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Try out PMC Labs and tell us what you think. Learn More. Language: English Spanish. Petersburg, Russia. We conducted a mixed methods study of young age 18—26 hard drug users in St. Thirty-nine structured and 10 semi-structured interviews were conducted. A new cohort of drug users in St. Petersburg may have emerged, which is much safer in its injection practices compared to previous cohorts. However, risky sexual practices among this new cohort may expose them to the possibility of sexual transmission of HIV and widespread drug paraphernalia sharing to the HCV epidemic. Se realizaron 39 entrevistas estructuradas y 10 semiestructuradas. Russia is one of the countries with the highest incidence rates of HIV infection 1. Petersburg with its estimated 80 PWID 5. Petersburg in particular, are well documented 6 — Petersburg from to 7 , 11 — Additionally, the HCV prevalence rate also increased from Petersburg, Russia 1. This is similar to previous studies that found the overwhelming majority of respondents named heroin as their drug of choice 15 , Petersburg, we can see that it examined roughly the same generational-grouping of drug users — those who felt the full brunt of the effects of the transition that occurred in Russia in the s, including the opioid and HIV epidemics, that were in their early twenties at the turn of the century, turning 30s in , and are now in their mid-thirties. Petersburg, those whose age is currently in the range of 18—29 years. For instance, studies conducted among young under 25 years new injectors in Vietnam 22 and heroin injectors in United Republic of Tanzania aged 17—25 years 23 provide evidence of high HIV prevalence - varying from Moreover, in St. A number of studies in different countries have found that young PWID are less likely to know or apply safer injection practices 26 and are more inclined to share syringes and other drug paraphernalia than older PWID 23 , 27 — Given the lack of studies of young drug users in St. Petersburg in recent years and the fact that this group is particularly vulnerable to HIV infection and other risks, we undertook a mixed-methods pilot study of young age 18 — 26 hard drug users in St. Petersburg as a precursor to attempting to organize a major respondent driven sampling RDS study informed by the results of the pilot project. In this pilot we sought to explore what substances are used by young drug users, their drug use patterns and trajectories, drug use and sexual network characteristics, risk injection and sexual practices, overdose risks, HIV and HCV prevalence, and other issues related to drug use. We employed a mixed-methods research design to capitalize on the relative strengths of both quantitative and qualitative research perspectives. We started the pilot by collecting and conducting preliminary analysis of qualitative data phase 1. To be eligible for the qualitative study, informants had to be: 18—26 years old, report any drug use apart from cannabinoids in the past 30 days, reside in St. Petersburg, speak Russian, and able to provide written informed consent. However, we were unable to recruit young age 18 — 26 hard drug users through these venues. We extended our search for informants by incorporating the City Drug Treatment Center and exploiting our good relations with the local Narcotics Anonymous NA community, again offering rubles as an incentive for recruitment of a study subject eligible for the study. We also asked our research interns to bring to the study their friends and acquaintances, if they were eligible for the study and ready to take part in it. These strategies proved fruitful and we managed to recruit 10 participants. Two were recruited at the City Drug Treatment Center, both at the higher end of our age range 26 years old ; eight were recruited through our NA connections. Serological status was self-reported. Amphetamine was the drug of choice for three of the subjects, one regularly used methadone, and the rest reported polydrug use. Nine out of ten respondents reported injecting drug use methadone, amphetamine, mephedrone, or their combination. Data collection, consisting of semi-structured interviews, was conducted in February Informants were interviewed in cafes or a private room at the City Drug Treatment Center. Interviews were conducted in Russian language, recorded, and lasted on average around 90 minutes. All participants provided written informed consent and were reimbursed for their time and effort with the sum in rubles equal to 15 USD. Interviews were conducted by two members of the research team PM and AD. The names of the informants have been changed to pseudonyms. The qualitative part of the study was approved by the Ethical Committee of the St. Petersburg Association of Sociologists. Participants were recruited from February through April using RDS, a method designed to overcome some of the biases inherent in the non-random nature of sampling hard-to-reach populations without a clear sampling frame 37 , Eligibility criteria were the same as in the qualitative part, with one addition: participants had to be willing both to self-test for HIV and HCV in the presence of the interviewers immediately after completing structured interviews and also to disclose their test results to them. Participants who looked 25 or older were asked to produce their photo ID for age verification. Drug use was self-reported; those who reported recent injection use were visually assessed for injection marks. Seeds were provided with three coupons with which to recruit other eligible participants. This process was repeated with recruited participants until we had engaged 39 subjects, after which we stopped recruiting subjects due to the budget considerations. We used a dual-incentives system: each participant received the ruble equivalent of 8 USD for taking part in the study and the ruble equivalent of 8 USD for each study participant successfully recruited. Structured interviews lasted between 90 to minutes and included the same thematic blocks that were used in the qualitative phase. In writing the questionnaire items, we drew on language used by the participants in semi-structured interviews, where necessary, to help word questions appropriately. Additionally, based on results of preliminary analysis of semi-structured interviews, we introduced questions related to social distance between different categories of drug users with respect to types of drugs used, routes of their use, injection practices and serological status. Following Karakayali 39 , we view social distance as a multidimensional phenomenon and adopt the concepts of affective and interactive distances as separate aspects of social distance; thus affective distance is measured in terms of attitudes and emotions toward the group, whereas interactive distance reflects the frequency of interaction between the groups. Participant interviews were transcribed verbatim. Thematic analysis 40 was conducted with the aid of a free software program called Open Code 3. All interviews were initially coded using a priori codes developed on the basis of the interview guide, and then data were coded again inductively based on emergent findings from the data. To exclude possible discrepancies in interpretations, the coders met after every third transcript was coded and disputes in interpretation were resolved on a consensus basis. Variables were summarized using medians and interquartile ranges IQR or relative frequencies and percentages, as appropriate. In this section we first present the results of the quantitative part of the study and then elaborate them or illustrate them with qualitative data in accordance with Complementarity Design. We report percentages for the quantitative data only. Petersburg 4. Sociodemographic characteristics, HIV testing and drug use behaviors among 39 young people who use drugs in St. Petersburg, Russia, Exclusive use of amphetamine was more prevalent among NIDU, none of whom used mephedrone. We can see from this data that opiates are much less popular among young hard drug users compared to their popularity among older drug using cohorts. Seventy-two percent reported injecting in the past 90 days. Injection practices among 29 young people who inject drugs in St. In the qualitative interviews participants told us of their fear of contracting HIV and HCV, and also that non-sharing of syringes was to a large extent a matter of personal hygiene. The following exchange illustrates this point:. Informant: Yes, I think so, naturally. However, the data on sharing other drug preparation paraphernalia i. Ksenia, who got tested and learned that she was HCV-positive during her first several months after she started to inject and later underwent HCV treatment, explains:. Before I was told that you just have to watch that you always have your own syringe. Junkies told me this, and I thought so The qualitative data show that in addition to not sharing syringes, many participants took care of themselves in multiple ways. They sniffed drugs if they did not have their own syringe. They tried to maintain nutrition even when they were not feeling hungry, took vitamins, mineral supplements, used medicines for vein treatment, and visited a doctor when they were sick. The following quote illustrates this point of safety embedding:. Sergey aged 20, PWID carried naloxone with him because he could find himself in a company where opiates were used, despite the fact that he did not use opiates himself. Ksenia describes how safety norms can even be enforced:. Sexual practices in past 90 days among 39 young people who use drugs in St. Petersburg, Russia, , by sex. We then explored affective and interactive distances that exist between different categories of drug users with respect to types of drugs, patterns of their use as well as behaviors and outcomes associated with drug use e. As mentioned above, we interpret affective distance in terms of attitudes and emotions toward a particular group and interactive distance - as a frequency of interaction with members of the group. The data suggest that opiate use is controversial. The qualitative data support the quantitative on this dual status of opiates. So therefore, I hid it from them However, several of them were disillusioned after trying it. As Lena tells:. Well, one time. We thought that it was something special, as people say, it is the best of all drugs. These pilot data suggest that a new generation of hard drug users, that is quite different in their drug use practices from older generations of PWUD in St. Petersburg, may have emerged. However, Kornilova et al. Obviously, a larger study or studies are needed to confirm or refute this statement. Further studies must explicate these and other aspects of different social contexts for different generations of drug users in Russia. Nearly half of the participants used only amphetamines, and a substantial number used amphetamines and novel psychoactive substances NPS such as mephedrone also a stimulant , whereas opioids were used by a much smaller number of participants and almost always episodically. Both serological and behavioral data indicate that this generation seems to be much safer in its injection practices than older PWID cohorts - none of the participants reported syringe sharing in the past 12 months, and about half the subsample reported using new syringes only. Lower rates of syringe sharing among young PWID are observed not only in Russia but in countries with similar histories of drug epidemics, such as Estonia and Ukraine where younger PWID inject more safely than their older peers 45 , This raises an intriguing and important question: how did these new pro-safety norms among young hard drug users in St. Petersburg emerge, especially in the context of a Russian drug policy that neglects and often opposes harm reduction among PWID? The answer clearly does not reside in the fact that new generation switched to stimulants since a number of studies report that injection of amphetamine-type stimulants is associated with more needle sharing compared to opiates 49 — Also, to add complexity to the question, a number of studies have found that young injectors are particularly vulnerable to HIV and HCV infections 19 , 20 but our study data do not show this. We can learn from this pilot study that relationships between drug and HIV policies and behavioral and serological outcomes cannot be reduced to policies per se and involves much more complex social and cultural processes. Also, broader policies and socioeconomic conditions are very important. These conditions appeared not as governmental AIDS response but were formed by market forces after the collapse of the Soviet Union. Sound HIV and drug policies are extremely important. This is shown by numerous successful implementations of syringe exchange programs throughout the world 53 , However, programs and policies are not everything. Collective representations of acceptable and unacceptable behaviors such as syringe sharing or lack thereof seem to be quite resilient and independent of policies. This parallels the relative lack of influence of drug policy on the prevalence of drug use and drug addiction. Similarly, Friedman et al. These data suggest that such independence between policy and enforcement and behaviors exists for injection risk behavior as well as for the number of people who use drugs. The results of this pilot study indicate a possible norm change regarding injection safety among young hard drug users in St. Previous studies 58 — 60 have suggested an important part of the norm change process: stigmatization of the previous cohort, the substance s they use, the way they administer these substances, and behavioral norms around their consumption. Stigmatization of opiate users and particularly of old opiate users was also observed in both qualitative and quantitative data. Aversion to the older opiate users may be related to a stigmatized image of a heavy opioid user or may be a psychological strategy against greater involvement in opiate use or both. More research is needed on this topic. It also potentially guards them from absorbing norms supportive of syringe sharing that are widespread in the older PWID injection networks. Separateness from older opioid cohorts along with safer injection behaviors found in our sample may make them resilient to parenteral HIV-infection. This is epidemiologically parallel to Friedman et al. Similar findings regarding negative interpretation of effects of heroin and cocaine by inexperienced users were reported by Bancroft et al. As a result, many participants discontinued opiate use. More research is needed to clarify whether this phenomenon is related to poor heroin and methadone quality in the St. Petersburg drug market, the subjective and social nature of the drug high described in the literature 67 — 69 , or both. Though the low prevalence of HIV and HCV detected in the sample is encouraging, considerable risks exist with regards to HCV- and HIV-infection via indirect sharing and sexual transmission, since few participants reported that they never shared drug paraphernalia and only a tenth reported consistent condom use. Also worrisome is that over two thirds of the respondents reported having known someone who died of overdose. Indeed, in qualitative interviews several informants told us that they themselves had had opiate overdoses while using opiates episodically, and knew episodic opiate users who had died of opiate overdose. The spread in Russia of fentanyl and fentanyl-type substances renders the opiate overdose problem, perhaps particularly among inexperienced users, especially critical. Petersburg , at the end of a number of interviews we asked the respondents whether they would be willing to exchange syringes at syringe exchange programs. The answer was always negative. When probed why, informants named financial well-being and the cheap price of syringes. These findings are in accordance with those that report an unwillingness of young drug injectors to access harm reduction services in other settings It may turn out that SEPs are not attractive to young hard drug users. However, this study shows that participants are often involved in providing their peers with clean injecting equipment, supporting safe injecting practices and discouraging unsafe ones — actions that Friedman et. Intraventions can be a powerful vehicle for reduction of various risks among PWID, especially in the settings where sufficient harm reduction services are lacking, like in Russia High digital literacy every participant used the Internet on a daily basis and youth civic potential can also be capitalized upon — HIV and drug user online and offline activism may be attractive to this group of highly educated young hard drug users. This study has several limitations. First, due to the pilot nature of the data and small sample size, data analysis was performed in an exploratory manner so all p-values should be interpreted as indicators that there might be some relationships, which should be verified in further studies. Third, one of the primary reasons for using RDS procedures in this study, despite the small sample size, was to demonstrate feasibility of an RDS study of young hard drug users in St. Previous research 25 showed that HIV prevalence was very high among street youth who injected drugs in recent years in St. Petersburg, but we were unable to recruit this group of PWID. Petersburg young hard drug users. Substance consumption was self-reported without confirmatory toxicology. Behavioral data can be inaccurate due to recall and social desirability bias. Thus, participants may have over-reported the use of sterile needles. Social distance from opiate users among 39 young people who use drugs in St. Petersburg in National Center for Biotechnology Information , U. AIDS Behav. Author manuscript; available in PMC Dec 1. Peter Meylakhs , a Samuel R. Ompad , c, d Alisa Alieva , a and Alexandra Dmitrieva e. Petersburg, Russia Find articles by Peter Meylakhs. Samuel R. Petersburg, Russia Find articles by Anastasia Meylakhs. Danielle C. Find articles by Danielle C. Petersburg, Russia Find articles by Alisa Alieva. Author information Copyright and License information Disclaimer. Contact person: Peter Meylakhs, Kantemirovskaya st. Copyright notice. See other articles in PMC that cite the published article. Open in a separate window. Figure 1. Petersburg, Russia 1 1 Based on the following studies: 7 , 12 — METHODS We employed a mixed-methods research design to capitalize on the relative strengths of both quantitative and qualitative research perspectives. Participants and Data Collection Qualitative We started the pilot by collecting and conducting preliminary analysis of qualitative data phase 1. Quantitative Participants were recruited from February through April using RDS, a method designed to overcome some of the biases inherent in the non-random nature of sampling hard-to-reach populations without a clear sampling frame 37 , Analysis Qualitative Participant interviews were transcribed verbatim. RESULTS In this section we first present the results of the quantitative part of the study and then elaborate them or illustrate them with qualitative data in accordance with Complementarity Design. Table 1. Petersburg resident registration 0. Petersburg 21 24 10 Ethnic group 0. Table 2. Table 3. Table 5. Stockholm: ECDC; Characterization of an emerging heterosexual HIV epidemic in Russia. Sex Transm Dis. September; 35 9 — Medicine Baltimore. November 4; 95 Petersburg and Leningrad oblast in January-December, Petersburg and Leningrad Oblast; Heimer R, White E. Estimation of the number of injection drug users in St. Drug Alcohol Depend. June 1; 1—3 — Prevalence of HIV, hepatitis C and syphilis among injecting drug users in Russia: a multi-city study. Individual-level, network-level and city-level factors associated with HIV prevalence among people who inject drugs in eight Russian cities: a cross-sectional study. BMJ Open. June 14; 3 6. Harm Reduct J. July 31; 6 Estimates of HIV incidence among drug users in St. Petersburg, Russia: continued growth of a rapidly expanding epidemic. Eur J Public Health. October; 21 5 —9. Potential bridges of heterosexual HIV transmission from drug users to the general population in St. Petersburg, Russia: is it easy to be a young female? July; 86 Suppl 1 — Emergence of Methadone as a Street Drug in St. Int J Drug Policy. January; 27 — Non-fatal overdoses and related risk factors among people who inject drugs in St. BMC Public Health. December 18; High-risk behaviors after release from incarceration among people who inject drugs in St. February 1; — Estimating the prevalence of syringe-borne and sexually transmitted diseases among injection drug users in St Petersburg, Russia. October 1; 14 10 — HIV prevalence, sociodemographic, and behavioral correlates and recruitment methods among injection drug users in St. J Acquir Immune Defic Syndr April 15; 41 5 — August; 14 4 — Hepatitis C virus seroprevalence among people who inject drugs and factors associated with infection in eight Russian cities. BMC Infect Dis. September 19; 14 Suppl 6 :S Subcultural evolution and illicit drug use. Addict Res Theory. Bekker L-G, Hosek S. HIV and adolescents: focus on young key populations. February 26; 18 2 Suppl 1. Young and recent-onset injecting drug users are at higher risk for HIV. November 1; 92 11 — HIV and young people who inject drugs: a technical brief. Ministry of Health - Viet Nam. Hanoi, Viet Nam; HIV risk behaviors, perceived severity of drug use problems, and prior treatment experience in a sample of young heroin injectors in Dar es Salaam, Tanzania. Afr J Drug Alcohol Stud. November; 21 17 — Decline in HIV seroprevalence in street youth —, St. March 1; 28 4 — Young people and injecting drug use in selected countries of Central and Eastern Europe. Vilnius: Eurasian Harm Reduction Network; April 1; 18 3 — Health behaviors of young adult heroin injectors in the Seattle area. January 1; —9. Sex-and drug-related risk among populations of younger and older injection drug users in adjacent neighborhoods in San Francisco. June; 24 2 —7. Am J Epidemiol. March 1; 5 — Biological and behavioural survey among injection drug users. The estimation of the prevalence of HIV and viral hepatitis C infection, risk factors, risk behavior and the use of services among the population of young injecting drug users in Belgrade , Novi Sad and Nis. Hard drug use in Norway. Nord Stud Alcohol Drugs. February 1; 27 1 — Designing and conducting mixed methods research. Sage publications; Educ Eval Policy Anal. Patton MQ. Qualitative evaluation and research methods. Thousands Oaks. CA: Sage Publication; March 1; 6 1 — Effectiveness of respondent-driven sampling for recruiting drug users in New York City: findings from a pilot study. May; 83 3 — Sociol Forum. Applied the matic analysis. IBM Corp. June 5; 14 Expanded syringe exchange programs and reduced HIV infection among new injection drug users in Tallinn, Estonia. June 30; 11 Slowing of the HIV epidemic in Ukraine: evidence from case reporting and key population surveys, — PloS One. Symbiotic goals and the prevention of blood-borne viruses among injection drug users. Subst Use Misuse. Sociol Health Illn. May; 37 4 — Patterns of drug use and risk-taking among injecting amphetamine and opioid drug users in Sydney, Australia. Addict Abingdon Engl. April; 88 4 — April 4; 20 6 —6. Sexual and injection risk among women who inject methamphetamine in San Francisco. HIV risk behavior among amphetamine injectors at U. December; 17 6 — Full participation in harm reduction programmes is associated with decreased risk for human immunodeficiency virus and hepatitis C virus: evidence from the Amsterdam Cohort Studies among drug users. September 1; 9 — Wodak A, Cooney A. Do needle syringe programs reduce HIV infection among injecting drug users: a comprehensive review of the international evidence. April; 4 —7. Drug Arrests and Injection Drug Deterrence. Am J Public Health. February 1; 2 —9. Income inequality, drug-related arrests, and the health of people who inject drugs: Reflections on seventeen years of research. June 1; 32 —6. Golub A, Brownstein HH. J Drug Issues. July 1; 43 3. J Crim Law Criminol. Deviant Behav. Cohort changes in illegal drug use among arrestees in Manhattan: from the Heroin Injection Generation to the Blunts Generation. November; 34 13 — Douglas M Purity and Danger. N Y Routedge; ; \\\\\\\\\\\\\[ Google Scholar \\\\\\\\\\\\\]. Douglas M Risk and blame. Routledge; New York: Raven Press; London: UCL Press; Bancroft A, Reid PS. Concepts of illicit drug quality among darknet market users: Purity, embodied experience, craft and chemical knowledge. Becker HS. Becoming a marihuana user. Am J Sociol. Zinberg NE. Drug, set, and setting: The basis for controlled intoxicant use. Yale University Press; Bourgois P Anthropology and epidemiology on drugs: the challenges of cross-methodological and theoretical dialogue. October 1; 13 4 — June; 16 3 — Support Center Support Center. External link. Please review our privacy policy. Median age in years IQR 2. Registration outside of St. Did not complete higher education. With partner without children. With partner with children. Amphetamines and mephedrone. Polydrug use 4. Ever experienced physical dependence on opiates. Median years of injection drug use IQR 1. Median age at first injection in years IQR. Did not inject in past 12 months. Spoke with people inject with about the need to inject safely in the past 6 months. Did not inject in past 6 months or missing. Supplied sterile syringes to people inject with in the past 6 months. Made sure had enough sterile syringes so can provide to others in the past 6 months. We will not let them do it. They will not be invited into our company again. There will be sarcastic jokes, etc. Everything will continue as if nothing happened. Such people do not come into our company. Median number of vaginal, anal, or oral sex partners IQR 2. Number of partners that were regular drug users. Number of partners that were drug injectors in past 90 days. Only had sex with another woman.

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