Heroin production in Colombia: A time-bomb for a drug injection-driven HIV epidemic in Colombia?
P. Mateu-Gelabert1, D. Berbesi2, I.E.M. Motta3,4, H. Guarino1, S. Harris1. 1National Development and Research Institutes, Inc., United States; 2CES University, Colombia; 3Pan American Health Organization, Columbia; 4Colombian Ministry of Health, Colombia
Background: Colombia’s heroin production and exportation to the United States have increased from negligible in 2001 to the country’s current status as the US’s main supplier of heroin (UNODC, 2013). We sought to examine how this major shift in production may be affecting heroin consumption and HIV risk behavior among Colombians. Methods: Using Respondent-driven Sampling (RDS), we recruited adults 18 years or older who inject drugs in Medellín and Pereira, cities located in opium poppy cultivation areas. A structured interview inquired about sexual and drug injection behaviors. After HIV counseling, blood was collected for HIV testing. Results: Three seeds per city generated 540 participants (Pereira= 300; Medellin=240) indicating extensive injection networks. Participants were primarily male (93%) and young (85% were 18-29 years of age), and all injected heroin. Injection and sexual risk behaviors were widespread: in the last 6 months, 44% reported sharing needles, 31% having two or more casual sex partners, and 15% engaging in sex work. Thirty-three percent reported never having used condoms. RDS-based HIV prevalence estimates for populations of injectors were 3.8 % (Medellín) and 1.9% (Pereira). Conclusions: Heroin production in Colombia appears to lead to the formation of large, predominantly young male heroin injection networks. HIV could easily spread among these networks. We recommend a wide implementation of harm reduction services and monitoring of drug use patterns, risk behaviors and HIV prevalence along Columbia’s heroin cultivation and transportation routes to provide early warning and prevention of heroin-related HIV outbreaks.