Abstract
BackgroundInjecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce HIV-transmission. However, former injecting drug users (fIDUs) are often overlooked as a high risk group for HIV transmission. We compared HIV risk behavior among current and former injecting drug users (IDUs) in Indonesia, which has a rapidly growing HIV-epidemic largely driven by injecting drug use.MethodsCurrent and former IDUs were recruited by respondent driven sampling in an urban setting in Java, and interviewed regarding drug use and HIV risk behavior using the European Addiction Severity Index and the Blood Borne Virus Transmission Questionnaire. Drug use and HIV transmission risk behavior were compared between current IDUs and former IDUs, using the Mann-Whitney and Pearson Chi-square test.ResultsNinety-two out of 210 participants (44%) were self reported former IDUs. Risk behavior related to sex, tattooing or piercing was common among current as well as former IDUs, 13% of former IDUs were still exposed to contaminated injecting equipment. HIV-infection was high among former (66%) and current (60%) IDUs.ConclusionFormer IDUs may contribute significantly to the HIV-epidemic in Indonesia, and HIV-prevention should therefore also target this group, addressing sexual and other risk behavior.
Highlights
Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia
With help from local non-governmental organizations involved in outreach to injecting drug users (IDUs), three current IDUs (cIDUs) and three former injecting drug users (fIDUs) from different parts of Bandung were selected to act as ‘seeds’ for RDS and invited to a community clinic which has a specific program for IDUs
Current IDUs obviously had much higher risks of viral transmission related to injecting drugs, and former IDUs had risks related to blood to blood transmission
Summary
Injecting drug use is an increasingly important cause of HIV transmission in most countries worldwide, especially in eastern Europe, South America, and east and southeast Asia. Among people actively injecting drugs, provision of clean needles and opioid substitution reduce HIV-transmission. Former injecting drug users (fIDUs) are often overlooked as a high risk group for HIV transmission. HIV-prevention programs for injecting drug users (IDUs) put emphasis on people actively injecting drugs, especially through needle exchange or opioid replacement. Besides active IDUs, people who have a previous history of injecting drug use (former IDUs) are probably an important risk group for HIV transmission. Sporadic studies from western countries have shown that former IDUs (fIDUs) may have a high risk of becoming HIV-infected or spreading. No studies on fIDUs have been reported from low- or middle-income countries
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