Centrul Naţional De Managament În Sănătate
NationalCenterof Health Management
Monitoring and Evaluation of National Health Programmes
National DrugObservatory
Surveillanceof Risk Behavior associated to HIV
Assessment of Risksto HIV infection among young Injecting Drug Users, Men having Sex with Men, Commercial Sex Workers and Juveniles in Detention
Report
Third draft
Chisinau 2008
Study was implemented by the National Center of Health Management in collaboration with the nongovernmental organizations
Implementation Team:
Study Coordination:
Otilia Scutelniciuc, Monitoring and Evaluation of National Health Programmes, NationalCenter of Health Management
Diana Postoronca, National Drug Observatory, Monitoring and Evaluation of National Health Programmes, NationalCenter of Health Management
National consultants:
Mihai Ciocanu, MD, PhD
Stela Bivol, MD, MPH
Participating Organizations and interviewers:
„Youth for Right to Life” NGO, Balti
Lina Osoianu
ElenaBurlac
Vitalie Robinciuc
Alexandru Stoliar
Ludmila Corneev
„Medical Reforms” NGO, Chisinau
Alexei Leorda
LiliaTodirascu
Diana Rotaru
EugenTanciac
Maria Portarescu
„Future Generation” NGO, Tiraspol
Natalia Hineva
„Homodiversus” NGO, Chisinau
Eugen Iliinschi
Igor Doncila
Sociological Company CBS AXA
Department of Penitentiary Institutions, Ministry of Justice of the Republic of Moldova
Technical assistance: LondonSchool of Hygiene and Tropical Diseases, London, Great Britain
Study commissioners:
UNICEF Moldova
National Program on Prevention and Control of HIV/AIDS/STIs2006 - 2010
The study was implemented with the support of:
UNICEF Moldova
World Bank’s AIDS Control Project inMoldova
Report written by:
Otilia Scutelniciuc (quantitative component)
Eugen Iliinschi (qualitative component)
Acknowledgements
Study Implementation Group expresses its gratitude to all involved organizations,including the respondents, for participation and sincerity. Special thanks are due to UNICEF Moldova team: Larisa Lazarescu, Sergiu Tomsa and Silviu Domente, former UNICEF Moldova officer.
Contents
Quantitative assessment......
INJECTION DRUG USERS......
Summary of findings......
Study Objectives......
Study Method......
Target Group......
Inclusion/Exclusion Criteria......
Study Type......
Sampling and Recruitment......
Data Collection Tool......
Confidentiality and Anonymity......
Data Quality Assurance......
Data analysis......
Study limitations......
Socio-Demographics......
Sex and Age......
Marital Status......
Education......
Occupation......
Ethnicity and Spoken Language......
Residency Area......
Mobility......
Identity Papers......
Use of Legal and Illegal Drugs......
Use of Legal Drugs......
Use of Illegal Drugs......
Length of Drug Use......
Last Injection of drugs......
Drugs Used during the Last Month before the Interview......
Frequency of Drug Injection......
Places for Injecting Drugs......
Practices for Using Equipment for Injecting Drugs......
Sources of Sterile Syringes......
Drug Addiction Treatment......
Surveillance in the National Narcologic Service......
Sexual Behavior at Risk......
Sexual Behavior......
Condom Availability......
Sexually Transmitted Infections......
Pregnancy and Birth Delivery......
Knowledge about HIV/AIDS......
HIV Testing......
Benefiting from Services......
Contacts with Public Order Maintenance Forces......
IDUs’ Permanent Sexual Partners......
Target Group......
Sampling and Recruitment......
Sample Profile......
JUVENILES IN DETENTION......
Summary of findings......
Study Objectives......
Study Method......
Target Group......
Inclusion/Exclusion Criteria......
Study Type......
Sampling and Recruitment......
Data Collecting Tool......
Confidentiality and Anonymity......
Data Quality Assurance......
Study limitations......
Socio-Demographics......
Sex and Age......
Education Level......
Residency Area......
Ethnicity and Spoken Language......
Detention......
Identity papers......
Marital Status......
Use of Legal and Illegal Drugs......
Risk-Associated Sexual Behavior......
Sexual Behavior......
Condom Availability......
Sexually Transmitted Infections......
Pregnancy and Birth Delivery......
Knowledge about HIV/AIDS......
HIV Testing......
Benefiting from Services......
Contact with Representatives of Force Institutions......
Annex 1......
List of Tables......
List of Figures......
Qualitative Assessment......
Target groups......
Methodology......
Recruitment......
Men having Sex with Men......
Commercial Sex Workers (CSW)......
Access and use of services......
Quantitative reseacrh
INJECTION DRUG USERS
Summary of findings
The survey reached respondents of range of age between 12 and 24 years with a mean age of 18.8 years. Within the survey were recruited 78.6% male respondents and 21.4% female respondents. The mean age of recruited females (19.6 years) is higher that the mean age of recruited males (18.6 years). 81.3% out of the study sample stated that they are unmarried, this proportion being higher in males (86.6%) than in females (62.0%). In the age group of 19 – 24 years old the proportion of unmarried respondents registered 64.8%.Out of the total sample,43.9% of respondents have occasional or permanent income and 23.0% are not involved in studies/unemployed and without income. The percentage of 19 – 24 years old respondents who have occasional or permanent income reached 64.2%.14.4% of the entire sample stated that most frequently they communicate in Moldovan/Romanian language, 84.8% prefer Russian language.92.4% of respondents are from urban area (81.8% in big cities like Chisinau, Balti and Tiraspol and 10.6% in rayon centers or towns) and 7.6% - from rural area. The last month before the interview, the majority of respondents lived mostly in parents’ apartment/house (60.2%).The majority of respondents (81.8%) did not leave the locality during the last year longer than for one month for other purposes than treatment.
The lifetime prevalence of tobacco use within the survey sample accounts for 96.2%. 90.8% out of the sample were smokers at the interview time. The lowest proportion of smokers was registered in the age group of 12 - 14 years old (74.1%). Last month prevalence of alcohol use (in last 30 days) was reported by 83.7% of respondents. Last month prevalence of alcohol use registered the lowest values in case of the age group of 12 – 14 years old (56.5%). In case of respondents who used alcohol during the last 30 days, weekly use[1] was more frequently stated by respondents from the age group of 12 - 14 (97.1%).
The mean length of drug use in the survey sample accounts for 2.75 years and the mean length of injecting drug use - 1.6 years. The mean age at first injection drug use accounts for 17.2 years old. For 22.5% of the respondents the last injection of drugs was more than one month ago before the interview and for 31.4%– more than one week ago, but during the last month before the interview. The rest of respondents stated more recent last injection (45.8% stated the last weekbefore the interview). In case of males, the proportion of last injection of drugs during the last month is higher (77.2%) as comparing to female respondents (65.2%). Out of respondents who used injecting drugs during the last month 35.3% stated that they used injecting drugs one in five days and 32.2% stated that they used injecting drugs once per month. The proportion of using injecting drugs one in five days and once per month drops while the respondents’ age increases. Thus in the reached sample, the injecting drug use appears to increase in last month prevalence and in frequency with increasing age. Being asked where they have injected drugs most frequently during the last month, the majority of respondents mentioned about private house/apartment (40.9%) and the place where the injection drug users congregate to inject drugs (33.2%). The most injected drugs during the last month are the extract of opium (67.5%), methamphetamines (29.7%) and ephedron (19.2%).
93.7% of the total number of respondents who have injected drugs during the last month before the interview stated that at last injection within the last month before the interview they used sterile needles/syringes. When asked how frequently during the last month before the interview they used syringes previously used by somebody else, 83.6% of respondents stated that something like this never happened and 16.4% of respondents used at least once needles/syringes previously used by somebody else. Female respondents reported more frequently (31.3%) than male respondents (11.9%) the use of syringes previously used by somebody else at least once during the last month. Consistent use of sterile equipment[2] to inject drugs during the last month is increasing with age. The majority of respondents who injected drugs during the last month before the interview stated that they used a common jar (56.3%) and about one third of them have injected drugs with preloaded syringes (36.0%) and have used a common big syringe to inhale drugs (34.3%). 85.3% of the total number of respondents who have injected drugs during the last month before the interview made an indirect sharing of injection equipment at least once. Indirect sharing of injecting equipment during the last month is decreasing with age.
27.9% of the general sample stated that during the last 12 months received syringes for free. While the age goes up the proportion of beneficiaries of free-of-charge syringes increases as well. During the last year before the interview, the highest proportion of respondents mentioned that they bought sterile syringes from pharmacy (70.2%) and/or took them from other IDUs (42.3%). Respondents from the age group of 12 – 14 years old more frequently than respondents from the other two age groups got sterile syringes from other IDUs (76.2%) and more rarely they bought those from pharmacy (47.6%). In the context of a social network, younger IDUs, being at the beginning of injecting drug users’ career, resort more frequently to other IDUs so as to obtain sterile syringes. No respondent from the age group of 12 - 14 years old stated that he/she benefited from Harm Reduction Programmes services. Benefiting from sterile syringes from Harm Reduction Programmes goes up while respondents’ age increases. Male respondents more frequently bought sterile syringes from pharmacies (71.7%) and resorted to other IDUs to get syringes (45.2%) as compared to female respondents (64.6 % and 31.6% respectively). Female respondents more frequently benefited from sterile syringes distributed by Harm Reduction Programmes (27.9%) as compared to male respondents (20.7%).
16.5% (61 respondents of the 369) of the entire sample stated that they are officially registered as drug users by the National Narcologic Service withmean lengthreaching 2.3 years. No respondent from the age group of 12 - 14 years old stated that he/she is officially registered as drug user. Official registrationas drug usergoes up while respondents’ age increases. As source ofregistration, the majority of respondents officially registered as drug users mentioned the police (83.6% or 51 respondents out of 61).
92.7% of the entire sample related about sexual experience and 78.3% had sexual intercourses during the last year before the survey. The mean age at first vaginal intercourse accounts for 15.2 years. The lowest proportion of sexually active respondents was registered within the age group of 12 - 14 years old (47.6% have ever had vaginal sexual intercourse, 38.1% have had during the period of the last 12 months and 23.9% have had during the period of the last 30 days). 55.3% of the total sample related having more than one sexual partner during the last 12 months. The mean number of sexual partners accounts for 4.2. The highest number of sexual partners was registered within the age group of 15 - 18 years old (mean - 4.7) and the proportion of respondents who stated about multiple sexual partners during the last year reached 65.7%, being the highest rate among age groups.57.2% of the total number of respondents had occasional sexual partnersduring the last 12 month. The proportion of respondents having occasional sexual partners during the last 12 months is the highest in the 15 – 18 years old respondents (65.7%). The proportion of respondents who stated about commercial sexual partners is low (7.6%) in the sample, explained by the age group the survey targeted. Condom use at last sexual intercourse reached 60.5% of the respondents who have sex at least once during the last year. The highest rate for condom use during the last sexual intercourse regardless of partner’s type was registered for the age group of 15 – 18 years old (73.5%).
The incidence of pregnancy among female respondents reached 60.3% and only 20.3% gave birth.
The absolute majority of respondents (90.8%) know where they can get condoms in case of need, and pharmacy was mentioned in 50.4% of cases as the most important source for obtaining condoms. All listed sources in the questionnaire register the highest rates for the age group of 15 – 18 years old – this fact may be explained by sexual activity and high rate of condom use within this age group. 34.0% of respondents who use condoms received them free of charge. When disaggregating the data by age groups, only 0.9% of respondents of 12 - 14 years old who use condoms received them for free during the last 12 months.
Out of 78 survey female respondents who accepted to give answers, 60.3% have ever been pregnant (the mean number of pregnancies during lifetime - 2.26 pregnancies) and 20.3% have given birth.
95.9% of the entire sample has heard about STIs, and 44.6% of the sample could not tell any symptom of STIs for females and 35.9% - for males.
The integrated indicator on HIV knowledge reached the value of 42.0%. The value of this indicator goes up while the respondents’ age increases.The HIV testing indicatorreached24.4%. The value of this indicator goes up while the respondents’ age increases.
37.9% of the entire sample have benefited during the last year from services ofHarm Reduction Programmes. The meanlength of benefiting from these services accounts for 1.32 years. The proportion of beneficiaries goes up while the respondents’ age increases. The coverage with HIV prevention activities reached 18.7% and the value of this indicator goes up while the respondents’ age increases.
During the last year 48.5% of respondents were detained or harassed by police(mean - 5.56 times, SD = 7.9, median – 3 times).
Disaggregating by data collection sites, the reached samples have different risky behavior patterns.
The sample recruited in Baltiregistered the lowest mean age– 18.0 years and the majority constituted male respondents (88.0%). During the last month, most of respondents lived in the parents’ apartment (69.3%). The mean age of respondents form Balti site explains the low age at first injection (16.3 years), and the lowest rate of respondents that injected during the last month before the interview (59.3%). The respondents from Balti reported the private house/apartment as the most frequent place for injecting drugs during the last month (57.3%). The proportion of opiates is the highest in Balti and actually accounts for the absolute majority of drugs injected during the last month (91.0%). The consistent use of sterile injecting equipment during the last month before the interview in Balti registered 85.4%. The indirect sharing of equipment during the last month before the interview reached the lowest value (79.8%) among data collection sites. The last year vaginal intercourse was reported by 80.7% of respondents from Balti. In Balti the mean number of sexual partners reached the highest values (5.8 partners) among data collection sites and the highest rate of condom use during the last sexual intercourse (68.0%).The integrated HIV knowledge indicator reached 38.2% and the HIV testing during the last year with known result reached 12.7%. In Balti sample the coverage with HIV prevention interventions reached the lowest value (9.3%) among all data collection sites.
The sample recruited in Tiraspol registered the highestmean age– 20.2 years. The Tiraspol sample has a higher proportion of female respondents (46.2%) comparing to other two data collection sites. During the last month, less than half of respondents lived in the parents’ apartment (46.2%). The mean age of respondents form Tiraspol site explains the higher age at first injection (18.8 years), and the highest rate of respondents that injected during the last month before the interview (96.7%). The respondents from Tiraspol reported the place where the injecting drug users congregate to inject drugs as the most frequent place for injecting drugs during the last month (44.9%), being higher than in other two data collection locations. The proportion of opiates injected during the last month among Tiraspol respondents reached 64.0%, methamphetamines registered 23.6% and ephedron was mentioned by 20.2% of respondents. The consistent use of sterile equipment during the last month before the interview in Tiraspol registered 62.9%, being the lowest among data collection sites. The indirect sharing of equipment during the last month before the interview reached the highest value (93.3%) among data collection sites. The last year vaginal intercourse was reported by 52.7% of respondents. The mean number of sexual partners reached the lowest values (1.8 partners) comparing to other two data collection sites. The low sexual activity is explained by high rate of female respondents in this site and marital status of respondents. In Tiraspol was registered the lowest rate of condom use during the last sexual intercourse (31.3%).The integrated HIV knowledge indicator reached 34.1%. The HIV testing during the last year with known result reached 44.0%, being the higher among data collection sites. In Tiraspol sample the coverage with HIV prevention interventions reached the highest value (26.4%) among data collection sites.
In the sample recruited in Chisinau the mean ageaccounted for 18.7 years with a high proportion of male respondents (85.2%). During the last month, more than half of respondents lived in the parents’ apartment (59.4%). The mean age at first injection reached 17.1 years with high rate of respondents that injected during the last month before the interview (84.4%). The respondents from Chisinau reported the place where the injecting drug users congregate to inject drugs (36.1%) and private house/apartment (38.9%) as the most frequent places for injecting drugs during the last month. The proportion of methamphetamines injected during the last month amongChisinau respondents reached 57.4%, opiates registered 50.9% and ephedron was mentioned by 26.9% of respondents. The consistent use of sterile equipment during the last month before the interview in Chisinau registered 99.1%, being the highest among data collection sites. The indirect sharing of equipment during the last month before the interview reached 83.3%. The last year vaginal intercourse was reported by 93.0% of respondents, being the highest among data collection sites. The mean number of sexual partners reached 3.7 partners. In Chisinau the rate of condom use during the last sexual intercourse registered 64.0%.The integrated HIV knowledge indicator reached 53.9%, being the higher among data collection sites. The HIV testing during the last year with known result reached 24.2%. In Chisinau sample the coverage with HIV prevention interventions registered 24.2%.