title: Not all injection drug users are created equal: heterogeneity of HIV, hepatitis C virus, and hepatitis B virus infection in Georgia.
abstract: Injection drug users (IDU) are widely believed to have accelerated the looming HIV/AIDS epidemic now faced by the Russian Federation and countries of the former Soviet Union. However, IDUs may be heterogeneous with regard to risk behaviors, and a subpopulation may be responsible for the majority of blood-borne pathogen transmission. We studied 926 adult injection drug users (IDU) from the cities of Tbilisi, Batumi, and Poti in Georgia, a small country in the Caucuses region between the Black and Caspian Seas, between 1997 and 1998. Study participants were administered a confidential questionnaire and were tested for antibody to HIV, hepatitis C virus (HCV), hepatitis B virus surface antigen (HBsAg), and hepatitis B core antibody (anti-HBc). Five (0.5%) individuals were positive for HIV; 539 (58.2%), for HCV; 67 (7.2%), for HBsAg; and 475, for (51.3%) anti-HBc. Surveyed individuals, 88.7%, reported sharing needles with others, and needle sharing with more than 10 other individuals versus no sharing was a highly significant predictor (OR: 278.12, 95% CI: 77.57, 997.20) of HCV seropositivity. In adjusted analysis, individuals who usually injected stolen medical/synthetic drugs had significantly lower odds of HCV (OR: 0.38, 95% CI: 0.22, 0.68) and HBV (OR: 0.58, 95% CI: 0.37, 0.90) than individuals most commonly injecting opium. Despite some limitations, these results suggest the presence of substantial heterogeneity between different injection drug-using groups in Georgia. Identification of high-risk IDU subpopulations is vital to efficiently target risk reduction programs and to prevent confounding by risk status in large HIV/AIDS behavioral intervention and vaccine trials.
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA. mkunihol@jhsph.edu
authors.forename: Mark H
authors.initials: MH
authors.lastname: Kuniholm
authors.forename: Malvina
authors.initials: M
authors.lastname: Aladashvili
authors.forename: Carlos
authors.initials: C
authors.lastname: Del Rio
authors.forename: Ketavan
authors.initials: K
authors.lastname: Stvilia
authors.forename: Nino
authors.initials: N
authors.lastname: Gabelia
authors.forename: Rohit A
authors.initials: RA
authors.lastname: Chitale
authors.forename: Tengiz
authors.initials: T
authors.lastname: Tsertsvadze
authors.forename: Kenrad E
authors.initials: KE
authors.lastname: Nelson
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005846:Georgia (Republic) / Q000453:epidemiology; D015483:HIV Antibodies / Q000032:analysis*; D015658:HIV Infections / Q000453:epidemiology; D006505:Hepatitis; D006509:Hepatitis B / Q000453:epidemiology*; D006510:Hepatitis B Antibodies / Q000032:analysis*; D006526:Hepatitis C / Q000453:epidemiology*; D018937:Hepatitis C Antibodies / Q000032:analysis*; D006801:Humans; D008297:Male; D012309:Risk-Taking; D016036:Seroepidemiologic Studies; D015819:Substance Abuse, Intravenous; D011795:Surveys and Questionnaires
chemical_list: D015483:HIV Antibodies; D006510:Hepatitis B Antibodies; D018937:Hepatitis C Antibodies