Evolution of Illicit Opioid Use Among People With HIV Infection in St Petersburg, Russia, in the Period 2004–2015

E Blokhina; EM Krupitsky; DM Cheng; AY Walley; O Toussova; T Yaroslavtseva; N Gnatienko; C Bridden; LS Forman; S Bendiks; JH Samet

Disclosures

HIV Medicine. 2019;20(7):450-455. 

In This Article

Discussion

Across four cohorts of PLWH who use opioids recruited over the past 10 years in St Petersburg, Russia, a dramatic decrease of heroin use was observed. Use of opioids other than heroin or a combination of heroin with other opioids has surpassed heroin use alone in the period from 2004 to 2015. Additionally, two social trends were observed: (1) PLWH who use opioids in these studies are aging (mean age of 33.0 years in the latest cohort versus 24.5 years in the earliest); and (2) there has been an increase in self-reported unemployment in the cohorts (35.3% in 2004–2005 versus 65.3% in 2012–2015). The sites or recruitment approaches, including narcology hospitals, an infectious disease hospital, and snowball recruitment, do not explain why participants were not similarly aged. The data on ages of PWID are consistent with those of other studies in St Petersburg, Russia, where the mean age was 23.6 years in 2004 versus 32.8 years in 2014.[5]

Public health goals may be better achieved with an understanding of which opioids are used among PLWH. Recent findings from St Petersburg suggest that street methadone is the most commonly available opioid in the city, and its use is associated with less frequent injections than heroin and thus reduced injection-related HIV risk.[7] This may in part explain the observed trend of a decrease in injection-related HIV transmission and an increase in sexual transmission of HIV in Russia in recent years.[19] In a qualitative study among PWID in St Petersburg, some reasons participants cited for the initiation of methadone were the disappearance or irregularity of the heroin supply, a drop in the quality of heroin, longer effects of methadone and prevention of heroin withdrawal. Lastly, the need for fewer injections to prevent opioid withdrawal made this drug less expensive.[9]

The study has several limitations. First, it was a secondary data analysis and the entry criteria of each cohort were different. Differences in entry criteria and recruitment sites could partly explain the apparent temporal trends that were observed.

Secondly, data on methadone use explicitly were only available in two cohorts; therefore, assumptions were made about 'illicit opioids other than heroin' in the other cohorts. Thirdly, cohorts analysed in this study were from St Petersburg and the surrounding region, and the results may not apply to other regions of Russia. Lastly, we compared different age groups (mean age 24.5 years in PREVENT versus 33.3 years in ARCH in 2015). If the study had had a primary goal of exploring the change of substance use patterns over time and had assessed a population with a mean age closer to that of PREVENT participants, the results may have been different.

Despite these limitations, data from this analysis have value, as they reveal a change in the pattern of opioid use that may have implications for injection behaviour among PLWH in St Petersburg. Such data may in part explain HIV transmission patterns in Russia. These findings may be useful in the development of HIV prevention approaches to combat further HIV transmission, as some past interventions have been effective in targeting injection-related HIV risks in St Petersburg.[20]

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