Rapid assessment of injection drug use and HIV in the Republic of Georgia

In January 1998 the authors conducted a rapid assessment of injecting drug use and HIV in the Republic of Georgia. We collected and analyzed information through a review of available documents, interviews with key informants, focus group interviews with injection drug users (IDUs), and observations of drug scenes. The guiding principles in our methodology were derived from the WHO manuals on Rapid Assessment Methodology (RAM). Although many information gaps remain in our findings, we did not find indications for an emerging HIV epidemic among IDUs, such as that occurring in of her regions within the former USSR. On the other hand, a future HIV epidemic among IDUs cannot be precluded because of a high prevalence of injecting drug use and the common practices of needle sharing, "front loading," and unprotected sex among IDUs. In order to maintain the relatively favorable situation regarding HIV infections among IDUs in Georgia, additional interventions are needed and should be targeted toward the general population as well as specific subgroups and situations posing high levels of risk behaviors (e.g., prisons). The limited opportunities for offering services directly to IDUs are an obstacle for targeted prevention. Since injecting at home for medical purposes is quite common in the general population, a mass media-based safe injection campaign and improved access to syringes and condoms through pharmacies are preferable and more feasible than setting up needle-exchange programs. In reflecting on the use of rapid assessment methodology, we see the need for evaluation of the approach. Its further development should aim at synthesizing social science methodology and practical knowledge on policy making and intervention development.