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Condom use and partnership intimacy among drug injectors and their sexual partners in Estonia
  1. Anneli Uusküla1,
  2. Katri Abel-Ollo2,
  3. Anna Markina3,
  4. Louise-Anne McNutt4,
  5. Robert Heimer5
  1. 1Department of Public Health, University of Tartu, Tartu, Estonia
  2. 2Estonian Drug Monitoring Centre, National Institute for Health Development, Tallinn, Estonia
  3. 3Department of Law, University of Tartu, Tartu, Estonia
  4. 4Department of Epidemiology, School of Public Health, University at Albany, State University of New York, Albany, New York, USA
  5. 5Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, USA
  1. Correspondence to Dr Anneli Uusküla, Department of Public Health, University of Tartu, Ravila 19, Tartu 50411, Estonia; anneli.uuskula{at}


Objectives Young age coupled with a high HIV prevalence among injection drug users (IDUs) and the prevalence of drug use in Eastern Europe can lead from an HIV epidemic concentrated among IDU to a self-sustained heterosexual HIV epidemic. Our objective was to explore the contexts of the prevention of sexual transmission of HIV among IDUs and their sexual partners and to provide insight into beliefs and behaviours related to condom use.

Methods The authors undertook in-depth qualitative interviews to explore narratives about experience of preventing sexual transmission of HIV among 27 individuals (15 current IDUs and 12 main sexual partners of IDUs) in Kohtla-Järve, Estonia.

Results The safe-sex ‘norm’ was not common and factors that tended to reduce condom use included valuing the relationship above health risks, established gender roles, perceptions that condoms distributed via harm reduction programmes were of low quality and the stigma attached to HIV status disclosure. HIV risk management strategies among participants included consistent condom use and serosorting but were countered by a fatalism that encompassed consciously subjecting oneself to the inevitability of HIV infection in an HIV-discordant sexual partnership.

Conclusions Qualitative methods can significantly contribute to the prevention of sexual transmission of HIV among and beyond IDUs by improving our understanding of risky behaviours and the reasons for such behaviours that can be incorporated into tailored public health interventions.

  • Epidemiology
  • STD
  • STD clinic
  • HSV-1
  • vulval skin disease

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  • Funding This study was supported by the grant # ESX0-2722-TA-06 from CRDF (USA); Norwegian Financial Mechanism/EEA (grant EE0016); New York State International Training and Research Program (grant 2D43TW000233), NIH—Fogarty International Center and National Institute on Drug Abuse; the Basic Financing and the Target Financing of Estonian Ministry of Education and Research (grant SF0180060s09).

  • Correction notice This article has been corrected since it was published Online First. The sentence ‘an HIV epidemic concentrated among IUD’ has been amended to ‘an HIV epidemic concentrated among IDU’.

  • Competing interests None.

  • Ethics approval The Ethics Review Board at the University of Tartu (Estonia).

  • Provenance and peer review Not commissioned; externally peer reviewed.