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 informati on 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 infor mation gaps remain in our findings, we did not find indications for an emer ging HIV epidemic among IDUs, such as that occurring in of her regions with in the former USSR. On the other hand, a future HIV epidemic among IDUs can not be precluded because of a high prevalence of injecting drug use and the common practices of needle sharing, "front loading," and unprotected sex a mong IDUs. In order to maintain the relatively favorable situation regardin g HIV infections among IDUs in Georgia, additional interventions are needed and should be targeted toward the general population as well as specific s ubgroups 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 purpo ses is quite common in the general population, a mass media-based safe inje ction campaign and improved access to syringes and condoms through pharmaci es are preferable and more feasible than setting up needle-exchange program s. In reflecting on the use of rapid assessment methodology, we see the nee d for evaluation of the approach. Its further development should aim at syn thesizing social science methodology and practical knowledge on policy maki ng and intervention development.