Background In 2012 60.4% of registered HIV cases were attributed to injection drug use in Russia and is up 8% in Barnaul (2012). We sought to describe socio-demographic and drug related risk factors among PWI recently diagnosed with HIV in Barnaul, Russia.

Methods A cross sectional survey among PWID using RDS was conducted between August and October 2012. PWID were recruited by 5 PWID “seeds.” Blood specimens were collected for HIV and CD4 testing.

Results 500 PWID were surveyed. 251 respondents reported a prior HIV- test result. Of these, 61.2% (95% CI: 32.8, 85.0) reported their prior negative result was within the last 18 months, 53 PWID (20% (95% CI: 8.9, 29.1)) were HIV+. Median CD4+ count in HIV+ was 543 while in HIV- 841 cells mm3 (p = 0.0001). Subset of 251 PWID represented predominantly by: male (64.7%, 95% CI 53.1, 78.9), 30–39 years old (68.8%, 95% CI 51.4, 82.6), single (56.2%, 95% CI 36.5, 65.7), unemployed (74.5%, 95% 59.9, 85.8), first injection was at age < 14 (46.2%, 95% CI 26.2, 64.4). A majority injected in the last month (63.9%, 95% CI 51.5, 80.7) from ≥ 2 to ≤ 9 (74.8%, 95% CI 46.7, 96.2) times a day. Predominantly used drugs during the last month were heroin, marijuana (51.3%, 95% CI 35.1, 56.9), and desomorphine (27.9%, 95% CI 11.3, 37.6). 85.0% of PIWD injected in a group with 1–5 injectors (95% CI 67.7, 96.5) with > 6 non-sterile injections (50.1%, 95% CI 26.0, 77.6) on average and 88.1% (95% CI 70.2, 97.1) shared paraphernalia. Prevalence of Hep C was 81.7% (95% CI 70.3, 90.3).

Conclusions Even with frequent testing, one fifth of PWID did not know their correct HIV status. This is likely attributable to their frequent high risk exposures. HIV transmission among PWID appears to be occurring at a rapid pace. Essential interventions are needed to slow transmission.