Increased heroin use puts Colombia at risk of HIV epidemic among people who inject drugs

Heroin use and injection risk behaviors in Colombia: implications for HIV/AIDS prevention.

Mateu-Gelabert P, Harris S, Berbesi D, Cardona AM, Velez LP, Motta IE, Jessell L, Guarino H, Friedman SR.Subst Use Misuse. 2016 Jan 22:1-11. [Epub ahead of print]

Background: Heroin production in Colombia has increased dramatically in recent decades, and some studies point to an increase in local heroin use since the mid-1990s. Despite this rapid increase, little is known about the effects of these activities on heroin injection within Colombia. One of the biggest concerns surrounding heroin injection is the potential spread of HIV through drug user networks.

Objectives: This article examines injection risk behaviors among heroin injectors in the Colombian cities of Medellin and Pereira to explore the implications for possible increased HIV transmission within this group.

Methods: A cross-sectional study used respondent-driving sampling to recruit a sample of 540 people who inject drugs (PWID) over 18 years of age (Medellin: n = 242, Pereira: n = 298). Structured interviews with each participant were conducted using the World Health Organization Drug Injection Study Phase II Survey. An HIV test was also administered.

Results: Information regarding the socio-demographics, injection drug use, HIV risk and transmission behaviors, injection risk management, and HIV knowledge and prevalence of participants are reported. The study identified many young, newly initiated injectors who engage in risky injection practices. The study also found that HIV prevalence is fairly low among participants (2.7%).

Conclusions/Importance: Findings indicate a potential risk for the spread of HIV among PWID in Colombia given their widespread sharing practices, high rate of new injector initiation, and unsafe syringe cleaning practices. Colombia has a possibly time-limited opportunity to prevent an HIV epidemic by implementing harm reduction interventions among young, newly initiated PWID.

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Editor’s notes: Little is known about the prevalence of HIV or of HIV transmission risk factors among people who inject drugs in Colombia. There is evidence that the size of this key population has increased in recent years, coinciding with an increase in domestic production of heroin. This study used a novel sampling method to recruit 540 people who inject heroin from two cities in Colombia in 2010. Key findings are that the prevalence of HIV was 2.7% and that multi-person use of contaminated injecting equipment was common. Without imminent implementation of a needle-syringe programme, rapid transmission of HIV within this population – and to sexual partners in the general population - is to be expected. As injection drug use continues to expand in low- and middle-income countries, this study provides a template for researchers to collect data which can directly inform a policy response.

Latin America
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