The interview is based on the latest wave of the integrated Bio- behavioral surveillance survey conducted People Who Inject drugs (PWID) in 7 cities of Georgia. The research aims to measure the prevalence of Human Immunodeficiency Virus (HIV) and Hepatitis C virus (HCV) among PWID, define key risk behaviors related to HIV and generate evidence for advocacy and policy development.
The research was conducted in cooperation with the Bemoni Public Union and with the financial support of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Curatio International Foundation is grateful to Tamar Sirbiladze, the technical expert of the study for answering the questions.
1. What is the estimated number of drug users and related trend in the country?
According to the latest survey the estimated number of injecting drug users is 52,500. The rate of prevalence among adults (18-65 years old) is 2,24%. This is a rather high rate – we come third after Seychelles and Russia with the number of problem drug users. It should be emphasized that there is a clear trend of a steady increase in the number of PWID – such survey has been conducted in Georgia since 2009 and every two years the number of people who inject drugs increases by several thousand people.
Download the study findings: Population Size Estimation of People who Inject Drugs in Georgia 2016-2017
2. Which drugs are used mostly? Has anything changed compared to previous surveys?
Buprenorphine (Subutex and Suboxone) and heroine, especially its cheap variety – raw heroine (not pure heroine) are leading injecting drugs. Compared to the previous waive of the survey (2014), Buprenorphine consumption has almost doubled, while the heroine consumption rate has slightly decreased; the level of use of homemade injecting drugs prepared through mixing different medications bought from pharmacies – so-called Krokodil (Desomorphine), Vint (Methamphetamine) and Jeff (Methcathinone) – has sharply decreased. And a new injection drug has appeared – the so-called ‘niddles’ (‘Ephedra Vint’, the injecting drug prepared from evergreen Ephedra bush needles having a stimulating effect).
As for non-injecting psychoactive substances, consumption of cannabis (marijuana) and psychoactive medications is still very common among this population. Basically, they use psychoactive drugs with a dizzying effect. It should be noted that compared to previous years the rate of use of these medications has decreased.
3. Which risk behaviors are associated with PWID? What about a sharing practice?
In terms of the risk of HIV infection, PWID behaviors are basically divided into two groups. These are risk behaviors related to drug injection and sexual behaviors. Compared to previous surveys, the proportion of safe injection became better in every city; the practice of sharing previousely used needles/syringes and other injecting equipment has decreased. As for a sexual behavior, condom use with paid and occasional sexual partner is high, however, using condom with a regular sexual partner still presents a problem.
4. How would you evaluate the current situation with HIV and Hepatitis C prevalence?
It should be noted that the prevalence of HCV among PWI
D is much higher compared to HIV.
The average indicator of HIV prevalence has actually not changed since 2015; the survey revealed 47 confirmed HIV positive cases. The previous waives of the bio-behavioral surveilence survey also demonstrated a high prevalence of Hepatitis C virus.
Download the study findings: HIV risk and prevention behaviors among People Who Inject Drugs in seven cities of Georgia, 2017
5. Which cities in Georgia have a high prevalence of HIV and Hepatitis C?
According to the survey, Batumi has the highest HIV and HCV prevalence rate among the seven cities of the survey. Gori and Kutaisi also have leading positions in terms of HIV prevalence; the survey showed a decrease of HIV prevalence in Zugdidi in 2017, which had the highest rates during the previous two waives. Rustavi has the HIV lowest prevalence. The prevalence of HCV is also high in Tbilisi, Gori and Kutaisi, while Telavi has the lowest indicator.
6. 27% of study population have never been tested for Hepatitis C. Should we raise PWID awareness of the existing risks?
It is necessary to inform general population and especially the injecting drug user population about testing for Hepatitis C as well as about treatment. Unfortunately, the population has wrong opinions and views about the Hepatitis C elimination program. Some of our respondents are afraid to be involved in the program because of negative stereotypes associated with the treatment and, therefore they do not get tested either. Other drug users cannot get tests because they cannot afford clinical, laboratory and instrumental examinations.
7. According to the survey, 71% of PWID are unemployed and an average monthly income of the one third of respondents ranges from GEL 100 to GEL 300. Is this factor related to the risk behaviors the survey focuses on?
This is a rather interesting question, however our survey cannot answer this question. Generally, it is rather difficult to answer the question why people engage in behaviours posing risk to their health. There is a combination of a number of factors. One of the factors in term of PWID is the way of preparing a drug – if a drug solution is prepared in a common vessel, the risk of sharing injection equipment is higher; frequency of injection is another factor – the more frequently the person injects drugs, the higher is the probability of risky injection behaviors. Peer norms and views, level of awareness etc. also affect drug use behaviors. Coming back to your question, it is widely known that people with a higher social and economic status take much better care of their health.
8. The age of initial drug use for injecting and non-injecting drugs are 19 and 16 respectively, is this compatible with the global statistics?
According to our surveys, the age of initial drug use and injection has actually not changed since 2009. The figures do not differ much from other countries’ data.
9. According to the survey, the level of referral to narcological institutions is low. Almost half of respondents (47%) says that they do not want to undergo treatment. Does this figure indicate some gaps in access to the service or can it be explained by other factors?
We should point out in the first place that a wide range of behaviors related to drug use can be divided into two main categories in medical terms: casual drug use and drug addiction. Those people who do not use drugs regularly are not addicted, therefore they do not need treatment. As for drug addiction, i.e. the people who do need treatment, the main obstacle for them is access to treatment services – the number of hospital beds for this category of patients is limited. There is a sharp imbalance between the center and a region in terms of access to a respective service. The number of patients financed nationwide is limited. Therefore, patients have to wait for a long time to get a free treatment. Currently, the majority of drug addicts have to cover treatment costs themselves, which is one of the key obstacles to the treatment.
CIF prezented qualitative research findings about adherence to Drug Resistant TB treatment and led discussion around the findings – what can be done to improve treatment adherence among TB patients, looking through health system lens. The study report will be available by the end of January, 2017.