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Krokodile Injectors in Ukraine: Fueling the HIV Epidemic?

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Abstract

This study was designed to assess the characteristics of krokodile injectors, a recent phenomenon in Ukraine, and HIV-related risk factors among people who inject drugs (PWID). In three Ukraine cities, Odessa, Donetsk and Nikolayev, 550 PWID were recruited between December 2012 and October 2013 using modified targeted sampling methods. The sample averaged 31 years of age and they had been injecting for over 12 years. Overall, 39 % tested positive for HIV, including 45 % of krokodile injectors. In the past 30 days, 25 % reported injecting krokodile. Those who injected krokodile injected more frequently (p < 0.001) and they injected more often with others (p = 0.005). Despite knowing their HIV status to be positive, krokodile users did not reduce their injection frequency, indeed, they injected as much as 85 % (p = 0.016) more frequently than those who did not know their HIV status or thought they were negative. This behavior was not seen in non-krokodile using PWID. Although only a small sample of knowledgeable HIV positive krokodile users was available (N = 12), this suggests that krokodile users may disregard their HIV status more so than nonkrokodile users. In spite of widespread knowledge of its harmful physical consequences, a growing number of PWID are turning to injecting krokodile in Ukraine. Given the recency of krokodile use the country, the associated higher frequency of injecting, a propensity to inject more often with others, and what could be a unique level of disregard of HIV among krokodile users, HIV incidence could increase in future years.

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Acknowledgments

This study was supported by the National Institute on Drug Abuse (Grant RO1 DA026739). We acknowledge the dedicated staff and directors who participated in this project, including Dimitry Kryzhko with Health of Nation in Donetsk; Olga Kostyuk and Tatiana Semikop with Faith, Hope and Love in Odessa; and Elena Goryacheva with the Charity Foundation Vykhod in Nikolayev. Their dedication to preventing the spread of HIV among PWID in Ukraine is inspiring. We are also indebted to the drug users who agreed to participate and gave their time, without which we could not have conducted this study.

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Authors and Affiliations

  1. University of Colorado Denver, Denver, CO, USA

    Robert E. Booth, Jonathan M. Davis & John T. Brewster

  2. Psychiatry, University of Colorado School of Medicine, Project Safe 1557 Ogden Street, Denver, CO, 80218, USA

    Robert E. Booth

  3. Ukrainian Institute on Public Health Policy, Kiev, 01001, Ukraine

    Oksana Lisovska & Sergey Dvoryak

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  1. Robert E. Booth
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  2. Jonathan M. Davis
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  3. John T. Brewster
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  4. Oksana Lisovska
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  5. Sergey Dvoryak
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Correspondence to Robert E. Booth.

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Booth, R.E., Davis, J.M., Brewster, J.T. et al. Krokodile Injectors in Ukraine: Fueling the HIV Epidemic?. AIDS Behav 20, 369–376 (2016). https://doi.org/10.1007/s10461-015-1008-z

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  • DOI: https://doi.org/10.1007/s10461-015-1008-z

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