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Financial Vulnerability and Its Association with HIV Transmission Risk Behaviors Among People Who Inject Drugs in Kyrgyzstan

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Abstract

The Family Resource Scale (FRS) is a three-factor financial vulnerability (FV) measure. FV may impact HIV transmission risks. Cross-sectional data from 279 people who inject drugs (PWID) in Kyrgyzstan surveyed April–October 2021 was used to validate the FRS and estimate associations between FV on past 6-month injection and sexual HIV risk outcomes. The three-factor FRS reflected housing, essential needs, and fiscal independence, and had good internal reliability and structural validity. Greater cumulative, housing, and essential needs FRS scores were associated with increased relative risk on public injection (adjusted risk ratio [aRR], 95% confidence interval [95% CI]: 1.03 [1.01, 1.04]; aRR [95% CI]: 1.06 [1.02, 1.09]; aRR [95% CI]: 1.06 [1.03, 1.08], respectively, all p < 0.001) and preparing injections with unsafe water sources (aRR [95% CI]: 1.04 [1.02, 1.07]; aRR [95% CI]: 1.09 [1.04, 1.15]; aRR [95% CI]: 1.08 [1.03, 1.14], respectively, all p < 0.001). Results suggest that PWID housing- and essential needs-related FV may exacerbate injection HIV transmission risks. Reducing PWIDs’ FV may enhance the HIV response in Kyrgyzstan.

Resumen

La Escala de Recursos Familiares (FRS, por sus siglas en inglés) es una medida de vulnerabilidad financiera (FV, por sus siglas en inglés) de tres factores. La FV puede afectar los riesgos de transmisión del VIH. Se utilizaron datos transversales de 279 personas que se inyectan drogas (PWID, por sus siglas en inglés) en Kirguistán encuestadas de abril a octubre de 2021 para validar la FRS y estimar las asociaciones entre la FV en la inyección y los resultados de riesgo sexual del VIH en los últimos seis meses. La FRS de tres factores reflejaba la vivienda, las necesidades esenciales y la independencia fiscal, y presentaba una buena confiabilidad interna y validez estructural. Mayores puntajes acumulativos de la FRS en vivienda y necesidades esenciales se asociaron con un mayor riesgo relativo en la inyección pública (Riesgo relativo ajustada [aRR], Intervalo de Confianza del 95% [IC95%]: 1.03 [1.01, 1.04]; aRR [IC95%]: 1.06 [1.02, 1.09]; aRR [IC95%]: 1.06 [1.03, 1.08], respectivamente, todos p < 0.001) y la preparación de inyección con fuentes de agua no seguras (aRR [IC95%]: 1.04 [1.02, 1.07]; aRR [IC95%]: 1.09 [1.04, 1.15]; aRR [IC95%]: 1.08 [1.03, 1.14], respectivamente, todos p < 0.001). Los resultados sugieren que la FV relacionada con la vivienda y las necesidades esenciales de las PWID puede exacerbar los riesgos de transmisión del VIH por la inyección. Reducir la FV de las PWID puede mejorar la respuesta al VIH en Kirguistán.

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Funding

This work was supported by the National Institutes of Health and Canadian Institutes of Health Research. Award Numbers R21TW011785, K01DA043421, and K01DA055521 from the National Institute on Drug Abuse and Fogarty International Center and CIHR PJH-175382 from the Canadian Institutes of Health Research. The San Diego Center for AIDS Research, Health Equity Sociobehavioral Science Core provided expert consultation on study design and recruitment strategies (P30 AI036214). The content is solely the responsibility of the authors and does not necessarily represent the views of the National Institutes of Health and Canadian Institutes of Health Research. Dan Werb is supported by the St. Michael’s Hospital Foundation.

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Authors and Affiliations

  1. Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA

    Angel B. Algarin

  2. Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, CA, 92093-0507, USA

    Dan Werb, Anna Blyum & Laramie R. Smith

  3. Centre On Drug Policy Evaluation, St. Michael’s Hospital, University of Toronto, Toronto, Canada

    Dan Werb

  4. AIDS Foundation – East West in the Kyrgyz Republic, Bishkek, Kyrgyzstan

    Natalya Shumskaya & Ainura Kurmanalieva

  5. Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA

    Javier Cepeda & Stefan Baral

  6. Department of Psychiatry, University of California, San Diego, La Jolla, USA

    Thomas L. Patterson

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Correspondence to Laramie R. Smith.

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Research Involving Human Participants and/or Animals

This study was approved by the University of California, San Diego Institutional Review Board (IRB) and GLObal Research Institute (GLORI) Foundation IRB in Kyrgyzstan. The study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

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Algarin, A.B., Werb, D., Shumskaya, N. et al. Financial Vulnerability and Its Association with HIV Transmission Risk Behaviors Among People Who Inject Drugs in Kyrgyzstan. AIDS Behav 28, 310–319 (2024). https://doi.org/10.1007/s10461-023-04129-6

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