Background: Although opioid overdose is the leading cause of death among people who inject drugs (PWID) in Kazakhstan there remains little research on how opioid overdose may share syndemic risk factors for HIV and HCV among PWID in Kazakhstan or Central Asia. This study aims to examine the relationships between non-fatal opioid overdose and HIV/HCV risks among PWID in Almaty, Kazakhstan.
Methods: We used baseline data from a couple-based HIV study for PWID and their sexual partners, restricting the sample to 580 participants who reported ever injecting drugs. We hypothesized that experiencing opioid overdose in the prior six months would be significantly associated with biological indicators for HIV and HCV and drug and sexual-related risk behaviors after adjusting for age, gender, ethnicity, marital status, education, homelessness and food insecurity. We employed multiple regression analysis with shared couple-level random effects to account for the dyadic structure of the data.
Results: Of the sample, 60% (n=278) identified as male. About one-fifth (20.5%, n=119) reported experiencing a non-fatal overdose in the past 6 months (See Table 1 for socio-demographic characteristics associated with non-fatal overdose). Non-fatal overdose was not significantly associated with biologically confirmed HIV. However, non-fatal overdose quadrupled the likelihood of testing positive for HCV (AOR=4.08, CI=1.32, 12.64). Multiple regression models further supported study hypotheses by identifying significant relationships between non-fatal overdose and any unsafe injection (AOR=1.82, CI=1.01, 3.25); number of people sharing needles (AIRR= 1.73, CI=1.37, 2.19), number of condomless vaginal sex acts (AIRR=1.26, CI=1.11, 1.34), having had vaginal sex under the influence of drugs or alcohol (AOR=2.21, CI=1.06, 4.59) and any condomless anal sex (AOR=5.47, CI=1.28, 23.41).
Conclusions: This study found non-fatal overdose is associated with both sexual and drug-related HIV risk behaviors and HCV. The extremely high rate of recent opioid overdose combined with its association with HCV and multiple behavioral risks for HIV underscore the urgent need to integrate opioid overdose prevention with HIV prevention and treatment as a public health priority to prevent the substantial loss of lives to overdose while achieving 90-90-90 goals among PWID in Kazakhstan.