title: Explosive spread and high prevalence of HIV infection among injecting drug users in Togliatti City, Russia.
abstract: OBJECTIVE
  To establish the prevalence of antibodies to HIV (anti-HIV) and associated risk factors among injecting drug users (IDU) in Togliatti City, Samara Oblast, Russian Federation.
  
  
  METHODS
  An unlinked anonymous cross-sectional community recruited survey with oral fluid sample collection.
  
  
  METHODS
  Between September and October 2001, 426 IDU were recruited by trained fieldworkers. Participants completed an interviewer administered questionnaire, and oral fluid samples were tested for anti-HIV. Univariate and multivariate analyses compared potential risk factors for anti-HIV.
  
  
  RESULTS
  Anti-HIV prevalence was 56% (234/418). Three-quarters of anti-HIV-positive IDU (74%) were unaware of their positive status. In an adjusted model, the odds of HIV infection were higher among IDU who had ever injected home-produced drugs, who reported injecting with used needles and syringes in the past 4 weeks, and who were living in one particular district of the city (Komsomolksii).
  
  
  CONCLUSIONS
  The high prevalence of HIV, and a recent increase in HIV detected through routine screening tests since 2000, suggests that an explosive epidemic has occurred among IDU in Togliatti City. In the face of currently inadequate HIV prevention coverage among IDU, this has urgent implications for maximizing the distribution of sterile injecting equipment as well as for enhancing sexual risk reduction. Recognizing that it is likely that similar explosive epidemics are taking place in other Russian cities, we recommend community-wide HIV prevention coverage supported by city and state policies oriented to harm reduction.
authors.affiliation: Department of Social Science and Medicine, Imperial College Faculty of Medicine, University of London, London, UK. t.rhodes@ic.ac.uk
authors.forename: Tim
authors.initials: T
authors.lastname: Rhodes
authors.forename: Catherine
authors.initials: C
authors.lastname: Lowndes
authors.forename: Ali
authors.initials: A
authors.lastname: Judd
authors.forename: Larissa A
authors.initials: LA
authors.lastname: Mikhailova
authors.forename: Anya
authors.initials: A
authors.lastname: Sarang
authors.forename: Andrey
authors.initials: A
authors.lastname: Rylkov
authors.forename: Mikhail
authors.initials: M
authors.lastname: Tichonov
authors.forename: Kim
authors.initials: K
authors.lastname: Lewis
authors.forename: Nina
authors.initials: N
authors.lastname: Ulyanova
authors.forename: Tatiana
authors.initials: T
authors.lastname: Alpatova
authors.forename: Victor
authors.initials: V
authors.lastname: Karavashkin
authors.forename: Mikhail
authors.initials: M
authors.lastname: Khutorskoy
authors.forename: Matthew
authors.initials: M
authors.lastname: Hickman
authors.forename: John V
authors.initials: JV
authors.lastname: Parry
authors.forename: Adrian
authors.initials: A
authors.lastname: Renton
mesh_terms: D015492:AIDS Serodiagnosis; D000328:Adult; D003430:Cross-Sectional Studies; D004196:Disease Outbreaks; D005260:Female; D015483:HIV Antibodies / Q000032:analysis*; D015658:HIV Infections / Q000453:epidemiology* / Q000517:prevention & control / Q000635:transmission; D006801:Humans; D008297:Male; D009055:Mouth / Q000276:immunology; D015995:Prevalence; D012309:Risk-Taking; D012426:Russia / Q000453:epidemiology; D015819:Substance Abuse, Intravenous / Q000150:complications*; D011795:Surveys and Questionnaires
chemical_list: D015483:HIV Antibodies