title: HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: implications for intervention.
abstract: BACKGROUND
  Following 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.
  
  
  METHODS
  In 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.
  
  
  RESULTS
  77% (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).
  
  
  CONCLUSIONS
  The injection of fentanyl is associated with elevated injecting risk behaviour derived from injection practice and situational risk factors, and needs urgently targeted interventions.
authors.affiliation: Estonian Drug Monitoring Centre, National Institute for Health Development, Hiiu 42, 11619 Tallinn, Estonia. ave.talu@tai.ee
authors.forename: Ave
authors.initials: A
authors.lastname: Talu
authors.forename: Kristiina
authors.initials: K
authors.lastname: Rajaleid
authors.forename: Katri
authors.initials: K
authors.lastname: Abel-Ollo
authors.forename: Kristi
authors.initials: K
authors.lastname: Rüütel
authors.forename: Mati
authors.initials: M
authors.lastname: Rahu
authors.forename: Tim
authors.initials: T
authors.lastname: Rhodes
authors.forename: Lucy
authors.initials: L
authors.lastname: Platt
authors.forename: Natalia
authors.initials: N
authors.lastname: Bobrova
authors.forename: Anneli
authors.initials: A
authors.lastname: Uusküla
mesh_terms: D000328:Adult; D000661:Amphetamine / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D062787:Drug Overdose; D004957:Estonia / Q000453:epidemiology; D005260:Female; D005283:Fentanyl / Q000008:administration & dosage*; D015658:HIV Infections / Q000150:complications / Q000175:diagnosis / Q000453:epidemiology*; D006801:Humans; D008297:Male; D016485:Needle Sharing / Q000706:statistics & numerical data; D015995:Prevalence; D012309:Risk-Taking; D013223:Statistics as Topic; D016320:Substance Abuse Treatment Centers / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000150:complications* / Q000523:psychology; D055815:Young Adult
chemical_list: D000661:Amphetamine; D005283:Fentanyl