Journal of Public Health Advance Access published online on February 28, 2008
Journal of Public Health, doi:10.1093/pubmed/fdn014
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High-prevalence and high-estimated incidence of HIV infection among new injecting drug users in Estonia: need for large scale prevention programs
Anneli Uusküla, Chair, Department of Public Health1,
Mart Kals, Statistician1
Kristiina Rajaleid, PhD-Student2
Katri Abel, Researcher3
Ave Talu, Head of the Estonian Drug Monitoring Centre3
Kristi Rüütel, Expert4
Lucy Platt, Lecturer in Public Health Epidemiology5
Tim Rhodes, Professor of Public Health Sociology5
Jack DeHovitz, Professor6
Don Des Jarlais, Director of Research7
1 Department of Public Health, University of Tartu, Ravila 19, 50411 Tartu, Estonia
2 Centre for Health Equity Studies, SE-106 91 Stockholm, Sweden
3 Estonian Drug monitoring center, National institute for health development, 11619 Tallinn, Estonia
4 Development center, National institute for health development, Tallinn, Estonia
5 Centre for Research on Drugs and Health Behaviour, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
6 Department of Preventive Medicine and Community Health, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA
7 Edmond de Rothschild Chemical Dependency Institute, Beth Israel Medical Center, New York, NY 10003, USA
Address correspondence to Anneli Uusküla, E-mail: anneli.uuskula{at}ut.ee
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Abstract |
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Objective To examine HIV risk behavior and HIV infection among new injectors in Tallinn, Estonia.
Design and methods Data from two cross-sectional surveys of injecting drug users (IDUs) recruited from a syringe exchange program (N = 162, Study 1) or using respondent driven sampling (N = 350, Study 2). Behavioral surveys were administered; serum samples were collected for HIV testing. Subjects were categorized into new injectors (injecting 
3 years) and long-term injectors (injecting > 3 years).
Results Twenty-eight of 161 (17%, Study 1) and 73/350 (21%, Study 2) of the study subjects were new injectors. HIV infection was substantial among the newer injectors: HIV prevalence was 50% (Study 1) and 34% (Study 2), and estimated HIV incidence 31/100 PY and 21/100 PY, respectively. In Study 2, new injectors were more likely to be female and ethnic Estonian and less likely to be injecting daily compared with long-term injectors. No significant difference was found among two groups on sharing injecting equipment or reported number of sexual partners.
Conclusions A continuing HIV epidemic among new injectors is of critical public health concern. Interventions to prevent initiation into injecting drug use and scaling up HIV prevention programs for IDUs in Estonia are of utmost importance.
Keywords: Estonia, HIV, IDU, injection drug use, new injecting drug users