Results of İntegrated Bio-Behavioral surveillance among PWID in Azerbaijan

Background:
In Azerbaijan, HIV infection is concentrated among the main risk groups, including PWID. According to the PSE results of 2020, the estimated number of PWID in Azerbaijan was 60,250. According to the official statistics of 2021, 14% of new HIV infections in the country were caused by injection drug use (97 of the 690 HIV infections were PWID). According to global recommendations, population-based surveys among higher risk groups of HIV infection are important for disease burden, risk behavior, service utilization, evaluation, and program development.
Methods:
In 2022, a respondent-based sampling (RDS) survey was conducted with 2,700 PWIDs over the age of 18 at 8 sites, where HIV is likely to be more prevalent among PWID across the country. Data on socio-demographic and risk behavior were collected, blood samples were taken for HIV, HCV, HbsAg and syphilis and tested by Elisa method in Republic AIDS CENTER and regional laboratories. In the case of a positive test result, the respondent was invited to the RAC for HIV confirmation or denial.
Results:
70% of the sampled drug users were aged between 25-44. Opiates remain the main drugs (62%), while stimulants are used by 35% of drug users. 80% of PWIDs reported using a sterile syringe for their last injection, 19% kept the syringe to reuse. HIV prevalence among PWID across the country was 6.2%, HCV prevalence was 33.3%, prevalence of HBsAg was 6.1% and prevalence of Syphilis was 5.1%. The percentage of condom use among regular and casual partners was 35.7%. The participation of PWID in syringe exchange programs made up 36.5%. 60% of PWID reported ever being tested for HIV and 48% reported being tested during the last 12 months, while in 2018, only 19% were tested for HIV. A relatively similar proportion of PWID reported being screened for HCV in different survey rounds- 38% of PWIDs in 2022.
Conclusions:
HIV and HCV testing has increased in the country. HIV prevalence is stable, but exhibits regional fluctuations, likely related to outbreaks in specific sub-populations mortality. Access to PWIDs of younger ages is limited and challenging. The drug scene is slowly changing, with an increasing use of stimulant drugs, potentially leading to more frequent injections. OST coverage is low. The vast majority have sexual partners, with a substantial proportion reporting multiple partners and practicing unprotected sex, which can affect HIV transmission to the general female population.