WITHDRAWN Syringe Sharing and HIV Testing Among Tajik Injection Drug Users Living in Moscow

Introduction: Tajikistan is at high risk of developing a major AIDS epidemic driven by injection drug use and circular migration.  A large proportion of its male population travels outside the country for work, including to Russia which is experiencing a devastating AIDS epidemic transmitted largely through injection drug use. Tajik migrants in Moscow report frequent contact with sex workers, unprotected sex, lack of information on HIV/AIDS, and harassment by law enforcement officers. Moreover, social exclusion due to illegal migration status may lead to associations with high risk social networks.

 Methods: Using respondent-driven sampling (RDS), we recruited a sample of 106 adult male migrant Tajik workers who were injecting drugs and living in Moscow. Six initial seeds were selected from different drug using networks reflecting the six regions of Tajikistan. Participants completed a survey including questions on demographics, migration, community and religion, alcohol and substance use, HIV knowledge, injection and sexual risk behavior, psychological states, and injection network. We created composite measures of family/social connectedness and religious practice (e.g. prayer, going to mosque). We conducted bivariate analyses and then estimated mixed effects regression analyses with random intercepts for region to examine demographic, migration, community, and religion variables as predictors of syringe sharing and HIV testing.

Results: The majority (84%) of respondents indicated that they had shared syringes in the past 30 days, and 20% had ever been tested for HIV. There was little variation in syringe sharing across demographic, migration, community and religion variables. HIV testing rates varied significantly across regions (p < .05), and by marital status (p < .05). Men with high family and social connectedness (p < .001) and those who indicated greater influence of religion on their life (p < .01) were more likely to have been tested. Religious practice was not associated with HIV testing. Men who indicated that they came to Russia for reasons other than to earn money were less likely to have been tested (p < .01). The results of mixed effect regression analyses indicated that varying levels of family and social connectedness may explain the regional differences in HIV testing rates. The effect of marital status was largely mediated by religiosity.

Conclusions: HIV testing was accessed more frequently by male migrants with high family/social connectedness, which varied across regions, or high religiosity, which was related to being married, and by those who came to Russia only to earn money. Interventions to increase HIV testing rates are especially needed for migrants who are unmarried and have low levels of family and social connectedness.