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Research Summary

People with Injection Drug Use Who Also Use Noninjecting Routes of Drug Administration Are Less Likely to Be HIV Positive

Injection drug use (IDU) remains a major public health threat for HIV transmission internationally. Several Eastern European countries face HIV epidemics stemming primarily from IDU. However, the impact of noninjecting practices on HIV transmission risk among people with IDU has not been explored. This cross-sectional study examined routes of drug administration and HIV serostatus as well as sexual risk behaviors among 350 people in Estonia with current IDU.

  • Eighty-six percent of participants reported administering illicit drugs solely by injection within the last 6 months.
  • Those who also used noninjecting routes of drug administration
    • were less likely to be HIV-infected than exclusive injectors (35% versus 59%; adjusted odds ratio [AOR], 0.49);
    • were more likely to have more than one sexual partner (59% versus 43%; AOR, 1.9); and
    • were more likely to report a past sexually transmitted infection (20% versus 9%; AOR, 2.38).


Only a small subset of people with current IDU in this study reported other routes of drug administration, which may limit the strength of associations. Also, the cross-sectional nature of the study limits causal inference, and the single study site in Estonia may limit generalizability. Nevertheless, the results may inform HIV prevention efforts. Jeanette M. Tetrault, MD


Vorobjov S, Uusküla A, Des Jarlais DC, et al. Multiple routes of drug administration and HIV risk among injecting drug users. J Subst Abuse Treat. 2012;42(4):413–420.