for heroin addiction. They note that these interventions have brought HIV epidemics under control in a number of countries, including parts of the U.S. and Western Europe.

High-prevalence and high-estimated incidence of HIV infection among new injecting drug users in Estonia: need for large scale prevention programs. Uuskula A, Kals M, Rajaleid K, Abel K. Talu A, Ruutel K, Platt L, Rhodes T, Dehovitz J, Des Jarlais D. J Public Health (Oxf). 2008.

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