Drug Addiction Influence on Incidence of Infections with Parenteral Transmission in St. Petersburg in 1999-2011

  Published: 10.01.13 Updated: 10.01.2013 11:05:50

I.A. Rakitin, N.S. Bashketova, I.G. Chkhindzheria, G.I. Markovich, V.F. Tsyganova
Directorate of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being (Rospotrebnadzor) in the City of St. Petersburg, Russia

Citation: Rakitin IA, Bashketova NS, Chkhindzheria IG, Markovich GI, Tsyganova VF. Drug Addiction Influence on Incidence of Infections with Parenteral Transmission in St. Petersburg in 1999-2011. EpiNorth 2012;13:96-104.

The incidence of drug addiction and infections with parenteral transmission in St. Petersburg from 1999 to 2011 is discussed. The most typical tendencies in the development of the epidemiological process for these infections in St. Petersburg are described.

HIV infection started to spread quickly in the Russian Federation during the second half of 1996 when several outbreaks of the infection were observed among injecting drug users (IDUs) (1). From 1996, the major risk factor for HIV-infection in Russia was intravenous injection of drugs with non-sterile equipment (2). In 2000, the increase in the number of new cases of HIV in the Russian Federation was the highest in the world (3).
A rapid increase in the incidence of drug addiction associated with usage of psychostimulant drugs was observed in St. Petersburg from 1996 to 2001 (1). The incidence of HIV-infection as well as acute and chronic forms of viral hepatitis B and C increased from 2000 and became significantly higher than the average incidence registered in the Russian Federation (1).
In this article we have analyzed data on the incidence of HIV-infection and viral hepatitis B and C in correlation with data on drug addiction incidence.

Materials and Methods
The Directorate of the Federal Service for Surveillance on Consumer Rights Protection and Human Well-Being (Rospotrebnadzor) in the City of St. Petersburg conducts epidemiological surveillance of infections and parasitic diseases. The activities include the organization of federal statistical monitoring on incidence of infections among the population. Data addressing the incidence of HIV-infection and viral hepatitides with a parenteral route of transmission was obtained through the federal statistical monitoring conducted from 1999 to 2011 (4).
We also analyzed data on the incidence of various types of drug addiction among the population of St. Petersburg during 2006-2011. The data was received from the Health Care Committee of the City Government and published in the information bulletin of 2011 (5). The term “drug addiction” existed in the classification that was used in the USSR prior to introduction of the International Classification of Diseases (ICD-10). This term can still be found in official documents as synonym for the following diagnosis: “addiction syndrome caused by usage of psychoactive drugs classified as narcotic substances”. The term is also used in the definitions of Federal Law No.3-FZ “On Narcotic Drugs and Psychotropic Substances” from December 10, 1997. The following types of addictions are indisputably categorized as drug addictions: addiction to opioids (Code F11.2), to cannabinoids (Code F12.2) and to cocaine (Code F14.2).

Drug Addiction Incidence
In 2000, the rate of drug addiction incidence in St. Petersburg was at the highest level in 25 years and reached 167 cases per 100,000 population. The incidence rate increased 9.4 times in comparison to the period from 1987 to 1995. Approximately 70% of drug users are men. Over 90% of newly registered IDUs are young people between 20-39 years of age.
Monitoring the incidence of psychostimulant drug users during 2006-2011 demonstrates a wave-curve trend of drug addiction (Fig. 1). This may be explained by the current attitude towards the so called “soft drugs” among young people in the city. 


From 2008, in St. Petersburg and the country on the whole, the incidence of primary drug addiction associated with the use of psychoactive substances was stable, and from 2011 the incidence started to decrease. The number of new cases of drug addiction in St. Petersburg is two times lower than the average in Russia. The majority of drug users attending state health care institutions are addicted to opioids. Despite the fact that the number of IDUs has decreased, HIV-infection and viral hepatitis B and C continue to be transmitted through a parenteral route (Fig. 2 and 3) (6).

HIV-Infection Incidence
The peak of HIV incidence in St. Petersburg was registered in 2001 (Fig. 4). The incidence reached 205.6 per 100,000 population, 3.4 times higher than the average incidence in Russia.
Since 2001, St. Petersburg has been one of the five industrial centers of the Russian Federation with the highest prevalence of HIV-infection. As of January 1, 2012 the prevalence was as high as 800 per 100,000 population; 0.8% of the city population was infected with HIV as compared to an average rate of 0.4% for the country. The HIV prevalence in the age group from 15 to 49 years in St. Petersburg was 1.4% which is two times higher than in the country in general (0.7%). In 2011 the HIV incidence in St. Petersburg was 61.5 per 100,000 population, which was two times higher than in the Russian Federation.

The infection transmission through parenteral use of drugs remains rather high and in 2011 consisted of 73.3% among newly detected cases of HIV-infection with known transmission route. At the same time, the number of new cases of HIV-infection through sexual transmission is increasing: 5.8% and 22.7% of new HIV cases were due to sexual transmission in 2004 and 2011, respectively (Fig. 5).

During recent years the HIV-infection incidence has decreased among teenagers 15-17 years of age. In 2007 the HIV incidence in this age group was 27.6 per 100,000 of the population, while by 2011 the incidence had decreased by 2.3 times (Fig. 6). People from 15 to 30 years account for more than 80% of all HIV cases. 


Among all cases of HIV infection registered since 1987, there are more men (66.8%) than women. However, from 2002 the share of women involved in the epidemic process is steadily growing: 80% of women were infected by their partners, who are IDUs, through sexual transmission. In 2011 the share of women among all newly detected HIV cases reached the peak level of 38%. More than 90% of HIV-infected women are of child-bearing age, which makes the problem of prevention against perinatal infection of children very urgent.

Viral Hepatitis B Incidence
The incidence of hepatitis B in St. Petersburg from 1992 to 1999 varied from 15 to 52 cases per 100,000 population (Fig. 7). 


In the late 1990s to early 2000s, the epidemic peak of hepatitis B was registered. The incidence of hepatitis B grew by 2-6 times and in 1999 reached the maximum level of 84.7 per 100,000 population. This can be explained by peak of drug addiction that was also registered during this period: 136.6 and 167 cases of drug addiction per 100,000 population were registered in 1999 and 2000, respectively.
The age structure of patients with acute forms of hepatitis B has changed; the share of patients in the age groups 30 to 39 years and 40 to 49 years grew considerably (Fig. 8). From 2000-2011 the share of patients of 15-19 years old decreased by 19.5 times. At the same time the share of patients in the age group 30-39 years increased by 4.1 times, and in the age group 40-49 years - by 2.6 times (Fig. 8).

Viral Hepatitis C Incidence
The incidence of hepatitis C in the Russian Federation in 1999-2001 varied from 12.9 to 29.0 per 100,000 population (Figure 9). In 1999, the hepatitis C incidence in St. Petersburg increased more than 3 times and reached 66.8 per 100,000 population (Fig. 9).


In the same period, the share of patients with acute hepatitis C in the age group 15-19 years decreased by 4 times, while the share of patients of 30-39 years increased by 3.3 times and the share of patients of 40-49 years increased by 4.3 times (Fig. 10). 

From 2001, the incidence of hepatitides with a parenteral route of transmission was decreasing. By 2011, the incidence of hepatitis B has decreased by 33 times and of hepatitis С by 45 times, and the incidence of hepatitis B and C was 2.6 and 2.1 per 100,000 population, respectively. Chronic forms of hepatitis B and C are most often registered among young people who were infected in 1999-2000. The incidence of the infections in the city is still considerably higher than in the country in general.

Discussion and Conclusions
The growth of drug addiction incidence in 1999-2000 caused a major increase in the incidence of infections with a parenteral route of transmission. The dynamics of HIV-infection incidence as well as the incidence of acute hepatitis B and C reflect the dynamics of drug addiction incidence, especially during periods of most evident growth.
Until now the injecting use of psychostimulant drugs remains the main transmission factor for HIV-infection and viral hepatitis B and C in St. Petersburg. The major population group which the intensity of the epidemic process for these infections depends on, is injecting drug users.
The peak incidence of viral hepatitis B and C is among the age groups of 30-39 and 40-49 years. This provides indirect evidence of the dominance of non-injecting use of psychostimulant drugs among people under 30 years of age.
From 2005 the share of HIV, HBV and HCV cases with sexual route of transmission has increased. This alarming tendency indicates that transmission is no longer typical among psychoactive drug users alone but involves other transmission routes.
The major measures against spread of HIV-infection and viral hepatitis with a parenteral route of transmission in St. Petersburg are taken in accordance with the HEALTH National Priority Project. The section titled “Detection, Treatment and Prevention of HIV-Infection and Hepatitis B and C” provides instructions for the implementation of the following steps:

1. All HIV-infected patients who need treatment are covered by antiretroviral therapy in accordance with the medical service standards.
2. Permanent monitoring of the epidemiological situations for HIV-infection and hepatitis B and C is to be provided; the screening expansion to include a wider range of risk groups (primarily IDUs).
3. Improved access to prevention and diagnostic services; better treatment services are to be provided for HIV-infected people and for patients infected with viral hepatitides.
4. The maximum coverage of the population by dispensary medical services is to be ensured.
5. All HIV-infected pregnant women are to undergo a complete course of preventive treatment in order to prevent infection of their baby.
6. Inter-sectorial cooperation is to be developed in order to stop the spread of HIV- and HBV-/HCV-infections.
7. All the anti-HIV and anti-HBV/HCV measures are to be thoroughly coordinated.
8. Target programs for prevention of HIV- and HBV-/HCV-infections are to be implemented. It is particularly important that programs address risk groups.
9. The civil society is to take a more active part in counteracting HIV epidemic.
10. HIV-infected people as well as patients with hepatitis B and C are to be provided with social and psychological support in order to enhance their adherence to medical checkups and treatment.

Through implementation of the National Priority Project, as of October 1, 2012, 86% of HIV patients are covered by health care services. In addition, 91% of HIV patients who need treatment receive antiretroviral therapy and 99% of new-born children with HIV-positive mothers undergo chemoprophylaxis. In 2010 the perinatal transmission rate was as low as 2.8%.

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