TITLE: Behavioral Survey among Injecting Drug Users in Tirana Albania

BACKGROUND: HIV transmission among drug users is typically associated with those
who share needles or syringes. IDUs function as a “bridging population” for HIV
transmission between a core HIV risk group and the general population. Even though
injecting is not the main pattern of drug use in Albania, it is a growing trend which has
been accompanied by a high prevalence of risk behaviors such as sharing equipment and
having unprotected sex. As of the end 2008, 291 HIV/AIDS cases have been reported in
Albania with 2 HIV cases having been detected among drug users. A silent expansion of
the epidemic is likely to take place following the pattern observed in other transition
countries.

OBJECTIVES OF THE STUDY: 1. understand both needle sharing and condom use
behavior among IDUs; 2. ascertain the IDU community’s level of consciousness
regarding syringe exchange programs; and 3. assess HIV/AIDS awareness among IDUs
and their risk perceptions.

METHODOLOGY: The study was conducted in Tirana, and IDUs recruitment was
carried out at the Mobile Needle Exchange program. Structured questionnaires were used
to collect behavioral data relating to drug injections, syringe/needle sharing and sexual
behavior among IDUs. IDUs (n=170) were defined as any person who has injected
substances into their bodies during the previous 12 months.

RESULTS: The majority of IDUs interviewed were male, about 40% were less than 24
years old, and the majority were not married (66.1%). Most IDUs had completed at least
middle school, with one-third having completed high school. The majority of IDUs
(71.6%) had injected for one year or less. The median age at first injection was 18 years,
with about 53% of IDUs estimated to have injected before the age of 19. Most of the
IDUs (85.2%) injected drugs multiple times daily. The most commonly used injectable
and non-injectable drugs were heroin (74.6%) and heroine + diazepam (20.3%). It is
estimated that 64.1% of IDUs have shared needles/syringes and other injecting
equipments.
CONCLUSIONS: IDUs enrolled in the study are predominantly male and the lack of
female respondents may reflect their strong desire to remain hidden or their small
numbers. The IDU population is young (half of the population is below the age of 24);
one-third started injecting before the age of 18; one-third engage in risky sexual
behaviors, and the level of condom use was 37.2%.In terms of risk behaviors, the
majority of IDUs injected multiple times per day, with heroin being the drug most
frequently injected, and half of IDUs have shared needles and drug-injecting equipment.
None reported using bleach to sterilize shared needles; most reported relying on cold
water as cleaning agents. In addition, more than half of IDU have never received
treatment or help for their addiction. These findings illustrate the need to develop HIV
prevention strategies that can reach IDU outside of these traditional facilities.

RECOMMENDATIONS:1. Harm Reduction programs for IDUs should be

continuously targeted for minimizing syringe sharing and reusing the previously used
syringes among IDUs. 2. IDUs who are not able to quit the injecting behaviors must be
taught the ways and procedures of needle/syringe cleaning. 3. Develop and support
rehabilitation programs that provide a comprehensive approach to treatment and care.