HIV infection and risk behaviour of primary fentanyl and amphetamine injectors in Tallinn, Estonia: implications for intervention

Int J Drug Policy. 2010 Jan;21(1):56-63. doi: 10.1016/j.drugpo.2009.02.007. Epub 2009 Apr 22.


Background: Following a heroin shortage, fentanyl and 3-methylfentanyl, known as "China White" and "White Persian", have become the most widely used drugs, along with amphetamine, among injecting drug users (IDUs) in Tallinn, Estonia.

Methods: In order to assess the relationships between the injection of fentanyl and amphetamine, and levels of HIV prevalence and risk behaviour, 350 current IDUs were recruited using respondent-driven sampling for an interviewer-administered unlinked cross-sectional survey and HIV testing. IDUs were categorised into groups based on self-report of the main drug used within the last 28 days.

Results: 77% (256/331) of participants reported fentanyl and 23% (75/331) amphetamine as their main drug of injection. HIV prevalence was 27% (95% confidence interval [CI]: 18.45-35.51) and 62% (95% CI: 56.97-67.03) among amphetamine and fentanyl injectors, respectively. After adjustment, fentanyl injectors had three times the odds of being HIV positive (adjusted odds ratio [AOR]=2.89; 95% CI: 1.55-5.39). They also had higher odds for injecting in the street with a previously used needle/syringe (AOR=2.39; 95% CI: 1.14-5.04) and sharing a needle/syringe with somebody known to have HIV (AOR=3.00, 95% CI: 1.33-6.79). Fentanyl injectors also had higher odds for lifetime overdose (AOR=3.02, 95% CI: 1.65-5.54).

Conclusion: The injection of fentanyl is associated with elevated injecting risk behaviour derived from injection practice and situational risk factors, and needs urgently targeted interventions.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Amphetamine / administration & dosage*
  • Cross-Sectional Studies
  • Drug Overdose
  • Estonia / epidemiology
  • Female
  • Fentanyl / administration & dosage*
  • HIV Infections / complications
  • HIV Infections / diagnosis
  • HIV Infections / epidemiology*
  • Humans
  • Male
  • Needle Sharing / statistics & numerical data
  • Prevalence
  • Risk-Taking*
  • Statistics as Topic
  • Substance Abuse Treatment Centers / statistics & numerical data
  • Substance Abuse, Intravenous / complications*
  • Substance Abuse, Intravenous / psychology
  • Young Adult


  • Amphetamine
  • Fentanyl