MANAGING THE QUALITY OF BEHAVIOR ON HIV AMONG INJECTING DRUG USERS IN PRISHTINA

Although Kosovo is a country with low HIV prevalence, the exposure to HIV among injecting drug users (IDUs) may be considerably higher. To assess the quality behaviors of HIV, HBV, HCV and Syphilis, as well HIV-relevant behavioral risks, a bio-behavioral RDS study was carried out in this key population in Prishtina in 2011. The study was a part of the second wave of HIV surveillance among most-at-risk populations. (The first wave was completed in 2006.) In total, 205 IDUs (of whom five were seeds) were tested and interviewed in the July-August 2011 period. Age range in the sample was 19-54 (Mean age = 31.0; SD = 7.14). Most participants were men (179/200; EPP 1 = 88.7%). In regard to education, the largest percentage of recruited IDUs had completed secondary education (EPP = 49.3%). Slightly less than a third of respondents have been married at the specific time the study have been carried on (EPP = 30.9%). Permanent employment was reported by 35.1% (EPP) of IDUs in the sample. No HIV+ cases were found. Four IDUs were infected with Syphilis (EPP = 2.0%; 95% CI = 0.3-4.3), 16 with HBV (EPP = 6.0%; 95% CI = 3.0-10.5) and 96 with HCV (EPP = 37.4%; 95% CI = 28.9-46.8). Of the HBV+ individuals, two were diagnosed as having an acute and nine as having chronic infection. A majority of IDUs were alone the last time they injected drugs (EPP = 63.0%). In the past week, 187 of 197 participants (EPP = 97.3%) did not share injecting equipment. A majority of IDUs (158/198; EPP = 83.8%) stated that they always use sterile injecting equipment. Slightly over a half of participants (EPP = 51.8%) were ever treated for drug abuse. In regard to sexual behaviors, a majority of recruited IDUs were sexually active in the month preceding the study (EPP = 74.1%), of which about a quarter had multiple sexual partners (EPP = 27.1%). A minority of participants had regular sexual partner who was also injecting drugs (EPP = 8.5%). Less than a third of the surveyed IDUs used condoms consistently in the past month (EPP = 30.3%). About one fifth of participants (EPP = 22.0%) answered correctly to all five standard UNGASS HIV knowledge indicators. Although the study met all basic requirements of RDS methodology (Johnston et al., 2009), generalizability of the findings should be approached with caution due to a relatively small sample size and the fact that a majority of recruited IDUs have used Labyrinth drop-in and needle-exchange services in the past. The findings point to low levels of injecting equipment sharing, although the prevalence of HCV infection suggests that this is a recent development. Relatively infrequent and inconsistent condom use, coupled with low HIV risk self-assessment, emphasizes a need for a stronger promotion of condom use in the population. Overall, the observed changes in the levels of risk-taking behaviors in this key population confirmed the importance of repeated high-quality biobehavioral HIV surveys in this key population (Zaba et al., 2005; Brown, 2003). 1 EPP = estimated population proportion (RDS-weighted percentage) European Journal of Research and Reflection in Management Sciences Vol. 4 No. 3, 2016 ISSN 2056-5992 Progressive Academic Publishing, UK Page 25 www.idpublications. org INTRODUCTION The fact that injecting drug use (IDU) has been responsible for a rapid spread of HIV epidemic in a number of countries world-wide (Aceijas & Rhodes, 2007; Reintjes & Wiesing, 2007; Jarlais, 2009) was taken as a starting point for setting surveillance priorities in Kosova. Apart from direct risks of HIV transmission through sharing injecting equipment, IDUs’ vulnerability stems from the characteristics of the social environment in which they commonly live (Rhodes et al., 2005; Strathdee, 2010). Poverty and poor health, inaccessibility of health services, violence, and lack of social support are typical characteristics of the social world in which many IDUs live. 2 Coupled with the existential centrality of securing a daily dose of drugs, such living conditions foster short-term planning and a high tolerance to a range of health risks. Despite the currently low levels of HIV risk in Kosovo (between 1986 and 2008, 74 HIV/AIDS cases were registered, mostly among migrant workers; Kosovar AIDS Committee, 2009), several potential drivers of the HIV epidemic remain present. Widespread poverty, high unemployment rates, and a rapid pace of societal transformation, which has been coupled with political instability and security issues related to the ongoing dispute with Serbia, provide a socio-cultural background conducive to risk taking. In addition, a growing drug problem (Arenliu & Donoghoe, 2001; Labyrinth, 2007) – closely associated with organized crime and the fact that Kosovo is on an important international drug trafficking route (heroin is relatively cheap in Kosovo) – has been increasing potential exposure to HIV, particularly among young people. According to a 2007 research report, about 3000 individuals may be injecting drugs in Kosovo, a half of them in Prishtina (Labyrinth, 2007). The number was expected to rise to about 5000 in 2012. It has been suggested that age at first heroin injection is decreasing and that the prevalence of IDU may be increasing among young women. In the 2007 mapping study carried out by the Labyrinth, an NGO working with IDU population, difficulties with obtaining sterile injecting equipment were noted. Taking into consideration the plan of action stipulated by Kosovo Strategic Plan on HIV/AIDS 2009-2013 (Kosovar AIDS Committee, 2009), which emphasized the need to strengthen the national HIV surveillance system focusing on key populations at risk, three BBS studies were carried out in 2011 among men having sex with men (MSM), female sex workers (FSW), and Injecting Drug Users (IDUs). A commitment to using high-quality, state of the art methodology was judged essential for all research activities within the Second generation HIV surveillance (SGHS) framework – both in terms of capacity building and future data comparability. In this report, findings from the bio-behavioral surveillance study carried out using RDS methodology among IDUs in Prishtina are presented and discussed. The primary aims of the study were to provide biological and behavioral indicators of HIV exposure in this key population and to compare the levels of risk exposure to those observed in the first surveillance round (2006; cf. Impact, 2007). 2 For the situation in Kosovo, see the recent Kosovar AIDS Committee report (2009). European Journal of Research and Reflection in Management Sciences Vol. 4 No. 3, 2016 ISSN 2056-5992 Progressive Academic Publishing, UK Page 26 www.idpublications. org METHOD