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An attempt was made to compare risk factors for injecting equipment sharing among injecting drug users in Togliatti city, Russia, where four hundred twenty-six injecting drug users answered an interviewer-administered questionnaire and tested oral fluid samples for HIV. The findings highlight the delicate balance in HIV prevention between potentially competing strategies of law enforcement and syringe distribution.

We undertook a qualitative study to explore the micro-environment of drug injecting, risk reduction and syringe exchange practices among injecting drug users (IDUs) in Togliatti City, Russia. Semi-structured qualitative interviews (n = 57) were undertaken with current IDUs in May 2001. Findings highlight a recent transition away from hanka (a home-produced liquid opiate derived from opium poppy) towards the injection of heroin powder, and a drug use culture in which injecting predominates. Findings emphasise that risk reduction practices may be influenced less by availability of injecting equipment than by an interplay of situational and micro-environmental factors. Principal among these is a reported fear of police detainment or arrest among IDUs which encourages a reluctance to carry needles and syringes, and which in turn, is associated with needle and syringe sharing at the point of drug sale. We note the role of policing practices in influencing risk reduction and the potential role of policing agencies in supporting HIV prevention initiatives among IDUs. Keywords: HIV prevention; Injection drug use; Russia; Police; Risk environment