Abstract
BackgroundSeveral former Soviet countries have witnessed the rapid emergence of major epidemics of injection drug use (IDU) and associated HIV/HCV, suggesting that immigrants from the former Soviet Union (FSU) may be at heightened risk for similar problems. This exploratory study examines substance use patterns among the understudied population of opioid-using FSU immigrants in the U.S., as well as social contextual factors that may increase these immigrants' susceptibility to opioid abuse and HIV/HCV infection.MethodsIn-depth interviews were conducted with 10 FSU immigrants living in New York City who initiated opioid use in adolescence or young adulthood, and with 6 drug treatment providers working with this population. Informed by a grounded theory approach, interview transcripts were inductively coded and analyzed to identify key themes.ResultsThe "trauma" of the immigration/acculturation experience was emphasized by participants as playing a critical role in motivating opioid use. Interview data suggest that substance use patterns formed in the high-risk environment of the FSU may persist as behavioral norms within New York City FSU immigrant communities - including a predilection for heroin use among youth, a high prevalence of injection, and a tolerance for syringe sharing within substance-using peer networks. Multiple levels of social context may reproduce FSU immigrants' vulnerability to substance abuse and disease such as: peer-based interactional contexts in which participants typically used opioids; community workplace settings in which some participants were introduced to and obtained opioids; and cultural norms, with roots in Soviet-era social policies, stigmatizing substance abuse which may contribute to immigrants' reluctance to seek disease prevention and drug treatment services.ConclusionSeveral behavioral and contextual factors appear to increase FSU immigrants' risk for opioid abuse, IDU and infectious disease. Further research on opioid-using FSU immigrants is warranted and may help prevent increases in HIV/HCV prevalence from occurring within these communities.
Highlights
Several former Soviet countries have witnessed the rapid emergence of major epidemics of injection drug use (IDU) and associated HIV/HCV, suggesting that immigrants from the former Soviet Union (FSU) may be at heightened risk for similar problems
6 drug treatment providers with extensive clinical experience with substance-using FSU immigrants were interviewed in order to access their expert insight into drug use patterns and drug treatment issues characteristic of FSU immigrants that may distinguish them from other groups of opioid users in New York City (NYC). (Treatment-related findings will be reported in a separate paper.)
Natalia points out that, in contrast to alcohol, it is easier to conceal one’s use of heroin from others - perhaps a critical factor within a culture that heavily stigmatizes substance use: “With heroin, it’s one of the drugs that is not very visible when you use it... you can hide and you can camouflage, and it kind of gives you that protection... “ Yet, for almost all interviewees, this sense of “control” proved to be illusory, as their dependence grew beyond their ability to manage. These findings suggest that a distinct set of sociocultural, historical and behavioral factors coalesce within NYC’s FSU immigrant community to comprise a particular risk environment that may be conducive to opioid abuse and IDU and may facilitate the spread of HIV and similar diseases
Summary
Several former Soviet countries have witnessed the rapid emergence of major epidemics of injection drug use (IDU) and associated HIV/HCV, suggesting that immigrants from the former Soviet Union (FSU) may be at heightened risk for similar problems. Immigrants from the vast, multi-ethnic territory of the FSU are a heterogeneous group with varied ethnic/racial identifications and religious affiliations - e.g., ethnic Russians, Central Asians, Jews and Christians They tend to see themselves as unified by their common history of living in the Soviet or former Soviet state, their shared use of the Russian language and a certain shared cultural identity [3,4]. A focus on “FSU immigrants” or “Russian-speaking immigrants” has become a standard approach in research on this population
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