HIV risk behaviour among participants of syringe exchange programmes in central/eastern Europe and Russia Don C. Des Jarlais a, *, Jean-Paul Grund a , Catherine Zadoretzky a , Judith Milliken a , Patricia Friedmann a , Stephen Titus a,c , Theresa Perlis b , Valentina Bodrova d , Elena Zemlianova e a Baron Edmond de Rothschild Chemical Dependency Institute/Beth Israel Medical Center, 1st Avenue & E. 16th Street, New York, NY 10003, USA b National Development and Research Institutes, New York, NY, USA c Columbia University, New York, NY, USA d Research Center for Public Opinion and Market Research, Moscow, Russia e Ministry of Health of Russia, Moscow, Russia Abstract Objective: To assess HIV risk behaviour among participants in syringe exchanges in five Central/Eastern European cities: Prague (Czech Republic), Budapest (Hungary), Skopje (Former Yugoslavian Republic of Macedonia), Krakow (Poland) and Poltava (Ukraine), and five Russian cities: Nizhniy Novgorod, Pskov, Rostov-Na-Donu, St. Petersburg, and Volgograd. Design: Cross- sectional survey with questions on injection risk behaviours for the 30 days prior to first use of the syringe exchange programme and for the 30 days prior to interview (while using the syringe exchange programme). Methods: Respondents were recruited from participants of the syringe exchanges. Structured questionnaires covering drug use and HIV risk behaviour were administered by trained interviewers. Results: 1671 respondents were interviewed across the ten programmes. Participants in the programmes tended to be young and relatively recent initiates into drug injection. Relatively low percentages of participants reported receptive syringe sharing (‘injecting with needles and syringes used by others’) in the past 30 days, from 1 to 29% across the ten programmes. These represented statistically significant reductions from the percentages of respondents reporting receptive syringe sharing in the 30 days prior to first use of the syringe exchange */from 7 to 47%. Conclusions: IDUs participating in the exchanges appear to be responding very positively in reducing sharing of needles and syringes. Syringe exchange and other HIV prevention programmes for injecting drug users (IDUs) in this geographic region should be expanded rapidly. # 2002 Elsevier Science B.V. All rights reserved. Keywords: HIV; Risk behaviour; Syringe exchange programmes; Eastern Europe; Russia Since the middle 1990s both injecting drug use and HIV among injecting drug users (IDUs) have spread rapidly in Central and Eastern Europe. HIV among IDUs has become a particular problem in Russia and the Newly Independent States, with the explosive HIV epidemics occurring in cities such as Kaliningrad and Sverdlogorsk (Dehne, Khodakevich, Hamers & Schwartlander, 1999; Kobyshcha, 1999; Rhodes et al., 1999; Shcherbinskaia et al., 1999). Additional rapid outbreaks of HIV among Russian IDUs have been reported in Krasnagor, Nizhniy Novgorod, Rostov-Na- Donu, Saratov, Tula, Tumen, Tver, Irkutsk, and Moscow (Alcabes, Beniowski & Grund, 1999; Dehne et al., 1999; Thomsen, 2000; World Health Organiza- tion, 2000). This spread of HIV among IDUs in Eastern Europe and Russia has occurred within a context of a general deterioration in public health and a decrease in life expectancy (Bobkov et al., 2001; Burger, Field & Twigg, 1998; Shkolnikov, McKee and Leon, 2001; Stone, 2000; Verevochkin et al., 1999). Effective programmes to prevent HIV infection among IDUs have been developed, including syringe exchange, community outreach, and drug abuse treat- ment (National Institutes of Health, 1997). Whether such programmes can bring the spread of HIV among IDUs in Central/Eastern Europe and Russia under * Corresponding author. Tel.:  /1-212-387-3803; fax:  /1-212-387- 3897 E-mail address: dcdesjarla@aol.com (D.C. Des Jarlais). International Journal of Drug Policy 13 (2002) 165  /174 www.elsevier.com/locate/drugpo 0955-3959/02/$ - see front matter # 2002 Elsevier Science B.V. All rights reserved. PII:S0955-3959(02)00070-1