HIV TRANSMISSION AMONG IDUS AND THEIR SEXUAL PARTNERS

1. HIV TRANSMISSION AMONG IDUS AND THEIR SEXUAL PARTNERS Cecile Kazatchkine IHRD- OSI Budapest

2. IDUS AND THEIR SEXUAL PARTNERS: WHY IS IT A CONCERN? • Contrary to the common myth that heroin is a death kiss to sexuality: IDUs are sexually active • IDU and their sexual partners are at risk of acquiring HIV both through unprotected sex and through sharing injecting equipment • IDUs’ sexual partners could be a link for generalised epidemic in Eastern Europe

3. SEXUAL PARTNERS OF IDUS • IDUs’ sexual partners include primary and casual partners, commercial and non-commercial partners - Belarus: 87% of injectors are sexually active and 40% have multiple partners (National Aids Center 2002) • Young IDUs are very likely to have an active sexual life and multiple partners • IDUs may have both IDU and non IDU sexual partners - Tver, Russia: 63% of IDUs have non-IDU sexual partners (Ivanov I., 2002)

4. RISKS OF HIV TRANSMISSION • High HIV prevalence among IDUs - Russia: 80% of reported HIV cases are among IDUs(UNAIDS 2006) - Odessa, Ukraine: 58% of IDUs are HIV positive(Ukrainian Aids center 2005) • Low rates of condom use, especially with primary partners - Belarus:27-50% of IDUs never use condom with primary partners, but 59% always use condoms with casual partners(National Aids Center 2002) - Togliatti and Nizhny Novgorod, Russia: 83% of male IDUs have not used a condom regularly in the last month: In Mirny, 23% never use a condom(UNAIDS/WHO, 2004) • IDUs are likely to share injecting equipments with IDUs sexual partners

5. WOMEN IDUS AND THEIR SEXUAL PARTNERS • Women IDUs are likely to have IDU sexual partners - St Petersburg, Russia: 59% of young women IDUs in a constant relationship have an IDU sexual partner(Gore-Felton, 2003) - Russia: 24% of female IDUs share injecting equipment with their IDU sexual partners(Berezhnova I. et al., 2006) • Women IDUs are very likely to be involved in sex work - Studies of female IDUs in eastern Europe estimate that 20-50% are involved in sex work(UNODC, 2005) - Nikolaev, Ukraine: 80% of street workers are estimated to be IDUs (UNAIDS, 2000) • Only few women IDUs visit harm reduction services - Ukraine, Belarus, Moldova, Kazakhstan: Women IDUs represent 10-20% of needle exchange attendees (Malinowska-Sempruch K., 2006)

6. EMPOWERING IDUS TO PROTECT THEMSELVES AND THEIR SEXUAL PARTNERS • Advocacy against policies and practices that prevent IDUs’ access to harm reduction and health care facilities • Development of comprehensive harm reduction services that would include reduction of high-risk sexual behaviours • Improvement of women’s access to comprehensive harm reduction services

7. CONCLUDING REMARKS • Sexual transmission of HIV in Eastern Europe is increasing. Sexual partners of IDUs may constitute a « bridging » population with regard to transmission. • IDUs are at high risk of transmitting HIV through injection and sexually • IDUs are, however, highly concerned about these risks and are willing to protect themselves and their partners from infection with HIV • Protecting an IDU’s sexual partner and the general population requires protecting the IDU from acquiring HIV • Stigma, discrimination, and criminalization of drug use prevents access to prevention and care • Comprehensive approaches to harm reduction must take into account the specific issues relating to women IDUs and women partners of IDUs