People who inject drugs: methods
Goal
The study goal was to gather strategic information regarding the risk factors contributing to
transmission of HIV, virus of Hepatitis B and C, and Sexually Transmitted Diseases in people who inject
drugs and their steady sexual partners for a better advocacy, planning, and design of the future
prevention programs.
Objectives:
1. To collect data for non-routine HIV surveillance purposes on people who inject drugs and their
steady sexual partners
2. To measure knowledge, attitudes and risk practices related to HIV and AIDS, Viral Hepatitis B
(HVB) and C (HVC), and Sexually Transmitted Diseases (STDs) among people who inject drugs
and their steady sexual partners in three main cities (municipality of Chisinau, municipality of
Balti and Tiraspol town).
3. To measure the seroprevalence of HIV, HCV, HBV and Syphilis in the people who inject drugs
and their steady sexual partners in three main cities (municipality of Chisinau, municipality of
Balti and Tiraspol town)
4. To contribute to the estimation of the size of the population of people who inject drugs in the
three main cities of the Republic of Moldova (municipality of Chisinau, municipality of Balti and
Tiraspol town).
Target groups
1. Person who injects drugs is a person of both sexes aged 18 and older who injected any type of
drugs at least once during the last 12 months.
2. Sexual partner of the person who inject drugs, participating in the study and identified by the
respondent as steady sexual partner according to the definition .
Inclusion/Exclusion Criteria for people who inject drugs
Inclusion criteria:
1. Self reported drug injection at least once in the last 12 months before the interview,
2. Physical and mental ability to understand the questionnaire, testing, and other instructions in
the study,
3. Provide informed consent at least for the questionnaire,
4. Aged 18 years and older,
5. Oral statement of living in geographical limits for each implementation location (municipality of
Chisinau, Balti and Bender and Tiraspol and surrounding localities) in the past 12 months,
6. Valid recruitment coupon for main sample.
Exclusion criteria:
7.
8.
9.
10.
1
Participation in the current study in another data collection site (locality)
Valid recruitment coupon for another data collection site1
Valid recruitment coupon for sexual partner
Enrolment in methadone substitution treatment
The recruitment cupons for the 3 localities and each target groups were of different colours .
Inclusion/Exclusion Criteria for steady sexual partners of the people who
inject drugs recruited within the study
Inclusion criteria:
1. Physical and mental ability to understand the questionnaire, testing, and other instructions in
the study,
2. Provide informed consent at least for the questionnaire,
3. Aged 18 years and older,
4. Oral statement of living in geographical limits for each implementation location (municipality of
Chisinau, municipality of Balti and Bender and Tiraspol towns and surrounding localities) in the
past 12 months,
5. Valid recruitment coupon for sexual partners’ sample.
Exclusion criteria:
6. Participation in the current study in another data collection site (locality)
7. Valid recruitment coupon for another data collection site
8. Valid recruitment coupon for main sample
Study Type
The study is:
 Multi-centric (3 implementation sites – municipality of Chisinau, municipality of Balti and
Tiraspol town)2
 Population-based
 Cross sectional
 Questionnaire-based,
 Linked with the qualitative testing for antibodies to HIV, HCV. HBV and Treponema Pallidum.
Sampling and Recruitment
Respondent Driven Sampling was applied. The recruitment was conducted independently in three
established study areas (municipality of Chisinau, municipality of Balti, and Tiraspol city). In each
location 6-10 persons - „seeds” were selected to represent different strata of people who inject drugs
(age group, opiate/ephedrine users, males/females, beneficiaries/non beneficiaries of harm reduction
services). Each respondent for participation received the primary incentive of 40-80 MDL (equivalent to
US $3.3-6.73). There were issued a maximum number of three coupons. The respondents received
secondary incentive of 25-50 MDL (equivalent to US $2 – 4.2).
An additional coupon4 was given to the respondents who reported having a steady sexual partner to
recruit him/her as well. For recruitment of sexual partner, the respondent received the secondary
incentive as well. The recruited sexual partner received incentives for participation and was not given
coupons for recruitment of other respondents. Maximum one coupon per respondent for sexual partner
was given and only one sexual partner per coupon was accepted in the study.
2
Data bases were not merged for analysis. Analysis was caried out for each site separatly.
The amount t of incentives varied according to the living standards in each of data collection localities and based
on the results of the formative research conducted before the study.
4
The cupon for sexual partners were of different colour than that for the main sample and of different colours in 3
data collection locations.
3
If the respondent refused blood taking, s/he received primary incentives of lower value (25 - 60 MDL or
equivalent to US $2 - 5).
The recruited samples by data collection locations are presented in the Table 1.
Table 1 The recruited samples by implementation locations of the Integrated Bio-Behavioral Survey in people who inject
drugs and their steady sexual partners, Republic of Moldova, 2009
No
1.
2.
3.
Name of implementing
organization
Youth friendly center “ATIS”
“Medical Reforms” NGO
“Healthy Generation” NGO
Location
Balti
Chisinau
Tiraspol
Sample size of people
who inject drugs
369
328
281
Sample size of steady
sexual partners
49
48
19
Data Collection
Data collection was carried out during the period of June 12-October 15, 2009.
The questionnaire was available in Romanian and Russian. The questionnaire was developed on the
basis of the recommendations developed by Family Health International for the Behaviour Surveillance
Survey among IDUs5 and the questionnaire applied in 2007 within the integrated bio-behavioral study6.
The chapter on drug use initiation and overdoses was developed by UNICEF consultants and LSHTM.
According to the method, after the questionnaire was administrated, 5-ml blood samples were
collected. The unique identifiers of the questionnaire and of the blood sample were identical, which
allowed the analysis of the results of the behavioral and biological components to be linked. In few cases
blood sample collection was refused or was impossible because of inaccessible veins (Table 16).
According to the method, the blood testing was linked and the respondents were notified about the
results, and pre- and post-test counseling was carried out. The testing was carried out in the national
reference laboratories in the Chisinau municipality and this fact increased the time of results delivery up
to 2-3 weeks. The laboratory methods applied for the testing for HIV, HCV, HBV, and Treponema
Pallidum antibodies are shown in Error! Reference source not found..
Each respondent received a set of informational materials on HIV prevention and the list of service
providers within the limits of the data collection locality and at national level.
Confidentiality/Anonymity
The survey was carried out under confidentiality/anonymity conditions. These conditions were assured
as follows:
1. Respondent’s name and surname were not used throughout the entire participation in the
survey. No records with the respondent’s name and surname were used,
2. Respondent’s name and surname did not serve as basis for the formula generating
questionnaire unique code, thus it is not possible to identify the respondent directly or
indirectly,
3. Every person involved in survey implementation signed an agreement, committing
himself/herself to respect the survey frame of confidentiality/anonymity.
5
Family Health International. "Behavior Surveillance Surveys: Guidelines for Repeated Behavioral Survey in
Population at Risk for HIV." 2004.
6
Scutelniciuc et. all
Data Quality Assurance
Several procedures were used within the study to assure data quality:
1.
2.
3.
4.
5.
6.
7.
8.
Staff training,
Progress reports on study implementation,
Field visits
Different colors coupons for each of target groups and for each of data collection locations
Regular verifications of the coupon management data base,
Questionnaire verification,
Double data entry,
Statistical data comparison.
Data analysis
The data collected in people who inject drugs were analyzed using the RDSAT software version 5.6.0. For
generation of numeric averages the weighted data were exported into SPSS software version 13.0.
The data collected among steady sexual partners of people who inject drugs were analyzed using the
SPSS software version 13.0.
Study limitations
All data were collected on self reporting basis, which encompasses social desirability in answers. Recall
bias might have occurred in answers of IDUs who experience less frequent actualization of events the
questionnaire mentioned as occurring over the last year and last month (such as last injection, last
sexual intercourse, etc.).
People who inject drugs living in Balti municipality: Results
Socio-Demographic Structure
Sex and Age
The study sample consists of 81.0% males and 19.0% females. The respondents’ ages vary between 18
and 52 years old. The majority of the study respondents belong to the group aged 25 years old and over
(85.4%) The 30-34 age group has the largest share in the study sample (26.6%), both for males (26.1%)
and females (30.8%).The mean ages are approximately the same for males and females. Significant
difference is registered in case of median age, females being older than males (Table 2).
Table 2 Socio-Demographic Structure of the Sample, people who inject drugs living in Balti municipality, Republic of
Moldova, 2009
Total
18 – 19 years old
20 – 24 years old
25 – 29 years old
30 – 34 years old
35 – 39 years old
40 – 49 years old
50 years old and >
Total
#
11
39
75
92
81
68
4
370
Males
%
3.0
12.1
22.8
26.6
19.4
15.4
0.8
-
#
9
32
64
65
60
56
3
289
Females
%
3.0
11.3
23.5
26.1
19.7
15.8
0.7
-
#
2
7
11
27
21
12
1
81
%
2.4
23.8
13.0
30.8
18.8
10.1
1.1
-
Mean age, years
SD, years
Median age, years
31.9
7.3
32
31.8
7.4
30
32.0
6.8
33
Marital status
When asked about their marital status, the largest group of respondents reported being single 42.9%. Of
the sample36.7% were married or living in a partnership. The share of males who are married or who
are living in a partnership (35.0%) is lower than the share of married females or females living in a
partnership (44.3%). To be noted the high share of divorced (16.1%) in the recruited sample both for
males (15.9%) and females (16.6%) The sample’s distribution, based on the marital status, is shown in
the Table 3.
Table 3 Marital status of the respondents, distribution based on gender and age group, IDUs from Balti municipality, %,
Republic of Moldova, 2009
Single
Married
Living in partnership
Divorced
Widowed
Total
42.9
12.5
24.2
16.1
4.2
Males
47.8
13.8
21.2
15.9
1.3
Females 25 years and older Under 25 years old
22.3
35.9
83.2
7.3
14.8
0.8
37.0
26.0
16.0
16.6
18.5
0.0
16.7
4.9
0.0
The share of respondents who are married or who are living in a partnership is larger in the age group of
25 years old and over both for males (38.9%) and females (49.9%) in comparison with the age group
under 25 (12.6% for males and 30.3% for females).
Educational level
The majority of the respondents completed secondary education or specialized secondary education
(65.3%). About fourth of respondents (17.5%) have not finished the secondary incomplete school level
(Table 4).
Table 4 Educational level, distribution based on gender and age group, people who inject drugs living in Balti municipality,
%, Republic of Moldova, 2009
Primary school (4 grades)
Less than 9 grades
Incomplete secondary
education
Complete secondary
education
Specialized secondary
education
Incomplete higher
education
Higher education
Total
1.0
16.5
Males
1.1
18.1
Females 25 years and older Under 25 years old
0.2
1.0
0.7
7.8
13.8
33.1
6.1
6.4
5.6
6.2
6.9
39.2
39.0
43.5
37.5
39.8
26.1
25.2
28.2
30.0
11.5
6.8
4.4
5.4
4.8
12.5
2.2
6.8
4.7
6.4
1.6
Language spoken and area of residency
Of the sample, 7.2% stated that most of the time they prefer to speak Moldovan/Romanian; 92.6%
prefer to use Russian and 0.2% of the respondents prefer other languages. There are no differences
between males (91.5% prefer Russian) and females (92.4% prefer Russian).
At the time of the interviews about 99.7% of the respondents were living in large urban areas and 0.3%
in rayon centers or other small urban localities around or part of the Balti municipality.
Mobility
Of the sample, 93.3% were born in the Republic of Moldova. The rest of 6.7% were born outside, but in
one of the former Soviet Union republics.
The respondents were living in the current area of residency 30.9 years on average (median –31.0,
SD=±8.7). Hence, respondents came to the Balti municipality 1-2 years old and were living there
permanently during there lifetime (Table 2). The vast majority of the respondents (82.0%) had not been
away from the area of their residence for longer than one month during the last year (Table 5).
Table 5 Being away from the area of residence for longer than a month during the last year, people who inject drugs living in
Balti municipality, %, Republic of Moldova, 2009
Being away from the area
of residence for longer
than a month during the
last year
Total
Males
Females
25 years and older
Under 25 years old
18.0
18.3
16.9
19.0
12.0
A higher rate of mobility within the last 12 months was registered in the case of respondents of 25 years
and older compared to respondents younger than 25.
Economic status
Employment and Income
Only 14.5% of the sample reported permanent employment. Half of respondents (50.6%) reported to be
unemployed at the interview time7.
7
Housekeepers were not taken into account in the calculation of the unemployment share.
Figure 1 Employment status, people who inject drugs living in Balti municipality, %, Republic of Moldova, 2009
The proportion of those unemployed is higher in the subsample of male respondents (52.1%) compared
to the female subsample (44.7%). The rate of housekeepers among female respondents is of 8.0%.
Respondents younger than 25 years less frequently are unemployed (48.3%) compared to those who are
25 and older (53.3%).
Of the total survey sample, 35.8% reported having no income (Figure 2). Another 2.8% lives in extreme
poverty on 330 MDL8 or less a month, equivalent to less than US$1/day, and 6.1% live on less than
US$2/day. Females and those younger than 25 years old reported a higher income.
8
In 2009 the annual average exchange rate of US 1$ was of 11.1134 MDL
Figure 2 Monthly income, people who use injecting drugs living in Balti municipality, %, Republic of Moldova, 2009
Ability to pay
More than half of respondents could pay for water bills (55.2%), electricity bills (57.8%) and medicines
for emergency situations (53.4%) (Figure 3). For less than half of respondents home heating (39.1%) and
meals with meat or fish every other day (28.6%)are within their means.
Figure 3 Ability to pay for basic items, people who inject drugs living in Balti municipality, %, Republic of Moldova, 2009
Unexpectedly high percent of respondents (11.4% – 20.3%) stated that they can afford to buy new items
which are part of the life comfort products (TV set, fridge, furniture, washing machine).
Drug Use
Legal drug use
Of the sample, 95.7% were smokers at the interview time and 98.6% of the sample has ever smoked
tobacco. Last month prevalence of the alcohol use in the recruited sample was of 85.3%.
Length of Illegal Drug Use
According to the respondents’ answers, the length of their drug use generally varies between one year
and 32 years. The mean length of drug use within the sample studied is of 12.8 years (median – 12.0,
SD=±7.2).
The length of injecting drug use varies between one year and 30 years. The mean length of injecting
drug use within the sample studied is 10.8 years (median – 10.0, SD=±7.1). The mean length of injecting
drug use in males is 11.0 years (median – 10.0, SD=±7.2), and in females it is 10.1 years (median – 9.0,
SD=±6.6). In the vast majority of cases the respondents’ first experience of injecting drugs occurred 3
years or more before the study (89.5%) (Figure 4).
Figure 4 Sample distribution based on length of injecting drug use, people who inject drugs living in Balti municipality, %,
Republic of Moldova, 2009
About 10.5% of the respondents have been using injecting drugs for less than 3 years (39 respondents),
these being the new entrants to the key population at higher risk. They are 24.2 years old on average
(median – 23.0, SD=±6.0) and 73.7% of them are males.
Initiation of Drug Use
According to the respondents’ answers, the age at which they first injected varies between 12 and 47
years. The first injection of drugs occurred at 21.3 years old on average (median - 20.0 years, SD=±5.7 )
with homemade extract of opium (shirka) (in 91.6% of cases), after an average of 2.0 years of non
injecting drug use (median –0.09, SD=±3.0). Among drugs used at first injection there was as well
ephedron (3.8%), heroine (2.7%), metamphetamines (1.3%) or other drugs (0.7%).
While the length of the injecting drug use is increasing, the mean age at first injection is decreasing
(Table 6).
Table 6 Mean age at first drug injection by length of drug injection, people who inject drugs living in Balti municipality, %,
Republic of Moldova, 2009
Length of injecting drug use
3 years and less
4 – 6 years
7 – 9 years
10 years and more
9
Less than 1 year.
# respondents
59
46
43
221
Mean
23.6
24.4
22.5
19.9
Median
21.0
23.5
20.0
19.0
SD
±7.0
±5.8
±6.3
±4.7
Total
369
21.3
20.0
±5.7
In 95.3% of cases, the initiation in injection of drugs was done by somebody else than the respondents
themselves. In most of the cases, the initiator has been part of the close social environment (friend 42.1%, acquaintance - 45.0%, sexual partner - 7.0% and siblings - 3.5%) and on average 3.4 years older
(mean age – 24.7 years, median –24.00, SD=±6.0) than the respondents themselves. At first injection,
14.8% of people who inject drugs used unsterile needles/syringes.
Most of the respondents agreed that prior to the first injection they had become curious as to what
injecting would be like (94.0%). Almost half of them wanted to inject drugs to be the same as their
friends (57.3%) and had come to see injecting as something that could be a good experience (46.0%).
About two thirds of the people who inject drugs (59.8%) have ever been asked to help with the initiation
in injection of drugs and one fifth (20.6%) have ever helped, being aware of the fact of initiation. Per
respondent who have ever been asked to help with the initiation, there were on average 0.5 persons in
last month (median –0.0, SD=±1.1) and 1.5 persons in the last 6 months (median –1.0, SD=±2.5). Per
respondent who have ever helped someone else, being aware of the fact of initiation, there were 0.5
persons on average in the last month (median – 0, SD=±1.3) and 1.2 persons on average in the last 6
months (median –1.0, SD=±1.9) who were helped with the initiation injection by the respondents
themselves. There may be underreporting due to social desirability. The last initiated were 21.9 years
old on average (median – 20 years, SD=±4.7).
Drugs Used During Lifetime
The recruited sample has used during the lifetime a diversity of injecting and non injecting drugs. Vast
majority mentioned lifetime use of no injecting drugs (cannabis) which occurred about 1-2 years before
the first injection. Every tenth respondent has ever sniffed glue and did it for the first time about 1-2
years before the first injection (Table 7).
Table 7 Lifetime prevalence of drug use, age and method at first use, people who inject drugs from Balti municipality, %,
Republic of Moldova, 2009
Type of drugs
Lifetime
Age at first use
prevalence, % Mean/median/SD
Method at first use, %
Inject
Smoke
99.2
-
Glue
Marijuana
Heroin
Methadone
Morphine
9.9
75.3
47.2
9.1
13.6
18.9/17.0/±6.5
18.3/17.0/±5.0
24.8/24.0/±7.1 98.0
33.2/32.8/±9.4 27.5
23.4/23.1/±6.0 100.0
Cocaine
5.1
27.3/27.0/±6.9
100.0
-
1.4
39.5
8.0
25.3
6.9
14.6
23.9/24.0/±6.5
19.3/18.0/±5.1
26.0/24.6/±10.2
22.6/23.0/±5.1
22.0/22.0/±4.4
25.7/25.0/±6.6
+
48.8
6.9
-
100.0
-
100.0
21.3/20.0/±5.7
95.0
-
Kalipsol
Hashish
Amphetamines
Tranquilizers
LSD
Ecstasy
Extract of opium
(“shirka”)
Sniff
Swallow
Age at first injection
Mean/median/SD
100.0
2.0
24.7/24/±7.1
72.5
31.4/32/±8.2
23.6/24/±6.0
60.9
4.3 (0.0) 31.6/35.5/±7.7
(0.0)
+
+
27.3/24/±5.7
0.0
51.2
28.3/27/±9.7
93.1
21.7/21/±5.0
100.0
100.0
-
5.0
21.5/20/±5.7
Ephedron
Metamphetamines
Codeine
34.5
16.9
29.7
21.0/21.0/±0.5
24.8/25.0/±2.4
24.0/24.0/±6.4
97.5
100.0
-
-
-
2.5
100.0
21.0/21/±0.5
24.8/25/±2.4
-
Historically the ephedrone was widely injected by people who inject drugs living in Balti municipality.
Thus, about third of respondents (34.5%) have ever tried ephedrone and injected it for the first time at
the age close to the initiation average age (Table 6). This drug is rarely injected currently in Balti
municipality. Thus, of those who injected in the last month, 3.1% have ever injected it in the last month
and for only 1.3% it was the main injected drug in the last month (Table 11).
Last Injection
When asked about the last time they had injected, 79.4% of the sample mentioned the last month,
14.3% more than one month ago, but during the last 3 months prior to the interview, and 6.3% of the
respondents had last injected drugs more than 3 months prior to the interview..
The rate of injecting during the last month was lower among females (66.8%) than among males
(82.4%). Comparing the results for each age group, a lower rate of injecting during the last month prior
to the interview was registered in respondents aged 25 years old and over (78.7%) compared to
respondents aged under 25 (86.5%).
Places for Injecting Drugs
Being asked where they have injected drugs most frequently during the last month, the majority of
respondents mentioned their private house/apartment (70.4%). About 16.5% mentioned the place
where the injection drug users congregate to inject drugs, 5.1%- the dealer’s house and 2.6% - in public
places (Table 8).
The disaggregation by age groups and length of drug injection is presented in the Table 8 and Compared
with respondents 25 years and older, those younger than 25 years and those with a shorter length of
drug injection less frequently injected in private house/apartment, but more frequently in the dealer’s
house/apartment and in places where people who inject drugs congregate to inject drugs (Table 8 and
Error! Not a valid bookmark self-reference.).
Table 9.
Table 8 The most frequent place for injecting drugs during the last month, disaggregation by age group, people who inject
drugs living in Balti municipality, %, Republic of Moldova, 2009
In private house, apartment, %
At a public institution, on premises, %
In a bathroom, %
In a dealer’s house/apartment, %
In a public place, %
In an abandoned building, %
In a building’s basement, %
In the place where people who inject
drugs congregate to inject drugs, %
Other, %
Total respondents, #
Total
70.4
0.2
0.0
5.1
2.6
1.1
2.1
Less than 25
years old
48.7
2.3
1.0
19.7
5.7
7.1
3.7
25 years and
older
71.6
0.2
0.2
3.4
2.4
0.4
2.2
16.5
10.8
16.7
1.9
289
1.0
42
2.9
247
Compared with respondents 25 years and older, those younger than 25 years and those with a shorter
length of drug injection less frequently injected in private house/apartment, but more frequently in the
dealer’s house/apartment and in places where people who inject drugs congregate to inject drugs (Table
8 and Error! Not a valid bookmark self-reference.).
Table 9 The most frequent place for injecting drugs during the last month, disaggregation by length of injection drug use,
people who inject drugs living in Balti municipality, %, Republic of Moldova, 2009
In private house, apartment, %
At a public institution, on premises, %
In a bathroom, %
In a dealer’s house/apartment, %
In a public place, %
In an abandoned building, %
In a building’s basement, %
In the place where people who inject
drugs congregate to inject drugs, %
Other, %
Total respondents, #
3 years and
less
49.1
1.7
1.1
18.8
7.1
6.2
3.9
4 – 6 years
7 – 9 years
76.9
1.2
1.2
2.8
3.3
1.2
2.8
63.1
1.4
1.6
1.4
0.9
1.4
1.8
10 years
and more
69.5
0.4
0.4
4.8
1.6
0.4
2.0
11.2
9.4
3.3
20.4
1.1
46
1.2
40
2.5
29
0.6
173
Compared to males, females more frequently injected in dealer’s house/apartment. In case of males,
they mentioned more frequently than females the place where injecting drug users congregate to inject
drugs (Table 10).
Table 10 The most frequent place for injecting drugs during the last month, disaggregation by gender, people who inject
drugs from Balti municipality, %, Republic of Moldova, 2009
In private house, apartment, %
At a public institution, on premises, %
In a bathroom, %
In a dealer’s house/apartment, %
In a public place, %
In an abandoned building, %
In a building’s basement, %
In the place where people who inject
drugs congregate to inject drugs, %
Other, %
Total respondents, #
Total
70.4
0.2
0.0
5.1
2.6
1.1
2.1
Males
70.1
0.3
0.2
2.6
2.6
1.1
2.6
Females
68.6
0.8
0.8
19.9
0.8
0.8
0.8
16.5
17.9
6.6
1.9
289
2.6
238
0.8
51
Drugs Used During the Last Month
The most commonly injected drug during the last month prior to the interview was the extract of opium
- in 92.2% of cases, followed by heroine with 4.3% (Table 11). Hence, the people who inject drugs living
in Balti municipality are in principal opiates users. Among non injected drugs, the highest rate is
registered for marijuana (30.4%).
Table 11 Drugs used during the last month, people who inject drugs living in Balti municipality, %, Republic of Moldova, 2009
Type of drug
Marijuana
Hashish
Heroin
Methadone
Morphine
Cocaine
Calipsol
Amphetamines
Tranquillizers
LSD
Ecstasy
Extract of opium (shirka)
Ephedrone
Methamphetamines
Codeine
Others
Last month noninjecting use
30.4
0.6
0.0
2.1
0.0
0.0
9.9
2.9
9.3
0.6
0.2
%
Last month injecting
use
17.3
0.4
0.9
4.0
96.1
3.1
3.6
-
Main injected drug in
the last month
4.3
0.3
0.7
92.2
1.3
1.2
-
The Frequency of Drug Injection in the Last Month
Third of the respondents who had injected drugs during the last month reported that they had injected
drugs less than once per week (38.2% of the cases). More than half of them did it 1-6 times per week
(53.1%). The daily use was reported by 8.8% of respondents (Figure 5).
Figure 5 The frequency of drug injection during the last month, disaggregation by gender and age groups, people who inject
drugs living in Balti municipality, %, Republic of Moldova, 2009
Injection of drugs on weekly basis is higher among males compared to females and in 25 years and older
compared to those less than 25 years old.
Sharing of Injecting Equipment
The value of the UNGASS indicator No. 21 is of 97.7%10. When asked about the frequency with which
they had used shared syringes during the last month, 92.4% of the respondents reported that it had
never happened and 6.0% of the respondents had used shared needles/syringes at least once in the past
month. No significant differences were found between the share of males who never shared syringes in
last month (91.5%) and females (95.2%), age groups (89.7% in those younger than 25 years old and
91.7% in those of 25 years and older).
When asked about how frequently offered/sold/lent their own personal needles/syringes to other
people who inject drugs, 98.0%of the respondents who had injected drugs during the last month
reported that they never did that in last month.
Less than half of the sample (42.9%) reported that they used a common jar to draw up drug solutions,
51.2% injected drugs using a preloaded syringe, and 17.8% of the respondents reported front-/backloading (Figure 6). Hence, the indirect sharing is spread in drugs injecting population from Balti
municipality.
10
UNGASS Indicator 21 takes into account only those respondents who had injected drugs during the last month
and had used sterile equipment for their last injection. National Centre of Health Management. "National
Report.Monitoring the Declaration of Commitment on HIV/AIDS." 2010.
Figure 6 Indirect sharing of injecting equipment during the last month, people who inject drugs from Balti municipality, %,
Republic of Moldova, 2009
The value of the integrated indicator11 for the indirect sharing of injecting equipment in the last month is
of 61.9%. Thus, more than half of the respondents who injected drugs in the last month shared their
injecting equipment indirectly. Females more frequently reported indirect sharing (74.7%) compared to
males (60.1%).
Availability of Sterile Syringes
Third of the respondents reported that they had received syringes for free (29.6%) during the last 12
months; 99.1% of the respondents can obtain sterile syringes when needed and 100.0% of the
respondents know where syringes can be obtained. When asked about their main source of sterile
syringes, the majority of the respondents reported buying syringes from pharmacies (63.1%), followed
by those who reported using needles exchange services (25.8%). Among the remaining 11.1% there
were mentioned the pharmacist (3.6%), family (0.1%), sexual partner (0.4%), friends (2.7%), other
people who inject drugs (1.0%), dealer (1.5%), buying in the street (0.8%) and others (1.0%).
Females get syringes in needles exchange services twice less frequently (26.1%) than in pharmacies
(52.4%). In case of males the pharmacy also is the main source even more frequently (65.1%) than
needles exchange services (25.6%). Pharmacy is the main source for 51.8% of HIV positive respondents
and for 72.2% of HIV negative respondents. Those who are HIV positive more frequently go for syringes
to needles exchange services (36.3%) compared to those who are HIV negative (17.1%). Younger people
who inject drugs buy syringes in pharmacies in 70.6% of cases and go to needles exchange services only
11
The respondents who reported at least one of the following practices during the last month: drawing up a drug
solution from a common jar, injecting drugs using a preloaded syringe, or front-/back-loading.
in 8.3% of cases, while those aged 25 years and older buy syringes in pharmacies in 60.2% of cases and
go to needles exchange services in 28.1% of cases.
Overdoses and Mortality in People Who Inject drugs
Of the 224 respondents12, 54.2% have ever had overdoses and 18.5% had it in last 12 months.
Respondents who reported overdoses in the last 12 months had it 1.9 times on average (median - 2,
SD±0.9) and only in 0.3 times (median - 0, SD±0.5) seeked for health care services in case of overdoses.
Males more frequently reported overdoses ever (56.9%) and within the last 12 months (35.0%)
compared to females (36.5% had ever and 15.5% in last 12 months).
When asked (101 respondents) how many people who inject drugs they knew who died in 2008 due to
different causes, on average they knew 3.0 persons (median – 3, SD±0.2) and of them – 1.7 persons
(median – 2, SD±1.0) died due to overdoses.
Drug Addiction Treatment
Of the sample, 47.9% consider themselves drug-addicted. The number of self-reported drug addicts is
higher in males (51.7%) compared to females (33.0%) and in the group aged 25 and older (51.8%)
compared to those less than 25 years old (28.3%).
Less than half of the respondents (43.2%) reported to be under narcological surveillance and in 95.6%
they were brought to the narcologist by the police. The share of respondents under narcological
surveillance is higher in males (46.5%) compared to females (28.9%) and in the group aged 25 and older
(44.7%) compared to those less than 25 years old (33.1%). The mean length of narcological surveillance
is of 8.3 years (median– 9, SD±5.9).
Of the sample, 32.4% reported that they had undergone drug addiction treatment at some point in time.
The share of the respondents who had undergone drug addiction treatment is much higher in the group
aged 25 and older (37.3%) compared to the under-25 age group (4.9%) and is higher in males (34.3%)
than in females (24.2%).
Most of the respondents had been through detoxification with other medications (31.6%) (2.0%)
followed by expert consultation (14.3%) (27.5%), detoxification without other medications (12.4%)
(18.3%) and outpatient treatment (10.3%) (20.8%). Other types of treatment reached lower values
(Figure 7).
12
The questions on overdoses were added to the data collection tool after the recruitment was initiated.
Figure 7 Drug addiction treatment followed by the respondents, people who inject drugs from Balti municipality, %, Republic
of Moldova, 2009
About one fourth (24.5%) think they (still) need treatment to stop their drug use. Half of self-reported
drug addicts (48.4%) and third of those who had undergone treatment at some point (29.2%) consider
that they (still) need treatment.
Sexual Behavior
Of the sample, 100.0% have lifetime sexual experience, and 89.9% had had sexual intercourse during the
last year. The ages of the 35 respondents (26 males and 9 females) who reported no sexual intercourse
during the last year ranged between 18 and 47 years old (mean – 35.6 years, median - 36 years, SD±).
When asked about the number of sexual partners they had had during the last year, 49.7% of the
respondents reported one partner and 50.3% had had more sexual partners. The mean number of
partners is of 2.6 and the median is 1 partner (SD±).
Of those who had had sex within the last year, 44.3% of the respondents had their spouse or live-in
partner as their sexual partner (mean – 1.00 partner, median – 1 partner, SD), 15.2% had steady sexual
partners living separately (mean – 1.7 partners, median – 1 partner, SD), 7.4% had commercial sexual
partners (mean – 2.4 partners , median – 1 partner, SD ) and 54.4% had casual partners (mean - 3.5
partners, median – 2 partners_ SD).
When asked if their cohabitating partner had ever injected drugs, 43.1% of the respondents answered
affirmatively. The proportion of affirmative answers is significantly higher in females (95.8%) compared
to males (24.2%).
Of the male respondents, 1.9% (5 respondents) reported homosexual anal intercourse during the last
year.
Condom Use
The rate of condom use varies depending on the type of sex partner (Table 12).
Table 12 Condom use, people who use injecting drug from Balti municipality, %, Republic of Moldova, 2009
Spouse/live-in partner
Steady partner
Commercial partner
Casual partner
Last sexual
intercourse
36.1
47.4
53.4
75.4
Consistent use during the
last month13
19.6
40.0
52.7
52.2
Consistent use during
the last year
21.4
21.4
-14
48.5
When asked if they knew the HIV status of their spouse/live-in partner, 84.8% of the respondents gave
an affirmative answer.
When asked why they did not use the condom the last time they had sexual intercourse with different
types of partners, the most frequent reason was that they did not consider it necessary in the case of
spouses and live-in partners (48.0%), in the case of steady partners (32.1%) and a reduction in pleasure
was stated in the case of casual partners (50.4%). The number of respondents who had commercial sex
and did not use condoms is too small to allow any calculations.
61.2% of the respondents used condoms the last time they had sexual intercourse; the value of UNGASS
indicator No. 20 are of 62.4%15. Lower values of UNGASS indicator No. 20 were registered among the
female respondents (50.1%) compared to male respondents (63.8%) and among the respondents aged
25 years and older (57.8%) compared to respondents under 25 years of age (79.1%)16.
Out of 2 male respondents who had had anal homosexual intercourse during the last 6 months, none
used condoms the last time they had anal homosexual intercourse.
Condoms Availability
About third of the respondents (29.9%) had received condoms for free in the last year and 100% knew
where they can get condoms if needed; 99.5% (would need up to an hour to get condoms if needed.
When asked about their main source of condoms, the most frequently mentioned source was the
pharmacy (59.0%), followed by needles exchange services (25.8%).
Females get condoms in needles exchange services twice less frequently (25.3%) than in pharmacies
(52.6%). In case of males the pharmacy is also the main source more frequently (59.9%) than needles
exchange services (25.6%). Pharmacy is the main source for 54.7% of HIV positive respondents and for
61.7% of HIV negative respondents. Those who are HIV positive more frequently go for condoms to
needles exchange services (32.2%) compared to those who are HIV negative (21.6%). Younger people
who inject drugs buy condoms in pharmacies in 69.3% of cases, while those aged 25 years and older buy
condoms in pharmacies only in half of cases 54.1%.
The availability of condoms was highly rated. Hence, 98.4% of respondents stated that on Sunday
evening their can find condoms, if needed.
13
Among those who had sex in the last month with such type of partner
The number of observations is too small to generate weighed frequencies.
15
UNGASS indicator No. 20, takes into account only the respondents who injected drugs and had sexual
intercourse in the last month.
16
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2010.
14
Sexually Transmitted Diseases
98.5% of the respondents have ever heard about STDs, but 24.8% could not name any STDs symptoms in
the case of females and 59.6% in the case of males. Of the sample, 2.6% had had STI symptoms17 during
the last year (males – 1.5%, females – 7.4%).
Pregnancy
Of the female subsample, 78.4% have been ever pregnant on average once in the lifetime (median – 1,
SD 0.1 times). Of those who have been ever pregnant, 65.6% had at least one pregnancy ended up with
an abortion on average 1.8 times (median – 1, SD=2) and 37.6% had miscarriages on average 0.9 times
(median – 0, SD = 1.1).
Health status
Less than half of the sample self assessed their health status as a good (31.4%) or a very good one
(7.4%). Every fifth respondent self assessed their health status as a poor (18.8%) or a very poor one
(3.5%). About 31.9% have health insurance.
Knowledge about HIV/AIDS
All the respondents have heard about HIV or AIDS. 82.7% of them know persons with HIV seropositive
status or persons who died due to AIDS. The share of respondents who know HIV-positive persons or
persons who died due to AIDS is higher in HIV positive respondents (87.8%) as compared to those who
are HIV negative (78.9%), and in the group aged 25 years old and over (87.9%) compared to the age
group under 25 (52.3%).
Overall, the respondents answered the questions on the routes of HIV transmission correctly (Table 13).
The study results make it clear that the level of tolerant attitudes is low.
Table 13 Knowledge and attitudes regarding HIV /AIDS, correct answers, people who use injecting drug from Balti
municipality, %, Republic of Moldova, 2009
Variable
Correct answer, %
Knowledge
1
Have heard about HIV or AIDS
100.0
2
Know HIV-positive persons or persons who died as a result of AIDS
82.7
3
The risk of infection may be reduced by correctly using condoms during
96.3
each episode of sexual intercourse.
4
The possibility of HIV transmission by using the same toilet
87.0
5
The risk of infection may be reduced by having one faithful and uninfected
94.5
sexual partner.
6
The possibility of HIV transmission by using the same plates and dishes
88.6
7
The possibility of HIV transmission by using a syringe previously used by
98.6
someone else
8
The risk of infection with HIV may be reduced by passing from injecting drug
93.6
use to non-injecting drug use
9
A healthy-looking person may be infected with HIV
95.5
Attitudes
10 Are ready to eat from the same plates and dishes as an HIV-positive person
76.2
11 Would not keep information secret if found out that a friend or
15.3
17
Abnormal genital discharges or ulcers.
acquaintance is HIV-positive
12- Integrated indicator on tolerant attitudes
XXXX
The integrated indicator of knowledge about HIV18 has a value of 80.6%19. The value of this indicator is
higher in the group aged 25 and older (83.6%) compared to the age group under 25 years old (59.9%).
Male respondents appear better informed (83.0%) compared to female respondents (71.8%).
Very low level of tolerant attitudes is registered among people who inject drugs living in Balti
municipality. Hence, only 15.3 % will not keep in secret if found out that a friend or acquaintance is HIVpositive even if 76.2% are ready to eat from the same plates and dishes as an HIV-positive person.
Differences between males-females, age groups.
Knowledge about viral hepatitis B and C
Of the sample 91.2% have ever heard about hepatitis B and 90.7% have ever heard about hepatitis C.
Younger respondents have ever heard less frequently about hepatitis B (77.0%) and C (78.1%) than
those 25 years and older (93.6% have ever heard about hepatitis B and 92.4% ahev ever heard about
hepatitis C). Of those who ever heard about hepatitis B or C, 95.3% identified them as infectious
diseases.
About half of the sample self assessed their level of knowledge on viral hepatitis B or C as a low or
lacking one, their share being higher among the younger age group and female respondents (Table 14).
Table 14 Self assessed level of information about Hepatitis B and C, people who use injecting drug from Balti municipality, %,
Republic of Moldova, 2009
Well informed
Somewhat informed
Poorly informed
Not informed
Well informed
Somewhat informed
Poorly informed
Not informed
Self assessed level of information about Hepatitis B
25 years
Less than 25
Males
Females
and older
years old
9.9
2.4
9.7
5.8
42.8
49.7
44.2
38.9
39.9
36.3
33.9
42.4
12.4
11.5
12.2
13.0
Self assessed level of information about Hepatitis C
25 years
Less than 25
Males
Females
and older
years old
10.5
2.5
9.6
9.0
44.4
51.6
44.7
47.1
32.2
34.6
33.2
31.1
12.8
11.3
12.6
12.8
Total
8.9
43.2
35.5
12.4
Total
9.5
45.0
32.8
12.7
Being asked about the sympthoms of the viral hepatitis B and C, every 10th respondent answered
correctly to all questions. Thus, the integrated indicator of knowledge on sympthoms20 of the viral
hepatitis reached 11.6% (males –11.3%, females –13.2%), being lower in younger respondents (5.0%),
compared to those who are 25 years and older (13.3%).
18
UNGASS Indicator No. 14, which takes into account only correct answers to all 5 standard questions (3,4,5,6,and
9 inTable 13).
19
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2008.
20
Table 15 Knowledge and attitudes regarding about Hepatitis B and C, correct answers, people who use injecting drug from
Balti municipality, %, Republic of Moldova, 2009
Variable
Risk of transmission through
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Sharing of needs/syringes
(direct sharing)
Sharing other equipment
to prepare drugs (indirect
sharing)
Dental
interventions/treatment
with unsterile equipment
Sharing of toothbrush,
shaving blades, manicure
scissors
Use of unsterile medical
equipment and needles
Heterosexual contacts
Homosexual contacts
Transfusion of infected
blood
Contact with body fluids
Kissing
Sharing plates, knives,
forks
Social contact (shaking
hands, coughing)
Piercing
Mother
to
child
transmission
Breastfeeding
Tattoo
Would
not
keep
information confidential
if found out that a friend
or
acquaintance is
Hepatitis B or C positive
Correct answers, %
Tota
l
>25
<25
M
F
Tota
l
>25
HCV
<25
80.6
84.9
57.0
83.5
69.1
82.2
86.7
57.1
83.3
76.1
74.9
79.7
47.5
78.9
58.0
75.5
80.5
46.9
78.9
61.3
75.6
79.0
56.5
78.9
61.7
76.2
79.6
56.6
78.8
65.7
69.4
72.6
51.8
71.7
59.9
70.3
73.6
51.8
71.6
62.9
78.1
82.5
52.7
80.0
71.1
78.7
83.1
53.7
79.7
74.5
59.2
57.6
79.2
64.3
61.9
83.4
32.5
32.9
57.1
58.4
56.1
81.2
64.9
66.4
71.6
61.0
58.7
79.7
66.1
62.9
84.0
34.8
34.9
56.8
59.1
56.3
80.9
70.3
70.5
75.0
30.5
50.7
53.6
33.1
51.7
55.6
13.8
41.9
42.0
31.6
53.8
54.2
24.9
37.5
50.9
31.0
48.6
52.3
33.7
49.2
54.1
13.7
41.8
41.9
31.5
50.5
51.8
27.8
40.7
54.5
65.4
67.8
52.5
65.6
65.3
63.7
65.9
51.8
62.6
68.8
75.8
47.5
79.9
51.1
52.2
29.5
77.9
47.1
65.7
50.9
75.7
48.0
79.6
51.7
53.1
29.6
76.9
47.1
69.1
50.1
11.8
76.8
13.0
82.1
6.8
50.1
12.8
79.0
7.3
68.7
12.1
78.1
13.4
83.3
6.8
50.7
13.2
79.5
7.0
73.1
M
F
18.4
Respondents 25 years old appeared tolerant in 33.6% of cases and younger age group – in
15.9% of cases. No significant differences were registered between males (18.3%) and females
(19.4%).
HIV Testing
When asked if they know where an HIV test can be taken, 67.5% of the respondents gave an affirmative
answer. Of the sample, 68.0% reported that there is a possibility to be tested to HIV in the locality where
they live. Females more frequently reported this possibility (72.8%) than males (66.7%). Older
respondents also appeared more informed (72.0%) than those younger than 25 years (43.1%). Of the
ample, 66.2% reported that HIV testing may be undertaken in a confidential manner.
Of the sample, 64.0% have undertaken an HIV test at some point in their lifetime (18.0% once in their
lifetime and 46.0% many times in their lifetime). Only 6 persons of the sample had had an HIV test at
some point and did not know the results of the last test. All respondents who have never undertaken
and HIV test would be interested to pass it.
During the last year, 29.1% of the sample took an HIV test and know the result of the last test. Males
slightly more frequently reported to be tested for HIV in last 12 months (30.2%) compared to females
(24.9%). The HIV testing indicator with known results during the last year is three times lower in the age
group under 25 years old (9.8%) compared to those who are 25 years and older (32.8%).
Being asked to tell their last HIV test result, 23.6% of the whole sample reported to be HIV positive (2.5%
where not confirmed when tested within the study). Additionally, within the study sample there where
found 18.7%respondents with HIV positive samples. Thus, almost half (46.9%) of the HIV positive people
who inject drugs recruited within the study were not aware of their HIV positive status. The non
response rate to the question is of 2% of those who were asked about the last test result (who have
been ever tested to HIV).
Viral hepatitis testing
Of the sample, 51.2% know where they can get tested to viral hepatitis B or C (52.1% of male
respondents and 47.4% of female respondents). About third (34.0%) had had ever been tested to both
infections (males – 35.7%, females – 28.2%). Only 0.4% of the sample had had ever been tested only to
viral hepatitis C and 1.3% of the sample had had ever been tested to viral hepatitis B. Of the sample
55.2% had had never been tested to any of two infections (56.1% of male subsample, 50.9% of female
subsample).
In those younger than 25 years, 18.3% know where they can get tested to viral hepatitis B or C. About
15.5% had had ever been tested to both infections, 63.7% had had never been tested to any of two
infections, o one had had ever been tested to viral hepatitis C and to viral hepatitis B n.
In those 25 years and older, 60.8% know where they can get tested to viral hepatitis B or C, 37.2% had
had ever been tested to both infections and 53.4% had had never been tested to any of two infections,
0.4% had had ever been tested to viral hepatitis C and 1.6% had had ever been tested to viral hepatitis
B.
Vaccination against viral hepatitis B
Of the sample 24.5% knew about vaccination against viral hepatitis B and only 4.0% have been
vaccinated. Respondents younger than 25 more reported vaccination in 0.6% of cases and those who
are 25 and older - in 4.6%). There were not registred differences between males (4.0%) and females
(3.5%).
HIV, HVC, HBV Prevalence, and Treponema Pallidum antibodies
Blood samples were subjected to testing for HIV, HCV, HBV, and Treponema Pallidum antibodies
(syphilis). The results are shown in the Table 16.
Table 16 HIV, HCV, HBV, and TP antibodies prevalence (weighted in RDSAT), people who inject drugs from Balti municipality,
%, Republic of Moldova, 2009
HIV Prevalence
#
%
HCV Prevalence
#
%
HBV Prevalence
#
%
TP Antibodies
#
%
152/352
39.8
249/362
70.2
41/362
14.2
13/362
2.7
Disaggregated by age group and gender (Table 17), the prevalence of bio-markers registered
significantly higher values in the age group 25 years old and over compared to the under-25 age group,
and higher in males than in females, except prevalence of Treponema Pallidum antibodies and HIV.
Along with the increase of the length of drug injection, there is an increase of HIV and HCV prevalence.
Table 17 HIV, HCV, HBV, and TP antibodies prevalence (weighted in RDSAT), disaggregation by age group, gender and length
of drug injection, people who inject drugs from Balti municipality, %, Republic of Moldova, 2009
Up to 25 years old
25 and over
Males
Females
Injected drug for 3
years and less
Injected drug for 4
-6 years
Injected drug for 79 years
Injected drug for 10
years and more
HIV prevalence
15.5
43.2
39.5
40.5
HCV prevalence
31.5
76.8
73.7
55.5
HBV prevalence
3.3
16.0
15.0
9.3
TP antibodies
0.6
3.1
2.4
4.3
19.6
22.0
1.1
5.0
31.7
4.0
10.0
50.6
39.9
76.8
24.7
3.7
47.4
86.7
16.1
3.6
Conclusions and implications for interventions
The sample method applied makes the study representative of the population of people who inject
drugs who are living in the assigned geographical location. The summary of the study results is as
follows:
1. The study sample consists of 81.0% male respondents and 19.0% female respondents. The
respondents’ ages ranged between 18 and 52 years old, the average being 31.9 years. The
majority of the respondents belong to the group aged 25 and older (86.1% of the respondents
who reported their age). The largest group of respondents reported being single (42.9%). The
majority of respondents have secondary education or specialized secondary education (65.3%).
Of the sample, 92.6% reported preferring to speak Russian. At the time of the interviews
approximately 99.7% of the respondents lived in large urban area (Balti). The majority of the
study respondents (82.0%) had not been away from home during the last year for longer than
one month.
2. The mean length of the drug injecting career in the study sample is 10.8 years. The mean age at
the time of the first injection was 21.3 years old. When asked about the last time they had
injected a drug, 79.4% of the sample reported that it had been during the last month. The most
commonly injected drug during the last month was extract of opium in 92.2% of cases.
3. The value of UNGASS indicator No. 21 is 97.7% 21. During the last month, 92.4% of the
respondents reported that they had not injected drugs with syringes previously used by
21
Respondents who used sterile needles/syringes the last time they had injected during the last month.
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2008.
someone else. The value of the integrated indicator22 of indirect sharing of injecting equipment
during the last month is 61.9%.
4. Of the total number of respondents, 47.9% consider themselves drug-addicted; 32.4% reported
having been treated for drug addiction at some point in their lifetime, and 24.5% consider that
they (still) need treatment to stop their drug use.
5. 89.9% had had sexual intercourse during the last year. The mean number of partners was 2.6.
When asked if their spouse or live-in partner had ever injected drugs, 43.1% of the respondents
gave an affirmative answer. The rate of this affirmative answer is higher among females (95.8%)
compared to males (24.2%). Homosexual anal intercourses during the last year were reported
by 1.9% of male respondents (5 respondents).
6. 61.2% of the sample used condoms the last time they had sexual intercourse; the value of
UNGASS indicator No. 20 is 62.4%23. The rate of condom use varies, depending on the type of
partner.
7. One third of the respondents (29.9%) had received condoms for free during the last year and
100% know where they can get condoms when they need to.
8. One third of the respondents (29.6%) had received syringes for free during the last year and
100% know where they can get condoms when they need to.
9. The integrated indicator on HIV24 knowledge has a value of 80.6%.
10. During the last year, out of the total sample, 29.1% of the respondents underwent an HIV test
and know the results.
11. HIV prevalence reached 39.8%, HCV prevalence -70.2%, HBV prevalence -14.2%, and the
prevalence of TP antibodies 2.7%. The prevalence of bio-markers registered higher values in the
group aged 25 and older compared to the age group under 25 years old and higher in males
compared to females, except the syphilis data.
People who inject drugs living in Chisinau municipality: results
Socio-Demographic Structure of the Sample
Sex and Age
The study sample consists of 81.0% males and 19.0% females. The respondents’ ages vary between 18
and 70 years old. The majority of the study respondents belong to the group aged 25 years old and over
(85.4%). The mean and median ages are approximately the same for males and females (Table 18). The
30 – 34 age group has the largest share of the study sample (26.6%), both for males (26.1%) and females
(30.8%).
22
The respondents who reported at least one of the following practices during the last month: drawing up the
drug solution from a common jar, injecting drugs with a preloaded syringe, front-/back-loading
23
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2008.
24
UNGASS indicator No. 14, which takes into consideration only the correct answers to all 5 standard questions (3,
4, 5, 6, and 9 of Table 13).
Table 18 Socio-Demographic Structure of the Sample, people who inject drugs from Chisinau municipality, Republic of
Moldova, 2009
Total
18 – 19 years old
20 – 24 years old
25 – 29 years old
30 – 34 years old
35 – 39 years old
40 – 49 years old
50 years old and >
Total
Mean age, years
SD, years
Median age, years
#
4
61
115
84
37
23
4
328
Males
%
0.5
18.6
34.7
26.7
11.6
4.4
3.6
-
#
3
55
99
74
32
19
4
286
30.3
7.7
29
Females
%
0.4
16.3
34.5
28.4
12.2
3.7
4.5
-
30.4
7.9
29
#
1
6
16
10
5
4
0
42
%
1.7
23.9
36.6
22.2
8.8
6.5
0.4
30.2
6.2
29
Marital status
When asked about their marital status, the largest group of respondents reported being single
(48.6%).Of the sample 38.1% of respondents were married or living in a partnership. The respondents’
distribution, based on their marital status, is shown in Table 19. Every tenth respondent is divorced.
Table 19 Marital Status of the Respondents, distribution based on gender and age group, IDUs from Chisinau municipality, %,
Republic of Moldova, 2009
Single
Married
Living in partnership
Divorced
Widowed
Total
48.7
14.0
24.1
10.5
2.8
Males
49.2
14.9
24.0
10.0
1.9
Females 25 years and older Under 25 years old
42.3
39.4
78.7
10.4
17.3
0.5
21.4
28.3
13.1
15.8
11.8
7.2
10.2
3.3
0.6
The share of males who are married or who are living in a partnership (38.9%) is higher than of married
females or females living in a partnership (31.8%). The number of respondents who are married or who
are living in a partnership is larger in the age group 25 years old and over both for males (46.9%) and
females (38.6%) in comparison with the age group under 25 (14.4% for males and 13.6% for females).
Educational level
The majority of the respondents have secondary education or specialized secondary education (65.4%)
(Table 20).
Table 20 Education level, distribution based on gender and age group, people who inject drugs from Chisinau municipality,
%, Republic of Moldova, 2009
Primary school (4 grades)
Less than 9 grades
Incomplete secondary
education
Complete secondary
Total
0.2
6.9
Males
0.2
7.7
Females 25 years and older Under 25 years old
0.6
0.2
0.2
3.5
6.8
6.8
6.9
6.3
11.2
47.4
46.3
54.1
6.9
45.3
7.4
62.2
education
Specialized secondary
education
Incomplete higher
education
Higher education
18.0
18.0
19.1
19.6
8.0
9.6
10.9
9.6
11.9
7.7
3.8
11.0
10.1
4.0
11.3
Language spoken and area of residency
Of the sample, 10.2% stated that most of the time they prefer to speak Moldovan/Romanian; 89.8%
prefer to use Russian. At the time of the interviews about 99.2% of the respondents were living in large
urban area and 0.8% in rayon centers or other small urban localities.
Mobility
Of the sample, 97.6% were born in the Republic of Moldova. The rest of 2.4% were born outside, but in
one of the Eastern European country (Russian Federation, Ukraine and Poland).
The respondents were living in the current area of residency 35.5 years on average (median –36.0,
SD=±3.0). The majority of the respondents (79.0%) had not been away from the area of their residence
for longer than a month during the last year (Table 21).
Table 21 Being away from the area of residence for longer than a month during the last year, people who inject drugs from
Chisinau municipality, %, Republic of Moldova, 2009
Being away from the
area of residence for
longer than a month
during the last year
Total
Males
Females
25 years and older
Under 25 years old
21.0
21.4
18.2
18.7
31.8
A higher rate of mobility was registered in the case of respondents under 25 years old compared to
respondents over 25.
Economic status
Employment and Income
Every fourth respondent (26.8%) reported permanent employment. Half of respondents (48.4%) were
unemployed at the interview time25.
25
Housewives were not taken into account in the calculation of the unemployment rate.
Figure 8 Employment status, people who inject drugs from Chisinau municipality, %, Republic of Moldova, 2009
The proportion of those unemployed in male respondents is of 49.2%, in female subsample - 44.5%.
About fourth of females are housewives (25.8%) There is no significant difference between those
younger than 25 (43.1%) and those 25 years old and older (41.0%).
Of the total survey sample, 39.5% reported having no income (Figure 9). Females more frequently
reported lack of income (54.0%) compared to males (37.9%). Another 0.3% lives in extreme poverty on
330 MDL or less a month, equivalent to less than US$1/day, and 1.4% live on less than US$2/day.
Figure 9 Monthly income, people who inject drugs from Chisinau municipality, %, Republic of Moldova, 2009
Ability to pay
More than half of respondents could pay for water bills (72.2%), electricity bills (73.4%) and medicines
for emergency situations (81.5%), home heating (60.3%) and meals with meat or fish every other day
(53.9%) (Figure 10). Unexpectedly high percent of respondents stated that they can afford to buy new
items which are part of the life comfort products (TV set, fridge, furniture, washing machine, new car) or
services (a vacation once per year).
Figure 10 Ability to pay for basic items, people who inject drugs from Chisinau municipality, %, Republic of Moldova, 2009
Drug Use
Legal drug use
Of the sample, 90.8% were tobacco smokers at the interview time and 99,1% had smoked at some point
in their lifetime. In the recruited sample, the last month alcohol use prevalence is of 72.5%.
Length of Illegal Drug Use
According to the respondents’ answers, the length of their drug use generally varies between one year
and 55 years. The mean length of drug use within the sample studied is 13.7 years (median – 13.0,
SD=±5.8).
The length of injecting drug use varies between less than one year and 51 years. The mean length of
injecting drug use within the sample studied is 11 years (median – 10.0, SD=±6.9). The mean length of
injecting drug use in males is 10.9 years (median – 10.0, SD=±6.8), and in females it is 11.6 years (median
– 11.0, SD=±7.3). Most of the respondents’ first experience of injecting drugs occurred 3 years or more
before the study (88.7%) (Figure 11).
Figure 11 Sample distribution based on length of drug use, people who inject drugs from Balti municipality, %, Republic of
Moldova, 2009
About 11.3% of the respondents have been using injecting drugs for less than 3 years (35 respondents),
these being the new entrants to the key population at higher risk. In 89.4% of cases they are males and
in 10.6%of cases they are females and 25.4 years old on average (median – 24.0, SD=±5.3).
Initiation of Injecting Drug Use
According to the respondents’ answers, the age at which they first injected varies between 10 and 42
years. The first injection of drugs occurred at 19.8 years old on average (median - 19.0 years, SD=±5.1) in
more than half of cases with homemade extract of opium (shirka) (in 63.1% of cases), after an average
of 3.4 years of non injecting drug use. Among drugs used at first injection there was as well heroine
(9.3%), metamphetamines (9.1%), ephedron (6.0%), and other drugs (12.5%).
While the length of the injecting drug use is increasing, the mean age at first injection is decreasing.
Hence, over time there is an increase in the mean/median age at first drug injection (Table 22).
Table 22 Mean age at first drug injection by length of drug injection, people who inject drugs from Chisinau municipality, %,
Republic of Moldova, 2009
Length of injecting drug use
3 years and less
4 – 6 years
7 – 9 years
10 years and more
Total
# respondents
47
59
36
184
326
Mean
23.8
20.8
19.2
18.6
19.8
Median
22
20
18
18
19
SD
±6.3
±4.0
±5.8
±4.3
±5.1
In 91.6% of cases, the initiation in injection of drugs was done by somebody else than the respondents
themselves. In most of the cases, the initiator has been part of the close social environment
(acquaintance - 66.1%, friend - 28.2%, sexual partner - 3.3% and siblings or other relatives - 0.7%,
stranger –1.6%) and on average 4.1 years older (mean age – 23.9 years, median –22.00, SD=±6.2) than
the respondents themselves. At first injection, 3.3% of respondents used unsterile needles/syringes.
Most of the respondents agreed that prior to the first injection they had become curious as to what
injecting would be like (90.0%). Less than third of them wanted to inject drugs to be the same as their
friends (28.3%), wanted to try drugs and injection is the easiest way to do it (26.2%) and had come to
see injecting as something that could be a good experience (21.4%).
Of the sample, 74.5% have ever been asked to help with the initiation injection of drugs and 15.2% have
ever helped, being aware of the fact of initiation. Per respondent who have been ever asked to help
with initiation, there were on average 0.3 persons in last month (median –0.0, SD=±1.8) and 0.8 persons
in the last 6 months (median –0.0, SD=±3.2) who asked for help with the initiation injection of drugs. Per
respondent who have ever helped with the first injection , none helped in the last month , but in the
last 6 months there were helped 3.0 persons on average (median – 3.0, SD=±1.1 with the first initiation
injection . There may be underreporting due to social desirability. The last initiated was 21.6 years old
on average (median – 20 years, SD=±5.0).
Drugs Used During Lifetime
The recruited sample has used during the lifetime a diversity of injecting and non injecting drugs. Vast
majority mentioned lifetime use of non injecting drugs (cannabis) which occurred about 3 years before
the first injection. Every tenth respondent has ever sniffed glue and did it for the first time about 4 years
before the first injection. About two thirds of the sample have ever tried heroine (72.9%) and
metamphetamines (66.5%) about 3 years before the initiation to the injecting drug use. The highest
lifetime prevalence rate (is registered for the home made extract of opium (Table 23).
Table 23 Lifetime prevalence of drug use and age at first use, people who inject drugs from Chisinau municipality, %,
Republic of Moldova, 2009
Type of drugs
Glue
Marijuana
Heroin
Methadone
Morphine
Cocaine
Kalipsol
Hashish
Amphetamines
Tranquilizers
LSD
Ecstasy
Shirka
Ephedron
Metamphetamines
Codeine
Lifetime
Age at first use
prevalence, % Mean/median/SD
25.0
95.4
72.9
12.7
33.9
23.2
20.2
63.1
46.3
50.5
9.4
44.4
94.6
33.2
66.5
50.4
15.0/15/±3.8
16.9/16/±4.3
23.2/22/±6.4
27.4/26/±6.9
32.8/33/±1.4
26.0/26/±0.2
18.8/18/±5.4
18.6/18/±4.5
20.9/20/±3.7
21.5/20/±7.3
25.0/25/±0.2
22.7/20/±5.6
20.3/19/±5.4
23.3/20/±7.1
23.2/23/±4.6
26.0/26/±0.6
Method at first use, %
Inject
Smoke
Sniff
Swallow
Age at first injection
Mean/median/SD
66.4
39.0
94.8
6.0
68.8
40.4
16.2
100.0
4.3
6.2
99.2
-
98.3
27.4
16.8
72.5
31.2
0.8
45.0
0.4
-
1.7
1.9
44.3
5.2
15.4
0.0
14.6
83.8
100.0
100.0
1.7
3.5
7.3
98.4
24.8/23/±8.1
22.8/24/±3.8
23.9/24/±3.8
25.8/23/±5.6
18.5/16/±5.5
24.3/24/±6.8
27.1/24/±9.5
20.0/19/±5.1
18.0/18/±0.3
22.7/23/±4.5
22.4/22/±3.8
98.3
96.5
92.3
1.6
Historically the ephedrone was widely injected by people who inject drugs living in Chisinau
municipality. Thus, about third of respondents (33.2%) have ever tried ephedrone and injected it for the
first time at the age close to the initiation average age (Table 22). This drug is rarely injected currently in
Chisinau municipality. Thus, of those who injected in the last month, 4.5% have ever injected it in the
last month and for only 1.3% it was the main injected drug in the last month (Table 11).
Last Injection
When asked about the last time they had injected, 71.3% of the sample mentioned the last month,
10.7% more than one month ago, but during the last 3 months prior to the interview, and 18.0% of the
respondents had last injected drugs more than 3 months prior to the interview..
The rate of injecting during the last month was lower among females (66.7%) than among males
(79.4%). Comparing the results for each age group, the rate of injecting during the last month prior to
the interview did not register significant difference in respondents aged 25 years old and over (71.7%)
compared to respondents aged under 25 (71.5%).
Places for Injecting Drugs
Being asked where they have injected drugs most frequently during the last month (255 respondents),
the majority of respondents mentioned their private house/apartment (80.9%) (Table 24). To be noted
that older and those with longer length of injecting drug use more frequently reported injection in
dealer’s house/apartment and in public places, but no significant differences were found out when
disaggregating by age groups, gender and length of drug injection (Table 24, Table 25 and Table 26).
Table 24 The most frequent place for injecting drugs during the last month, disaggregation by age group, people who inject
drugs from Chisinau municipality, %, Republic of Moldova, 2009
In private house, apartment, %
At a public institution, on premises, %
In a bathroom, %
In a dealer’s house/apartment, %
In a public place, %
In an abandoned building, %
In a building’s basement, %
In the place where injecting drug users
congregate to inject drugs, %
Other, %
Total respondents, #
Total
80.9
0.3
0.9
5.9
4.4
0.05.1
Less than 25
years old
80.3
0.5
0.5
2.0
0.5
0.0
11.1
25 years and
older
80.8
0.4
1.0
6.8
5.1
0.0
3.8
0.6
0.9
0.5
1.3
255
0.5
51
1.5
204
Table 25 The most frequent place for injecting drugs during the last month, disaggregation by length of injection drug use,
people who inject drugs from Chisinau municipality, %, Republic of Moldova, 2009
In private house, apartment, %
At a public institution, on premises, %
In a bathroom, %
In a dealer’s house/apartment, %
In a public place, %
3 years and
less
80.7
3.1
1.6
6.2
1.6
4 – 6 years
7 – 9 years
84.1
0.9
0.9
2.7
0.3
63.1
1.3
1.3
1.0
1.3
10 years
and more
76.6
0.3
1.5
7.7
6.6
In an abandoned building, %
In a building’s basement, %
In the place where injecting drug users
congregate to inject drugs, %
Other, %
Total respondents, #
0.0
2.1
0.0
1.6
0.0
26.4
0.0
5.6
1.6
1.8
1.6
0.3
1.6
31
2.6
45
2.6
28
1.1
150
Table 26 The most frequent place for injecting drugs during the last month, disaggregation by gender, people who inject
drugs from Chisinau municipality, %, Republic of Moldova, 2009
In private house, apartment, %
At a public institution, on premises, %
In a bathroom, %
In a dealer’s house/apartment, %
In a public place, %
In an abandoned building, %
In a building’s basement, %
In the place where injecting drug users
congregate to inject drugs, %
Other, %
Total respondents, #
Total
80.9
0.3
0.9
5.9
4.4
5.1
Males
80.9
0.4
1.1
7.0
5.1
0.3
Females
71.5
0.6
0.6
0.6
0.6
18.0
0.6
0.8
3.0
1.3
255
0.9
227
4.6
28
Drugs Used During the Last Month
The most commonly injected drug during the last month prior to the interview was extract of opium in
69.2% of cases, followed by metamphetamines with 15.3% and heroine with 8.9% (Table 27). Hence, the
people who inject drugs from Chisinau are in their majority opiates users (69.2% used mostly extract of
opium and 8.9% used mostly heroine). Among non injected drugs, the highest rate is registered for
cannabis (marijuana with 67.4% and hashish with 16.5%).
Table 27 Drugs used during the last month, people who inject drugs from Chisinau municipality, %, Republic of Moldova,
2009
Type of drug
Marijuana
Hashish
Heroin
Methadone
Morphine
Cocaine
Calipsol
Amphetamines
Tranquillizers
LSD
Ecstasy
Poppy (extract of opium)
Ephedrone
Last month noninjecting use
67.4
16.5
5.5
0.3
1.9
0.8
0.3
3.0
11.1
0.0
1.3
9.5
0.3
%
Last month injecting
use
24.4
2.7
4.1
79.9
4.5
Main injected drug in
the last month
8.9
2.6
69.2
1.4
Methamphetamines
Codeine
Others
2.2
1.0
0.0
29.4
-
15.3
2.6
The Frequency of Drug Use in the Last Month
Firth of the respondents who had injected drugs during the last month reported that they had injected
drugs less than once per week (21.5% of the cases). About half of them did it 1-6 times per week
(50.7%). The daily use was reported by 27.7% of respondents (Figure 12).
Figure 12 The frequency of drug injection during the last month, disaggregation by gender and age groups, people who inject
drugs from Chisinau municipality, %, Republic of Moldova, 2009
Sharing of Injecting Equipment
The value of the UNGASS No. 21 is 98.8%26. When asked about the frequency with which they had used
shared syringes during the last month, 98.8% of the respondents reported that it had never happened
and 1.2% of the respondents had used shared needles/syringes at least once in the past month. No
significant differences were found between males and females, age groups and length of injecting drug
use.
When asked about how frequently they offered/sold/lent their own personal needles/syringes to other
IDUs, 97.3% of the respondents who had injected drugs during the last month reported that they never
did that.
26
UNGASS Indicator 21 takes into account only those respondents who had injected drugs during the last month
and had used sterile equipment for their last injection. National Centre of Health Management. "National
Report.Monitoring the Declaration of Commitment on HIV/AIDS." 2010.
About half of the sample (45.2%) reported that they used a common jar to draw up drug solutions,
44.7% injected drugs using a preloaded syringe, and 1.6% of the respondents reported front-/backloading (Figure 13).
Figure 13 Indirect sharing of injecting equipment during the last month, people who inject drugs from Balti municipality, %,
Republic of Moldova, 2009
The value of the integrated indicator27 for the indirect sharing of injecting equipment in the last month is
65.6%. Thus, more than half of the respondents who injected drugs in the last month shared their
injecting equipment indirectly. Females less frequently reported indirect sharing (59.6%) compared to
males (66.6%).
Availability of Sterile Syringes
Of the sample, 9.3% reported that they had received syringes for free during the last 12 months; 99.7%
of the respondents can obtain sterile syringes when needed. When asked about their main source of
sterile syringes, the majority of the respondents reported buying syringes from pharmacies (96.2%),
followed by those who reported using needles exchange services (2.7%).
Females get syringes in needles exchange services much less frequently (4.9%) than in pharmacies
(92.6%). In case of males the pharmacy also is the main source (96.7%) than needles exchange services
(2.3%). Pharmacy is the main source for 85.9% of HIV positive respondents and for 96.2% of HIV
negative respondents. Those who are HIV positive more frequently go for syringes to needles exchange
services (9.6%) compared to those who are HIV negative (2.8%). Younger people who inject drugs buy
27
The respondents who reported at least one of the following practices during the last month: drawing up a drug
solution from a common jar, injecting drugs using a preloaded syringe, or front-/back-loading.
syringes in pharmacies in 95.3% of cases and go to needles exchange services only in 0.4% of cases,
while those aged 25 years and older buy syringes in pharmacies in 96.0% of cases and go to needles
exchange services in 3.3% of cases.
Overdoses and Mortality in IDUs
Of the 326 respondents, 40.5% have ever had overdoses and 7.9% had it in last 12 months. Respondents
who reported overdoses in the last 12 months had it 1.0 times on average (median – 1, SD 0.0) and only
in 0.5 of times seeked for health care services
Males more frequently reported overdoses ever (39.9%) and less within the last 12 months (6.8.0%)
compared to females (43.3% had ever and 14.2% in last 12 months).
When asked (109 respondents) how many people who inject drugs they knew who died in 2008, on
average they stated 2.1 people (median –1.0, SD 3.2), of them due to overdoses – 1.3 on average
(median –0.0, SD - 2.6).
Drug Addiction Treatment
Of the sample, 56.3% consider themselves drug-addicted. The share of self-reported drug addicts is
higher in females (77.7%) compared to males (52.9%).
More than half of the respondents (63.5%) reported to be under narcological surveillance and in 94.6%
of cases were brought to the narcologist by the police. The share of respondents under narcological
surveillance is lower in males (62.7%) compared to females (69.7%). The mean length of narcological
surveillance is 7.2 years (mediana, DS).
Of the sample, 36.6% reported that they had undergone drug addiction treatment at some point in their
life. The share of the respondents who had undergone drug addiction treatment is higher in the group
aged 25 and older (39.1%) compared to the under-25 age group (23.2%) and is higher in males (36.9%)
than in females (29.7%). Most of the respondents had been through detoxification with other
medications (27.1%) followed by expert consultation (26.5%), rehabilitation in a specialized centre
(21.0%), outpatient treatment (20.1%). Other types of treatment reached lower values (Figure 14).
Figure 14 Drug addiction treatment followed by the respondents, IDUs from Chisinau municipality, %, Republic of Moldova,
2009
Less than half of the sample (39.3%) thinks they (still) need treatment to stop their drug use. More than
half of self-reported drug addicts (65.9%) and about half of those who had undergone treatment at
some point (48.4%) consider that they (still) need treatment.
Sexual Behavior
Of the sample, 12.2% refused to answer to the questions related to sexual behavior. They were excluded
form the data analysis.
Of the analyzed sample, 100.0% have lifetime sexual experience, and 94.3% had had sexual intercourse
during the last year. The ages of the 13 respondents (12 males and 1 female) who reported no sexual
intercourse during the last year ranged between 19 and 48 years old (mean – 31.8 years , median- 31 ,
SD±8.4).
When asked about the number of sexual partners they had had during the last year, 54.9% of the
respondents reported one partner and 45.1% had had many sexual partners. The mean number of
partners in last 12 months is of 2.5 partners (median = 1 partner, SD±3.4 partners).
Of those who had had sex within the last year, 57.6% of the respondents had their spouse or live-in
partner as their sexual partner (mean –1.0 partner, median – 1 partner, SD±0.1), 57.6% had steady
sexual partners living separately (mean – 1.4 partners, median – 1 partner, SD±0.9), 4.7% had
commercial sexual partners (mean –3.6 partners, median –2 partners, SD±3.4) and 38.7% had casual
partners (mean - 4.0 partners, median – 2 partners, SD±5.0).
When asked if their cohabitating partner had ever injected drugs, 36.5% of the respondents answered
affirmatively. The proportion of affirmative answers is higher in females (86.2%) compared to males
(21.8%). Of the male respondents1 respondent reported homosexual anal intercourse during the last
year.
Condom Use
The rate of condom use varies depending on the type of partner (Table 28).
Table 28 Condom use with different types of partners, people who inject drugs from Chisinau municipality, %, Republic of
Moldova, 2009
Spouse/live-in partner
Steady partner
Commercial partner
Casual partner
Last sexual
intercourse
19.4
49.0
78.6
64.9
Consistent use during the
last month28
6.0
29.4
51.8
Consistent use during
the last year
6.1
26.6
71.4
52.1
When asked if they know the HIV status of their spouse/live-in partner, 94.0% of the respondents gave
an affirmative answer and 67.6% of the respondents reported the HIV status of their steady partner.
When asked why they did not use a condom the last time they had sexual intercourse with different
types of partners, the most frequent reason was that they did not consider it necessary in the case of
spouses and live-in partners (69.4%), in the case of steady partners (71.9%), in case of casual partners
(25.4%) and a reduction in pleasure was stated in the case of casual partners (14.4%) and steady partner
(12.0%). The number of respondents who had commercial sex and did not use condoms is too small to
allow any calculations.
At last sex 34.9% of the respondents used condoms; the value of UNGASS indicator No. 20 is 36.1%29.
Lower values of UNGASS indicator No. 20 were registered among the female respondents (12.2%)
compared to male respondents (40.5%). There are small differences in the rates of condom use at last
sex within the last month among the respondents aged 25 years and older (37.7%) compared to
respondents under 25 years of age (32.5%)30.
Condom Availability
Of the sample, 14.5% had received condoms for free in the last year and 91.9% knew where they can get
condoms if needed; 99.2% would need up to an hour to get condoms. When asked about their main
source of condoms, the most frequently mentioned source was the pharmacy (82.9%), followed by
needles exchange services (5.6%). Females got condoms in pharmacies less (63.9%) and more in needles
exchange services (23.6%). In case of males the pharmacy is also the main source (84.6%). To be noted
that 16.3% of females stated that they don’t need and/or don’t use condoms. Pharmacy is the main
source for 67.9% of HIV positive respondents and 87.0% of HIV negative respondents. Those who are
HIV positive four times frequently go for condoms to needles exchange services (14.2%) compared to
those HIV negative (4.7%). No significant differences were found out between younger and those aged
25 years and older.
The availability of condoms was highly rated. Hence, 96.9% of respondents stated that on Sunday
evening their can find condoms, if needed.
28
Among those who had sex in the last month with such type of partner
UNGASS indicator No. 20, takes into account only the respondents who injected drugs and had sexual
intercourse in the last month.
30
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2008.
29
Sexually Transmitted Diseases
100.0% of the respondents have ever heard about STDs, but 73.0% could not name any STDs symptoms
in the case of females and 29.7% in the case of males. Of the sample, 2.6% had had STD symptoms
during the last year31 (X% in males and X% in females).
Pregnancy
Of the female subsample, 76.9% have been ever pregnant on average 4 times in the lifetime (median –
3, SD 3 times). Of those who have been ever pregnant, 70.3% had at least one pregnancy ended up with
an abortion 1.4 times on average (median – 0, SD=1.5) and 30.6% have had ever a miscarriage 0.6 times
on average (median – 0, SD=0.8).
Health status
Less than half of the sample self assessed their health status as a good (26.7%) or a very good one
(5.6%). Every fifth respondent self assessed their health status as a poor (18.0%) or a very poor one
(0.5%). About 39.5% have health insurance.
Knowledge about HIV/AIDS
All the respondents have ever heard about HIV or AIDS and 77.4% of them know persons with HIV seropositive status or persons who died due to AIDS. The share of respondents who know HIV-positive
persons or persons who died due to AIDS is higher in HIV positive respondents (96.0%) as compared to
those who are HIV negative (73.9%), and in the group aged 25 years old and over (80.0%) compared to
the age group under 25 (64.5%).
In general, the respondents answered the questions on the route of HIV transmission correctly (Table
29). The study results make it clear that the level of tolerant attitudes is low.
Table 29 Knowledge and attitudes regarding HIV /AIDS, correct answers, people who inject drugs from Chisinau municipality,
%, Republic of Moldova, 2009
Variable
Correct answer, %
Knowledge
1
Have heard about HIV or AIDS
100.0
2
Know HIV-positive persons or persons who died as a result of AIDS
77.4
3
The risk of infection may be reduced by correctly using condoms during each
94.7
episode of sexual intercourse.
4
The possibility of HIV transmission by using the same toilet
82.4
5
The risk of infection may be reduced by having one faithful and uninfected
93.0
sexual partner.
6
The possibility of HIV transmission by using the same plates and dishes
86.0
7
The possibility of HIV transmission by using a syringe previously used by
99.1
someone else
8
The risk of infection with HIV may be reduced by passing from injecting drug
92.9
use to non-injecting drug use
9
A healthy-looking person may be infected with HIV
93.6
Attitudes
10 Are ready to eat from the same plates and dishes as an HIV-positive person
53.1
11 Would not keep information secret if found out that a friend or acquaintance
35.8
31
12
is HIV-positive
Integrated indicator on tolerant attitudes
The integrated indicator of knowledge about HIV32 has a value of (65.1%)33. The value of this indicator is
lower in the group aged 25 and older (64.7%) compared to the age group under 25 years old (70.3%).
Only 35.8% will not keep information secret if found out that a friend or acquaintance is HIV-positive
and 53.1% are ready to eat from the same plates and dishes as an HIV-positive person. The integrated
indicator for males, females, age groups.
Knowledge about viral hepatitis B and C
Of the sample 97.4% have ever heard about hepatitis B and 98.8% have ever heard about hepatitis C.
There were not differences between age groups and genders (in all subsamples more than 96% of
respondenst have ever heard about hepatitis B or C). Of those who ever heard about hepatitis B or C,
99.4% identified them as infectious diseases.
About half of the sample self assessed their level of knowledge on viral hepatitis B or C as a low or a
lacking one, their share being higher among the younger age group respondents (Table 30).
Table 30 Self assessed level of information about Hepatitis B and C, people who use injecting drug from Chisinau
municipality, %, Republic of Moldova, 2009
Well informed
Somewhat informed
Poorly informed
Not informed
Well informed
Somewhat informed
Poorly informed
Not informed
Self assessed level of information about Hepatitis B
25 years
Less than 25
Males
Females
and older
years old
12.3
4.6
11.1
9.9
39.7
20.5
36.8
30.7
41.8
59.3
44.7
46.1
6.3
15.6
7.4
13.3
Self assessed level of information about Hepatitis C
25 years
Less than 25
Males
Females
and older
years old
12.3
3.9
11.2
9.4
41.4
18.4
37.1
32.4
40.6
61.5
44.1
49.1
5.6
16.2
7.6
9.2
Total
10.9
36.0
45.0
8.1
Total
10.8
36.8
44.7
7.7
Being asked about the sympthoms of the viral hepatitis B and C, every 10th respondent answered
correctly to all questions. Thus, the integrated indicator of knowledge on sympthoms34 of the viral
hepatitis reached 11.6% (males –11.3%, females –13.2%), being lower in younger respondents (5.0%),
compared to those who are 25 years and older (13.3%).
Table 31 Knowledge and attitudes regarding about Hepatitis B and C, correct answers, people who use injecting drug from
Chisinau municipality, %, Republic of Moldova, 2009
Variable
Risk of transmission through
32
Correct answers, %
HCV
UNGASS Indicator No. 14, which takes into account only correct answers to all 5 standard questions (3,4,5,6,and
9 inTable 13).
33
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2008.
34
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
Sharing of needs/syringes
(direct sharing)
Sharing other equipment
to prepare drugs (indirect
sharing)
Dental
interventions/treatment
with unsterile equipment
Sharing of toothbrush,
shaving blades, manicure
scissors
Use of unsterile medical
equipment and needles
Heterosexual contacts
Homosexual contacts
Transfusion of infected
blood
Contact with body fluids
Kissing
Sharing plates, knives,
forks
Social contact (shaking
hands, coughing)
Piercing
Mother to child
transmission
Breastfeeding
Tattoo
Would not keep
information confidential
if found out that a friend
or acquaintance is
Hepatitis B or C positive
Tota
l
>25
<25
M
F
Tota
l
>25
<25
M
F
91.3
94.0
79.5
91.1
92.3
90.8
93.5
78.4
90.7
91.4
69.4
76.7
35.5
70.0
64.8
69.3
76.6
35.7
70.0
65.3
86.0
91.2
64.3
84.7
93.5
86.3
91.4
64.3
85.2
93.3
85.6
88.9
71.6
85.3
86.4
86.1
89.2
72.3
86.0
86.4
90.7
92.9
80.8
90.0
93.5
90.5
92.6
80.8
90.0
93.4
75.4
73.4
91.5
77.2
76.3
94.0
59.2
56.1
80.2
73.3
71.0
91.0
87.5
87.5
93.5
74.4
72.5
90.9
75.9
75.1
93.3
59.3
56.2
80.0
72.3
70.1
90.5
87.2
87.3
93.3
28.5
60.2
68.7
30.3
63.8
72.8
20.5
46.1
54.3
27.8
57.5
68.3
32.5
78.4
71.5
27.7
58.9
69.4
29.2
62.9
74.1
20.5
43.1
51.7
26.9
55.9
68.4
32.5
78.3
76.0
78.9
82.2
64.4
77.9
84.4
79.3
83.1
62.1
77.7
88.6
83.1
67.2
86.2
70.5
68.3
55.2
82.3
67.8
86.0
62.4
83.0
67.3
86.0
70.4
68.3
55.1
82.3
68.0
85.7
63.0
21.0
88.0
22.8
90.6
14.6
76.0
21.7
87.3
16.0
89.1
20.6
86.7
22.4
88.9
14.6
76.0
21.2
86.4
16.1
87.5
36.8
Respondents younger than 25 years old would not keep information confidential if found out that a
friend or acquaintance is Hepatitis B or C positive in 34.8% of cases, those 25 years and older - in 36.7%
of cases. No significant differences were registered between males (37.5%) and females (32.1%).
HIV Testing
When asked if they know where an HIV test can be taken, 67.5% of the respondents gave an affirmative
answer. Of the sample, 85.0% reported that there is a possibility to be tested to HIV in the locality where
they live without differences between females (86.1%) and males (85.0%). Older respondents appeared
more informed (86.3%) than those younger than 25 years (81.1%). Of the ample, 75.0% reported that
HIV testing may be undertaken in a confidential manner.
Of the sample, 63.9% have undertaken an HIV test at some point in their lifetime (18.0% once in their
lifetime and 46.0% many times in their lifetime). Only 6 persons of the sample had had an HIV test at
some point and did not know the results of the last test. Of the respondents who have never undertaken
an HIV test 98.4% would be interested to pass it.
During the last year, 29.1% of the sample took an HIV test and know the result of the last test. Males
slightly more frequently reported to be tested for HIV in last 12 months (30.2%) compared to females
(24.9%). The HIV testing indicator with known results during the last year is three times lower in the age
group under 25 years old (9.8%) compared to those who are 25 years and older (32.8%).
Being asked to tell their last HIV test result, 7.1% of the whole sample reported to be HIV positive (0.9%
where not confirmed when tested within the study). Additionally, within the study sample there where
found 8.6%respondents with HIV positive samples. Thus, almost half (50.8%) of the HIV positive people
who inject drugs recruited within the study were not aware of their HIV positive status. The non
response rate to the question is of 1.1% of those who were asked about the last test result (who have
been ever tested to HIV).
Viral hepatitis testing
Of the sample, 71.7% know where they can get tested to viral hepatitis B or C (71.6% of male
respondents and 70.5% of female respondents). More than half (53.0%) had had ever been tested to
both infections (males – 53.3%, females – 48.4%). Only 0.5% of the sample had had ever been tested
only to viral hepatitis C and 1.3% of the sample had had ever been tested to viral hepatitis B. Of the
sample 36.6% had had never been tested to any of two infections (35.5% of male subsample, 41.9% of
female subsample).
In those younger than 25 years, 63.2% know where they can get tested to viral hepatitis B or C. About
35.5% had had ever been tested to both infections, 40.6% had had never been tested to any of two
infections, 3.5% had had ever been tested to viral hepatitis B and 0,8% had had ever been tested to viral
hepatitis C.
In those 25 years and older, 72.5% know where they can get tested to viral hepatitis B or C, 56.4% had
had ever been tested to both infections, 34.6% had had never been tested to any of two infections, 0.8%
had had ever been tested to viral hepatitis C and 0.8% had had ever been tested to viral hepatitis B.
Vaccination against viral hepatitis B
Of the sample 54.3% were aware about vaccination against viral hepatitis B and 14.6% have been
vaccinated. Younger respondents twice more frequently reported vaccination against viral hepatitis B
(22.7%) compared to those 25 years and older (11.8%). There were not registred differences in the self
reported vaccination rate between males (14.5%) and females (13.1%).
HIV, HVC, HBV Prevalence, and TP antibodies
Blood samples were subjected to testing for HIV, HCV, HBV, and TP antibodies (syphilis). The detailed
results are shown in Table 32.
Table 32 HIV, HCV, HBV, and TP antibodies prevalence, people who inject drugs from Chisinau municipality, %, Republic of
Moldova, 2009
HIV Prevalence
#
%
48/301
16.4
HCV Prevalence
#
%
225/301
77.9
HBV Prevalence
#
%
34/301
10.3
TP Antibodies
#
%
13/301
4.2
Disaggregated by age group and gender (Table 33), HIV, HCV, and TP antibodies registered significantly
higher values in the age group 25 years old and over compared to the under-25 age group. Compared to
males, females registered higher values in case of HIV, HCV and TP prevalence.
Table 33 Prevalence of antibodies to HIV, HCV, HBV, and TP antibodies, disaggregation by age group, gender and length of
injecting drug use, people who inject drugs from Chisinau municipality, %, Republic of Moldova, 2009
Up to 25 years old
25 and over
Male
Female
Injected drug for 3
years and less
Injected drug for 4
-6 years
Injected drug for 79 years
Injected drug for 10
years and more
HIV prevalence
12.4
17.8
14.2
29.8
HCV prevalence
54.7
83.2
76.4
86.2
HBV prevalence
17.0
9.3
11.2
4.4
TP antibodies
0.0
5.0
4.1
6.8
1.2
25.1
21.0
4.3
2.5
10.2
52.9
2.3
23.4
24.1
75.0
3.8
23.0
6.9
95.4
5.5
Conclusions and implications for interventions
The sample method applied makes the study representative of the population of people who inject
drugs living in the assigned geographical location. The summary of the study results is as follows:
1. The study sample consists of 81.0% male respondents and 19.0% female respondents. The
respondents’ ages ranged between 18 and 70 years old, the average being 30.3 years. The
majority of the respondents belong to the group aged 25 and older (86.1% of the respondents
who reported their age). The largest group of respondents reported being single (48.6%). The
majority of respondents have secondary education or specialized secondary education (65.4%).
Of the sample, 89.8% reported speaking Russian most frequently. At the time of the interviews
99.2% of the respondents lived in large urban area (Chisinau). The majority of the study
respondents (79.0%) had not been away from home during the last year for longer than one
month.
2. The mean length of the drug injecting career in the study sample is 11.0 years. The mean age at
the time of the first injection was 19.8 years old. When asked about the last time they had
injected a drug, 71.3% of the sample reported that it had been during the last month. The most
commonly injected drug during the last month was extract of opium in 69.2% of cases, followed
by methamphetamine (pervitin) in 15.3% of cases.
3. The value of UNGASS indicator No. 21 is 98.8%35. During the last month, 98.8% of the
respondents reported that they had not used syringes previously used by someone else. The
35
Respondents who used sterile needles/syringes the last time they had injected during the last month.
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2008.
value of the integrated indicator36 of indirect sharing of injecting equipment during the last
month is 65.6%.
4. Of the total number of respondents, 56.3% consider themselves drug-addicted; 36.6% reported
having been treated for drug addiction at some point, and 39.3% consider that they (still) need
treatment to stop their drug use.
5. 94.3% had had sexual intercourse during the last year. The mean number of partners was 2.5.
When asked if their spouse or live-in partner had ever injected drugs, 36.5% of the respondents
gave an affirmative answer. The rate of this affirmative answer is higher among females (86.2%)
compared to males (21.8%). Homosexual anal contacts during the last year were reported by 1
male respondent.
6. 34.9% of the sample used condoms the last time they had sexual intercourse; the value of
UNGASS indicator No. 20 is 36.1%37. The rate of condom use varies, depending on the type of
partner.
7. 14.5% of respondents had received condoms for free during the last year and 91.9% know
where they can get condoms when they need to, and it would take up to an hour for 99.2% of
the respondents to get condoms.
8. The integrated indicator on HIV38 knowledge has a value of 65.1%.
9. Of the sample, 9.3% received syringes for free during the last 12 months
10. Of the sample, 14.5% received condoms for free during the last 12 months
11. During the last year, out of the total sample, 48.5% of the respondents underwent an HIV test
and know the results.
12. HIV prevalence reached 16.4%, HCV prevalence 77.9%, HBV prevalence 10.3%, and the
prevalence of TP antibodies 2.0%. The prevalence of HIV, HBV, and HCV registered higher values
in the group aged 25 and older compared to the age group under 25 years old.
Due to low coverage with HIV prevention programmes, the comparability analysis results between
beneficiaries and non beneficiaries of needles exchange services is not possible.
People who inject drugs living in Tiraspol town: results
Socio-Demographic Structure of the Sample
Sex and Age
The study sample consists of 69.4% males and 30.6% females. The respondents’ ages vary between 18
and 59 years old. The majority of the study respondents belong to the group aged 25 years old and over
(70.6%). The mean and median age is lower in case of females (Table 34).
36
The respondents who reported at least one of the following practices during the last month: drawing up the
drug solution from a common jar, injecting drugs with a preloaded syringe, front-/back-loading
37
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2008.
38
UNGASS indicator No. 14, which takes into consideration only the correct answers to all 5 standard questions (3,
4, 5, 6, and 9 of Table 13).
Table 34 Socio-Demographic Structure of the Sample, people who inject drugs from Tiraspol town, Republic of Moldova,
2009
Total
18 – 19 years old
20 – 24 years old
25 – 29 years old
30 – 34 years old
35 – 39 years old
40 – 49 years old
50 years old and >
Total
Mean age, years
SD, years
Median age, years
#
18
54
59
58
44
46
2
281
Males
%
10.6
19.6
18.4
20.7
13.9
16.1
0.8
-
#
10
37
48
37
38
38
2
210
30.5
8.8
30
Females
%
8.9
17.3
20.3
15.4
16.2
20.5
1.4
-
31.4
8.9
30
#
8
17
11
21
6
8
0
71
%
13.2
23.7
14.7
32.4
6.9
9.1
0.0
28.1
8.0
27
Marital status
When asked about their marital status, the largest group of respondents reported being single (48.0%).
Only 25.4% of respondents were married or living in a partnership. To be noted that one fifth of
respondents (22.5%) are divorced. Males reported more frequently (24.9%) to be divorced than females
(18.2%). The respondents’ distribution, based on their marital status is shown in Table 35.
Table 35 Marital Status of the Respondents, distribution based on gender and age group, %, people who inject drugs from
Tiraspol town, Republic of Moldova, 2009
Single
Married
Living in partnership
Divorced
Widowed
Total
48.0
16.8
8.6
22.5
4.0
Males
43.1
18.1
10.0
24.9
3.9
Females 25 years and older Under 25 years old
57.8
37.7
81.7
14.2
19.7
5.3
4.4
7.0
12.4
18.2
30.6
0.6
5.3
4.9
0.1
The share of respondents who are married or who are living in a partnership is larger in the age group
25 years old and over especially for males (29.6%) (23.9% in females) in comparison with the age group
under 25 (13.9% for males and 26.8% for females).
Educational level
The majority of the respondents have secondary education or specialized secondary education (58.2%).
Every tenth respondent did not complete the secondary school level (Table 36).
Table 36 Educational level, distribution based on gender and age group, %, people who inject drugs from Tiraspol town,
Republic of Moldova, 2009
Primary school (4 grades)
Less than 9 grades
Incomplete secondary education
Complete secondary education
Specialized secondary education
Total
0.0
9.3
14.7
27.3
30.9
Males
0.0
7.9
12.8
24.4
38.9
Females 25 years and older Under 25 years old
0.0
0.0
0.0
15.2
8.4
8.1
17.4
14.5
20.6
34.4
27.2
25.6
15.6
30.8
29.7
Incomplete higher education
Higher education
11.0
6.8
9.2
6.9
11.6
5.7
9.4
9.8
16.0
0.0
Language spoken and area of residency
Of the sample, 4.1% stated that most of the time they prefer to speak Moldovan/Romanian and 95.9%
prefer to use Russian.
At the time of the interviews about 55.0% of the respondents were living in large urban areas and 45.0%
in rayon centers or other small urban localities around Tiraspol.
Mobility
Of the sample, 78.3% were born in the Republic of Moldova. The rest of 21.7% were born outside, but in
one of the Eastern European country (Russian Federation, Ukraine, Belarus, Azerbaijan, Turkmenistan,
former Democratic Republic of Germany, and former Czechoslovakia).
The respondents were living in the current area of residency 25.5 years on average (median – 26.0,
SD=±11.0).
The majority of the respondents (98.8%) had not been away from the area of their residence for longer
than a month during the last year.
Economic status
Employment and Income
Every tenth respondent (12.1%) reported permanent employment. One third reprted to be employed
seasonaly. Less than half of respondents (39.0%) were unemployed39 (Figure 15). The proportion of
those unemployed is higher in female respondents (50.4%) compared to the male subsample (33.0%).
Males more frequently reported to be seasonally employed (38.1%) compared to females (26.2%). The
unemployment rate is higehr among those younger than 25 (45.1%) compared to and those 25 years
old and older (35.3%).
39
Housewives were not taken into account in the calculation of the unemployment rate.
Figure 15 Employment status, people who inject drugs from Tiraspol town, Republic of Moldova, 2009
Of the total survey sample, 14.9% reported having no income (Figure 16). Males more frequently
reported lack of income (16.6%) compared to females (12.4%). Among age groups, there are no
significant differences in lack of household income. Another 1.3% lives in extreme poverty on 330 MDL
or less a month, equivalent to less than US$1/day, and 8.5% live on less than US$2/day.
Figure 16 Monthly household income, IDUs from Tiraspol town, Republic of Moldova, 2009
Ability to pay
More than half of respondents could pay for water bills (62.4%), electricity bills (61.8%) and medicines
for emergency situations (67.2%), home heating (52.7%). Less than half of respondents can afford meals
with meat or fish every other day (38.9%) (Figure 17). Less than one fourth of respondents stated that
they can afford to buy new items which are part of the life comfort products (TV set, fridge, furniture,
washing machine) or services (a vacation once per year).
Figure 17 Ability to pay for basic items, people who inject drugs from Tiraspol town, %, people who inject drugs from Tiraspol
town, Republic of Moldova, 2009
Drug Use
Legal drug use
Of the sample, 98.0% were tobacco smokers at the interview time and 100.0% had smoked at some
point in their lifetime. In the recruited sample, the last month alcohol use prevalence is of 91.4%.
Length of Illegal Drug Use
According to the respondents’ answers, the length of their drug use generally varies between one year
and 37 years. The mean length of drug use within the sample studied is of 10.7 years (median –9.0,
SD=±7.7).
The length of injecting drug use varies between one year and 37 years. The mean length of injecting
drug use within the studied sample is of 7.9 years (median –5.0, SD=±7.3). The mean length of injecting
drug use in males is 8.9 years (median –6.0, SD=±7.8)), and in females - 5.1 years (median – 4.0,
SD=±4.8). Most of the respondents’ first experience of injecting drugs occurred 3 years or more before
the study (75,3%) (Figure 18).
Figure 18 Sample distribution based on length of drug use, people who inject drugs from Tiraspol town, %, Republic of
Moldova, 2009
About 24,7% of the respondents have been using injecting drugs for less than 3 years (54 respondents),
these being the new entrants to the key population at higher risk, 58.5% being males and 41.5% are
females of 25.5 years old on average (median – 22.0, SD=±8.1).
Initiation of Drug Use
According to the respondents’ answers, the age at which they first injected varies between 11 and 45
years. The first injection of drugs occurred at 23.0 years old on average (median - 20.0 years, SD=±7.0) in
more than half of cases with homemade extract of opium (shirka) (in 70.8% of cases), after an average
of 3.7 years of non injecting drug use (median –2.0 years, SD=±5.1). Among drugs used at first injection
there was as well ephedron (7.7%), heroine (8.4%), metamphetamines (4.5%), and other drugs (8.7%).
While the length of the injecting drug use is increasing, the mean age at first injection is decreasing.
Hence, over time there is an increase in the mean/median age at first drug injection (Table 37).
Table 37 Mean age at first drug injection by length of drug injection, people who inject drugs from Tiraspol town, %, Republic
of Moldova, 2009
Length of injecting drug use
3 years and less
4 – 6 years
7 – 9 years
10 years and more
Total
# respondents
78
48
45
99
281
Mean
25.3
26.1
20.9
20.5
23.0
Median
22.0
25.0
20.0
20.0
20.0
SD
±8.0
±8.2
±4.9
±4.6
±7.0
In 86.0% of cases, the initiation in injection of drugs was done by somebody else than the respondents
themselves. In most of the cases, the initiator has been part of the close social environment
(acquaintance - 38.2%, friend - 27.5%, sexual partner - 17.3% and siblings or other relatives - 10.7%,
stranger –4.1%, dealer –2.3%) and on average 4.7 years older (mean age –27.7 years, median –25.00,
SD=±9.1) than the respondents themselves. At first injection, 26.6% of respondents used unsterile
needles/syringes.
Most of the respondents agreed that prior to the first injection they had become curious as to what
injecting would be like (68.0%). Almost third of them wanted to inject drugs to be the same as their
friends (24.9%) and wanted to try drugs and injection is the easiest way to do (24.1%).
Of the sample, 56.8% have ever been asked to help with the initiation injection of drugs and 21.2% have
ever helped, being aware of the fact of initiation. Per respondent, there were on average 1.2 persons in
last month (median –0.0, SD=±1.9) and 3.2 persons in the last 6 months (median –2.0, SD=±4.2) who
asked for help with the initiation injection of drugs. Per respondent, 0.5 persons on average in the last
month (median –0.0, SD=±0.9) and 1.9 persons on average in the last 6 months (median – 1, SD=±2.3)
were helped with the first initiation injection by the respondents themselves. There may be
underreporting due to social desirability. The last initiated was 24.0 years old on average (median – 23
years, SD=±5.7).
Drugs Used During Lifetime
The recruited sample has used during the lifetime a diversity of injecting and non injecting drugs. Vast
majority mentioned lifetime use of non injecting drugs (cannabis) which occurred about 3 years before
the first injection. Every tenth respondent has ever sniffed glue and did it for the first time about 4 years
before the first injection. About two thirds of the sample has ever tried heroine (72.9%) and
metamphetamines (66.5%) about 3 years before the initiation to the injecting drug use. The highest
lifetime prevalence rate (is registered for the home made extract of opium (Table 23).
Table 38 Lifetime prevalence of drug use and age at first use, people who inject drugs from Tiraspol town, %, Republic of
Moldova, 2009
Type of drugs
Lifetime
Age at first use
prevalence, % Mean/median/SD
Glue
Marijuana
Heroin
21.7
92.1
27.9
14.9/15/±3.0
19.8/18/±7.0
25.1/23./±8.6
Methadone
4.0
28.9/26/±8.4
Morphine
19.1
21.9/21/±2.1
Cocaine
13.5
28.6/28/±7.4
Kalipsol
Hashish
2.8
31.9
21.6/23/±5.3
22.0/19/±7.7
Amphetamines
13.6
24.9/23/±8.3
Tranquilizers
LSD
Ecstasy
Shirka
Ephedron
36.6
22.1
19.2
94.4
25.0
23.6/21/±7.1
20.5/18/±6.3
28.2/28/±9.4
23.6/21/±7.3
24.0/20/±7.6
Method at first use, %
Inject
Smoke
40.9
100.0
0.0
Sniff
Swallow
100.0
0.0
59.1
7.1
36.1
53.1
(10.8)
100.0
0.0
31.0
4.8
64.3
- (-)
(22.1) (15.2) (62.7)
70.0 (-) - (-) 30.0 (-) - (-)
87.8 9.0 (6.3) 2.0 (1.1)
20.4
0.0
- (-)
0.0
(100.0)
38.3
61.7
100.0
9.2
90.8
100.0
83.6
16.4
Age at first injection
Mean/median/SD
27.3/23/±9.1
30.3/26/±10.8
21.9/21/±2.1
27.1/29/±4.7
22.3/23/±5.6
24.9/23/±7.4
23.2/22/±6.8
23.6/21/±7.3
23.5/20/±7.1
Metamphetamines 70.1 (16.1)
Codeine
5.9
25.1/25/±6.6
21.8/23/±4.8
100.0
16.4
-
-
83.6
24.6/23/±6.9
22.8/23/±2.5
Historically the ephedrone was widely injected by people who inject drugs living in Balti municipality.
Thus, about third of respondents (34.5%) have ever tried ephedrone and injected it for the first time at
the age close to the initiation average age (Table 6). This drug is rarely injected currently in Balti
municipality. Thus, of those who injected in the last month, 3.1% have ever injected it in the last month
and for only 1.3% it was the main injected drug in the last month (Table 11).
Last Injection
When asked about the last time they had injected, 47.2% of the sample mentioned the last month,
28.7% more than one month ago, but during the last 3 months prior to the interview, and 24.2% of the
respondents had last injected drugs more than 3 months prior to the interview.. No differences were
found when comparing male and female respondents.
Comparing the results for each age group, the rate of injecting during the last month prior to the
interview is higher in respondents aged under 25 (59.6%) compared to respondents 25 years old and
over (44.8%).
Places for Injecting Drugs
Being asked where they have injected drugs most frequently during the last month (136 respondents),
almost half of respondents mentioned their private house/apartment (44.9%) and almost half the place
where injecting drug users congregate to inject drugs (Table 39). When disaggregating by age groups,
gender and length of drug injection, no significant differences were found out (Table 39, Table 40 and
Table 41).
Table 39 The most frequent place for injecting drugs during the last month, disaggregation by age group, people who inject
drugs from Tiraspol town, %, Republic of Moldova, 2009
In private house, apartment, %
At a public institution, on premises, %
In a bathroom, %
In a dealer’s house/apartment, %
In a public place, %
In an abandoned building, %
In a building’s basement, %
In the place where injecting drug users
congregate to inject drugs, %
Total respondents, #
Total
44.9
0.0
0.7
3.7
5.1
2.9
0.7
41.9
Less than 25
years old
43.9
0.0
2.4
2.4
0.0
4.9
0.0
46.3
25 years and
older
45.3
0.0
0.0
4.2
7.4
2.1
1.1
40.0
136
41
95
Table 40 The most frequent place for injecting drugs during the last month, disaggregation by length of injection drug use,
people who inject drugs from Tiraspol town, %, Republic of Moldova, 2009
In private house, apartment, %
At a public institution, on premises, %
In a bathroom, %
3 years and
less
37.1
0.0
0.0
4 – 6 years
7 – 9 years
47.6
0.0
0.0
57.1
0.0
3.6
10 years
and more
40.4
0.0
0.0
In a dealer’s house/apartment, %
In a public place, %
In an abandoned building, %
In a building’s basement, %
In the place where injecting drug users
congregate to inject drugs, %
Total respondents, #
2.9
2.9
8.6
2.9
9.5
0.0
4.8
0.0
3.6
0.0
0.0
0.0
2.1
12.8
0.0
0.0
45.7
38.1
35.7
44.7
35
21
28
47
Table 41 The most frequent place for injecting drugs during the last month, disaggregation by gender, people who inject
drugs from Tiraspol town, %, Republic of Moldova, 2009
In private house, apartment, %
At a public institution, on premises, %
In a bathroom, %
In a dealer’s house/apartment, %
In a public place, %
In an abandoned building, %
In a building’s basement, %
In the place where injecting drug users
congregate to inject drugs, %
Total respondents, #
Total
44.9
0.0
0.7
3.7
5.1
2.9
0.7
41.9
Males
46.6
0.0
1.0
3.9
5.8
1.0
1.0
Females
39.4
0.0
0.0
3.0
3.0
9.1
0.0
40.8
45.5
136
103
33
Drugs Used During the Last Month
The most commonly injected drug during the last month prior to the interview was extract of opium in
87.6% of cases, followed by methamphetamine with 4.0% and heroine with 3.1%)(Table 42). Hence, the
people who inject drugs from Tiraspol are in their majority opiates users (87.6% used mostly extract of
opium and 3.1% used mostly heroine). Among non injected drugs, the highest rate is registered for
cannabis (marijuana with 58.9% and hashish with 13.2%).
Table 42 Drugs used during the last month, people who inject drugs from Tiraspol town, %, Republic of Moldova, 2009
Type of drug
Marijuana
Hashish
Heroin
Methadone
Morphine
Cocaine
Calipsol
Amphetamines
Tranquillizers
LSD
Ecstasy
Poppy (extract of opium)
Ephedrone
Methamphetamines
Last month noninjecting use
58.9
13.2
2.7
1.2
2.7
15.5
6.4
0.3
-
%
Last month injecting
use
3.8
0.0
0.0
2.8
91.8
6.8
10.3
Main injected drug in
the last month
3.1
1.3
87.6
3.2
4.0
Codeine
Others
1.4
0.0
0.3
0.4
0.5
The Frequency of Drug Use in the Last Month
About half of the respondents who had injected drugs during the last month reported that they had
injected drugs less than once per week (49.9% of the cases) and 1-6 times per week (42.0%). The daily
use was reported by 8.1% of respondents (Figure 19). Injection of drugs on weekly basis is higher among
females compared to males and in those 25 years and older compared to those less than 25 years old.
The daily use is higher in those 25 years and older compared to those less than 25 years old.
Figure 19 The frequency of drug injection during the last month, disaggregation by gender and age groups, people who inject
drugs from Tiraspol town, %, Republic of Moldova, 2009
Sharing of Injecting Equipment
The value of the UNGASS No. 21 is 86.0%40. When asked about the frequency with which they had used
shared syringes during the last month, 77.6% of the respondents reported that it had never happened.
The rate of consistent use of sterile syringes during the last month is lower in males (82.7%) compared
to females (95.2%).
When asked about how frequently they offered/sold/lent their own personal needles/syringes to other
persons, 85.2% of the respondents who had injected drugs during the last month reported that they
never did that in last month.
40
UNGASS Indicator 21 takes into account only those respondents who had injected drugs during the last month
and had used sterile equipment for their last injection. National Centre of Health Management. "National
Report.Monitoring the Declaration of Commitment on HIV/AIDS." 2010.
Less than half of the sample (41.1%) reported that they used a common jar to draw up drug solutions,
more than half (60.1%) injected drugs using a preloaded syringe, and few of them (3.5%) of the
respondents reported front-/back-loading (Figure 20).
Figure 20 Indirect sharing of injecting equipment during the last month, people who inject drugs from Tiraspol town, %,
Republic of Moldova, 2009
The value of the integrated indicator41 for the indirect sharing of injecting equipment in the last month is
81.8%. Thus, vast majority of the respondents who injected drugs in the last month shared their
injecting equipment indirectly.
Availability of Sterile Syringes
Almost fourth of respondents (28.6%) reported that they had received syringes for free during the last
12 months; 99.7% of the respondents can obtain sterile syringes when needed. When asked about their
main source of sterile syringes, the majority of the respondents reported buying syringes from
pharmacies (71.1%), followed by those who reported using needles exchange services (12.7%).
Females get syringes in needles exchange services much less frequently (15.2%) than in pharmacies
(57.5%). In case of males the pharmacy also is the main source (72.4%) than needles exchange services
(11.3%). Pharmacy is the main source for 67.5% of HIV positive respondents and for 69.5% of HIV
negative respondents. Those who are HIV positive less frequently go for syringes to needles exchange
services (10.0%) compared to those who are HIV negative (14.1%). Younger people who inject drugs buy
syringes in pharmacies in 65.2% of cases and go to needles exchange services only in 9.3% of cases,
41
The respondents who reported at least one of the following practices during the last month: drawing up a drug
solution from a common jar, injecting drugs using a preloaded syringe, or front-/back-loading.
while those aged 25 years and older buy syringes in pharmacies in 73.3% of cases and go to needles
exchange services in 14.3% of cases.
Overdoses and Mortality in people who inject drugs
Of 247 respondents, 24.8% have ever had overdoses and 7.3% had it in last 12 months. Respondents
who reported overdoses in the last 12 months had it 2.2 times on average and never seeked for health
care services in case of overdoses.
When asked (109 respondents) how many people who inject drugs they knew who died in 2008 due
different causes, on average they stated 3.5 persons (median – 2, SD=5,2), of them due to overdoses –
0.5 on average (median –0.0, SD=0.8).
Drug Addiction Treatment
Of the sample, 39.8% consider themselves drug-addicted. The number of self-reported drug addicts is
higher in males (44.1%) compared to females (32.5%). About one third of the respondents (32.6%)
reported to be under narcological surveillance and in 94.2% of cases they were brought to the
narcologist by the police. The share of respondents under narcological surveillance is higher in males
(38.5%) compared to females (17.9%). The mean length of narcological surveillance is 11.0 years
(mediana, DS).
Of the sample, 12.1% reported that they had undergone drug addiction treatment at some point. The
group aged 25 and older did not undergone a drug addiction treatment (0.0%) compared to the under25 age group (13.9%) (8.6%). The share of the respondents who had undergone drug addiction
treatment is higher in males (150%) than in females (6.2%).
Most of the respondents had been through expert consultation (14.2%) followed by detoxification with
other medications (13.9%), outpatient treatment (12.5%) and detoxification without medications
(11.0%). Other types of treatment reached lower values (Figure 21).
Figure 21 Drug addiction treatment followed by the respondents, people who inject drugs from Tiraspol town, %, Republic of
Moldova, 2009
Less than half of the sample (40.5%) think they (still) need treatment to stop their drug use. More than
half of self-reported drug addicts (76.3%) and half of those who had undergone treatment at some point
(48.6%) consider that they (still) need treatment.
Sexual Behavior
Of the analyzed sample, 100.0% have lifetime sexual experience, and 84.1% had had sexual intercourse
during the last year. The ages of the 47 respondents (37 males and 10 females) who reported no sexual
intercourse during the last year ranged between 18 and 49 years old (mean – 32.0 years, median- 30,
SD±8.7).
When asked about the number of sexual partners they had had during the last year, 39.9% of the
respondents reported one partner and 60.1% had had more sexual partners. The mean number of
partners is 3.7 partners (median = 2 partners, SD±5.1).
Of those who had had sex within the last year, 34.3% of the respondents had their spouse or live-in
partner as their sexual partner (mean –1.1 partner, median –1 partner, SD±0.3), 47.1% had steady
sexual partners living separately (mean –1.8 partners, median – 1 partner, SD±2.0), 13.7% had
commercial sexual partners (mean –3.4 partners, median – 2 partner, SD±5.0) and 53.6% had casual
partners (mean - 4.4 partners, median –3 partner, SD±5.4 ).
When asked if their cohabitating partner had ever injected drugs, 28.8% of the respondents answered
affirmatively. The proportion of affirmative answers is higher in females (58.8%) (100.0%) compared to
males (14.4%).
Of the male respondents, 18 have ever experienced a homosexual anal intercourse (8.5%). Only 1 male
respondent reported homosexual anal contact during the last year.
Condom Use
The rate of condom use varies depending on the type of partner (Table 43).
Table 43 Condom use with different types of partners, people who inject drugs from Tiraspol town, %, Republic of Moldova,
2009
Spouse/live-in partner
Steady partner
Commercial partner
Casual partner
Last sexual
intercourse
13.9
35.5
52.9
61.2
Consistent use during the
last month42
13.5
22.8
60.9
49.5
Consistent use during
the last year
11.2
18.6
29.3
46.1
When asked if they knew the HIV status of their spouse/live-in partner, 51.7% of the respondents gave
an affirmative answer.
When asked why they did not use a condom the last time they had sexual intercourse with different
types of partners, the most frequent reason was that they did not consider it necessary in the case of
spouses and live-in partners(78.1%), in the case of steady partners (37.1%) and a reduction in pleasure
was stated in the case of spouses and live-in partners (13.6%), casual partners (36.5%) and steady
partner (20.9%). The number of respondents who had commercial sex and did not use condoms is too
small to allow any calculations.
42
Among those who had sex in the last month with such type of partner
Of the sample 38.0% used condoms the last time they had sexual intercourse; the value of UNGASS
indicator No. 20 is 45.1%43. Lower values of UNGASS indicator No. 20 were registered among the female
respondents (30.3%) compared to male respondents (50.3%) and among the respondents aged 25 years
and older (47.2%) compared to respondents under 25 years of age (67.0%)44.
Condom Availability
One fifth of the respondents (20.3%) had received condoms for free in the last year and 98.7% knew
where they can get condoms if needed; 70.0% would need up to an hour to get condoms. When asked
about their main source of condoms, the most frequently mentioned source was the pharmacy (39.7%),
followed by shops (27.4%) and needles exchange services (18.2%). To be noted that 33.1% of
respondents stated that they don’t need and/or don’t use condoms.
Those females that get condoms mostly do it in pharmacies (33.6%) and needles exchange services
(30.9%). In case of males the pharmacy is the main source (42.1%). Pharmacy is the main source for
34.5% of HIV positive respondents and 40.2% of HIV negative respondents. Those who are HIV positive
four times frequently go for condoms to needles exchange services (26.4%) compared to those HIV
negative (17.3%). No significant differences were found out between younger and those aged 25 years
and older.
The availability of condoms was rated as a moderate one. Hence, 79.3% of respondents stated that on
Sunday evening their can find condoms, if needed.
Sexually Transmitted Diseases
Of the sample 98.7% have ever heard about STDs, but 21.3% could not name any STD symptoms in the
case of females and 49.7% in the case of males. Of the sample, 5.9% had had STD symptoms during the
last year.
Pregnancy
Of the female subsample, 90.3% have been ever pregnant on average 3.3 times in the lifetime (median –
3, SD =1.7 times). Of those who have been ever pregnant, 76.2% had at least one pregnancy ended up
with an abortion (mean – 1.3, median – 1, DS =1.4) and 11.7% have even had miscarriage 0.9 times on
average (median – 0, SD =2.3).
Health status
Less than half of the sample self assessed their health status as a good (38.6%) or a very good one
(3.3%). Every tenth respondent self assessed their health status as a poor (11.9%) or a very poor one
(0.7%).
Knowledge about HIV/AIDS
Almost all the respondents have heard about HIV or AIDS (98.7%). 51.9% of them know persons with HIV
seropositive status or persons who died due to AIDS. The share of respondents who know HIV-positive
persons or persons who died due to AIDS is higher in HIV positive respondents (58.3%) as compared to
43
UNGASS indicator No. 20, takes into account only the respondents who injected drugs and had sexual
intercourse in the last month.
44
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2010.
those who are HIV negative (50.4%), and in the group aged 25 years old and over (62.7%) compared to
the age group under 25 (30.3%).
In general, the respondents answered the questions on the route of HIV transmission correctly (Table
44). The study results make it clear that the level of tolerant attitudes is low.
Table 44 Knowledge and attitudes regarding HIV /AIDS, correct answers, people who inject drugs from Tiraspol town, %,
Republic of Moldova, 2009
Variable
Correct answer, %
Knowledge
1 Have heard about HIV or AIDS
98.7.
2 Know HIV-positive persons or persons who died as a result of AIDS
51.9
The risk of infection may be reduced by correctly using condoms during each
3
83.6
episode of sexual intercourse.
4 The possibility of HIV transmission by using the same toilet
52.2
The risk of infection may be reduced by having one faithful and uninfected
5
76.0
sexual partner.
6 The possibility of HIV transmission by using the same plates and dishes
67.6
The possibility of HIV transmission by using a syringe previously used by
7
98.5
someone else
The risk of infection with HIV may be reduced by passing from injecting drug
8
35.8
use to non-injecting drug use
9 A healthy-looking person may be infected with HIV
70.8
Attitudes
10 Are ready to eat from the same plates and dishes as an HIV-positive person
25.8
Would not keep information secret if found out that a friend or acquaintance
11
46.7
is HIV-positive
12 Integrated indicator on tolerant attitudes
XXXX
The integrated indicator of knowledge about HIV45 has a value of 34.3%46. The value of this indicator is
higher in the group aged 25 and older (38.3%) compared to the age group under 25 years old (27.4%).
Low level of tolerant attitudes is registered among people who inject drugs living in Tiraspol
municipality. Hence, half of the sample (46.7%) will not keep information secret if found out that a
friend or acquaintance is HIV-positive and only fourth (25.8%) are ready to eat from the same plates and
dishes as an HIV-positive person.
Knowledge about viral hepatitis B and C
Of the sample 74.0% have ever heard about hepatitis B and 76.4% have ever heard about hepatitis C.
Younger respondents have ever heard less frequently about hepatitis B (54.2%) and C (55.8%) than
those 25 years and older (77.9% have ever heard about hepatitis B and 83.0% ahev ever heard about
hepatitis C). Of those who ever heard about hepatitis B or C, 80.5% identified them as infectious
diseases.
45
UNGASS Indicator No. 14, which takes into account only correct answers to all 5 standard questions (3,4,5,6,and
9 inTable 13).
46
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2010.
Two thirds of the sample self assessed their level of knowledge on viral hepatitis B or C as a low or
lacking one, their share being higher among the younger age group and female respondents (Table 45).
Table 45 Self assessed level of information about Hepatitis B and C, people who use injecting drug from Tiraspol town, %,
Republic of Moldova, 2009
Well informed
Somewhat informed
Poorly informed
Not informed
Well informed
Somewhat informed
Poorly informed
Not informed
Self assessed level of information about Hepatitis B
25 years
Less than 25
Males
Females
and older
years old
3.5
1.5
3.3
1.5
30.6
18.9
30.3
22.0
37.6
31.4
36.9
37.3
27.7
48.2
28.8
39.0
Self assessed level of information about Hepatitis C
25 years
Less than 25
Males
Females
and older
years old
3.1
1.4
2.9
0.4
30.2
20.6
30.3
22.9
40.5
31.0
38.6
37.6
26.2
47.0
28.2
39.1
Total
2.8
27.2
37.2
32.1
Total
2.5
27.0
38.4
32.1
Being asked about the sympthoms of the viral hepatitis B and C, every 10th respondent answered
correctly to all questions. Thus, the integrated indicator of knowledge on sympthoms47 of the viral
hepatitis reached 11.6% (males –11.3%, females –13.2%), being lower in younger respondents (5.0%),
compared to those who are 25 years and older (13.3%).
Table 46 Knowledge and attitudes regarding about Hepatitis B and C, correct answers, people who use injecting drug from
Balti municipality, %, Republic of Moldova, 2009
Variable
Risk of transmission through
1.
2.
3.
4.
5.
6.
7.
8.
47
Sharing of needs/syringes
(direct sharing)
Sharing other equipment
to prepare drugs (indirect
sharing)
Dental
interventions/treatment
with unsterile equipment
Sharing of toothbrush,
shaving blades, manicure
scissors
Use of unsterile medical
equipment and needles
Heterosexual contacts
Homosexual contacts
Transfusion of infected
Correct answers, %
Tota
l
>25
<25
M
F
Tota
l
>25
HCV
<25
M
F
57.2
61.3
45.6
60.4
47.8
57.3
61.3
45.4
60.5
47.9
35.9
39.8
19.9
38.6
28.3
36.2
40,5
20.6
38,9
28.5
41.1
46.7
24.2
45.3
29.1
41.1
46.3
26.3
45.3
29.1
39.9
43.7
29.4
45.7
27.5
39.9
43.0
30.3
45.1
27.1
49.4
52.5
41.4
54.4
33.6
49.2
52.0
42.1
53.8
33.6
28.0
28.7
59.7
31.5
33.3
63.8
19.4
16.8
48.6
35.4
35.1
63.0
10.8
13.1
49.8
27.4
28.7
59.8
30.4
33.3
64.1
17.9
16.8
48.3
34.6
35.1
63.4
10.4
13.1
49.8
9.
10.
11.
12.
13.
14.
15.
16.
17.
blood
Contact with body fluids
Kissing
Sharing plates, knives,
forks
Social contact (shaking
hands, coughing)
Piercing
Mother
to
child
transmission
Breastfeeding
Tattoo
Would
not
keep
information confidential
if found out that a friend
or
acquaintance is
Hepatitis B or C positive
19.7
33.5
32.2
22.0
34.6
32.5
11.2
22.4
27.6
23.6
33.8
30.8
9.3
32.2
35.3
20.0
31.8
31.3
22.4
33.0
32.2
11.0
20.8
26.9
23.9
32.7
30.1
9.3
29.6
33.9
40.8
44.2
35.7
40.2
40.0
40.2
43.3
35.2
39.8
38.8
39.0
24.7
39.6
26.6
32.6
11.6
42.3
29.1
29.9
13.3
39.7
24.6
41.0
26.6
31.8
11.3
42.9
29.0
31.0
13.3
15.5
48.4
15.2
50.8
16.0
35.2
14.3
50.0
16.7
42.2
15.2
46.2
14.8
49.0
16.0
31.8
14.1
48.5
16.8
39.9
33.9
Respondents 25 years old appeared tolerant in 41.8% of cases and younger age group – in
30.0% of cases. Differences were registered between males (31.4%) and females (39.7%).
HIV Testing
When asked if they know where an HIV test can be taken, 68.7% of the respondents gave an affirmative
answer. Of the sample, 95.0% reported that there is a possibility to be tested to HIV in the locality where
they live without differences between females (96.2%) and males (95.0%), between older respondents
(95.5%) and those younger than 25 years (94.1%). Of the ample, 16.4% reported that HIV testing may be
undertaken in a confidential manner.
Of the sample, 43.2% have undertaken an HIV test at some point in their lifetime (18.9% once in their
lifetime and 24.3% many times in their lifetime). More than half (56.8%) have never been tested for HIV.
Only 6 persons had had an HIV test at some point and did not know the results (2.2% of those who have
been ever tested). Of respondents who have never undertaken an HIV test 98.9% would be interested to
pass it.
During the last year, 20.1% of the sample took an HIV test and know the result of the last test.
Being asked to tell their last HIV test result, 3.5% of the whole sample reported to be HIV positive (0.5%
where not confirmed when tested within the study). Additionally, within the study sample there where
found 7.3%respondents with HIV positive samples. Thus, more than half (75.9%) of the HIV positive
people who inject drugs recruited within the study were not aware of their HIV positive status. The non
response rate to the question is of 0.0% of those who were asked about the last test result (who have
been ever tested to HIV).
Viral hepatitis testing
Of the sample, 36.2% know where they can get tested to viral hepatitis B or C (39.4% of male
respondents and 27.9% of female respondents). About 15.9% had had ever been tested to both
infections (males – 16.1%, females – 15.2%). Only 1.0% of the sample had had ever been tested only to
viral hepatitis C and 0.6% of the sample had had ever been tested to viral hepatitis B. Of the sample
58.8% had had never been tested to any of two infections (58.3% of male subsample, 59.9% of female
subsample).
In those younger than 25 years, 25.1% know where they can get tested to viral hepatitis B or C. About
6.9% had had ever been tested to both infections, 51.2% had had never been tested to any of two
infections, and none had had ever been tested to only viral hepatitis B or only to viral hepatitis C.
In those 25 years and older, 39.0% know where they can get tested to viral hepatitis B or C, 18.7% had
had ever been tested to both infections, 60.8% had had never been tested to any of two infections, 1.4%
had had ever been tested to viral hepatitis C and 0.7% had had ever been tested to viral hepatitis B.
Vaccination against viral hepatitis B
Of the sample 31.3% were aware about vaccination against viral hepatitis B and 14.6% have been
vaccinated. Younger respondents reported a vaccination rate against viral hepatitis B of 3.7%) and those
25 years and older - 3.8%). There were not registred differences in the self reported vaccination rate
between males (5.4.5%) and females (0.7%).
HIV, HVC, HBV Prevalence, and TP antibodies
Blood samples were subjected to testing for HIV, HCV, HBV, and TP antibodies (syphilis). The detailed
results are shown in Table 47.
Table 47 HIV, HCV, HBV, and TP antibodies prevalence, people who inject drugs from Tiraspol town, %, Republic of Moldova,
2009
HIV Prevalence
#
%
40/281
12.1
HCV Prevalence
#
%
84/281
20.8
HBV Prevalence
#
%
25/281
7.7
TP Antibodies
#
%
4/281
1.3
Disaggregated by age group and gender (Table 48), the prevalence of antibodies to HIV, HCV and
Treponema Pallidum registered higher values in the age group 25 years old and over compared to the
under-25 age group. Compared to males, females registered higher values in case of HIV prevalence.
Table 48 HIV, HCV, HBV, and TP antibodies prevalence, disaggregation by age group and gender, people who inject drugs
from Tiraspol town, %, Republic of Moldova, 2009
Up to 25 years old
25 and over
Males
Females
Injected drug for 3
years and less
Injected drug for 4
-6 years
Injected drug for 79 years
Injected drug for 10
years and more
HIV prevalence
8.1
14.3
10.1
17.7
HCV prevalence
8.7
24.6
25.4
11.1
HBV prevalence
7.4
6.9
9.0
5.1
TP antibodies
4.3
0.3
1.7
0.0
12.6
6.1
6.4
0.0
11,2
21.0
5.8
2.6
20,1
30.9
1.9
1.2
12.5
33.7
11.7
0.8
Conclusions and implications for interventions
The sample method applied makes the study representative of the population of people who inject
drugs who are living in the assigned geographical location. The summary of the study results is as
follows:
1. The study sample consists of 69.4% male respondents and 30.6% female respondents. The
respondents’ ages ranged between 18 and 59 years old, the average being 30.5 years. The
majority of the respondents belong to the group aged 25 and older (70.6% of the respondents
who reported their age). The largest group of respondents reported being single (48.0%). The
majority of respondents have secondary education or specialized secondary education (58.3%).
Of the sample, 95.9% reported speaking Russian most frequently. At the time of the interviews
approximately 55.0% of the respondents lived in large urban area (Tiraspol or Bender). The
majority of the study respondents (98.8%) had not been away from home during the last year
for longer than one month.
2. The mean length of the drug injecting career in the study sample is 7.8 years. The mean age at
the time of the first injection was 23.0 years old. When asked about the last time they had
injected a drug, 47.2% of the sample reported that it had been during the last month. The most
commonly injected drug during the last month was extract of opium in 87.6% of cases.
3. The value of UNGASS indicator No. 21 is 86.0%48. During the last month, 81.8% of the
respondents reported that they had not used syringes previously used by someone else. The
value of the integrated indicator49 of indirect sharing of injecting equipment during the last
month is 81.8%.
4. Of the total number of respondents, 32.6% consider themselves drug-addicted; 12.1% reported
having been treated for drug addiction at some point, and 40.5% consider that they (still) need
treatment to stop their drug use.
5. 84.1% had had sexual intercourse during the last year. The mean number of partners was 3.7.
When asked if their spouse or live-in partner had ever injected drugs, 28.8% of the respondents
gave an affirmative answer. The rate of this affirmative answer is higher among females (58.8%)
compared to males (14.4%). Homosexual anal contacts during the last year were reported by 1
respondent.
6. 38.0% of the sample used condoms the last time they had sexual intercourse; the value of
UNGASS indicator No. 20 is of 45.1%50. The rate of condom use varies, depending on the type of
partner.
7. 20.3% of respondents had received condoms for free during the last year and 98.7% know
where they can get condoms when they need to, and it would take up to an hour for 70.0% of
the respondents to get condoms.
8. The integrated indicator on HIV51 knowledge has a value of 34.3%.
48
Respondents who used sterile needles/syringes the last time they had injected during the last month.
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2008.
49
The respondents who reported at least one of the following practices during the last month: drawing up the
drug solution from a common jar, injecting drugs with a preloaded syringe, front-/back-loading
50
National Centre of Health Management. "National Report.Monitoring the Declaration of Commitment on
HIV/AIDS." 2008.
9. About one fourth of respondents (28.6%) had received syringes for free in last 12 months
10. During the last year, out of the total sample, 20.1% of the respondents underwent an HIV test
and know the results.
11. HIV prevalence reached 12.1%, HCV prevalence 20.8%, HBV prevalence 7.7%, and the
prevalence of TP antibodies 1.3%. The prevalence of HIV, and HCV registered higher values in
the group aged 25 and older compared to the age group under 25 years old.
Due to low coverage with HIV prevention programmes, the comparability analysis between beneficiaries
and non beneficiaries is not possible.
51
UNGASS indicator No. 14, which takes into consideration only the correct answers to all 5 standard questions (3,
4, 5, 6, and 9 of Table 13).