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This is particularly relevant in settings where injection drug use accounts for a substantial proportion of the HIV burden, such as in Kyrgyzstan, a former Soviet Republic. This study assessed whether injecting \u201csalts\u201d is associated with sexual and injection\u2010related HIV risk behaviours among people who inject drugs in Kyrgyzstan.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The Kyrgyzstan InterSectional Stigma Study is a cohort of people who inject drugs in Kyrgyzstan's capital of Bishkek and the surrounding rural administrative division of Chuy Oblast. We conducted a cross\u2010sectional analysis using survey data collected from cohort participants between July and November 2021, which included information on injection drug use (including \u201csalts\u201d) and HIV risk behaviours. To minimize confounding by measured covariates, we used inverse\u2010probability\u2010weighted logistic and Poisson regression models to estimate associations between recent \u201csalt\u201d injection and HIV risk behaviours.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Of 181 participants included in the analysis (80.7% men, 19.3% women), the mean age was 40.1 years (standard deviation [SD] = 8.8), and 22% (<jats:italic>n<\/jats:italic> = 39) reported that they had injected \u201csalts\u201d in the past 6 months. Among people who injected \u201csalts,\u201d 72% (<jats:italic>n<\/jats:italic> = 28) were men, and most were ethnically Russian 59% (<jats:italic>n<\/jats:italic> = 23), with a mean age of 34.6 (SD = 9.6). Injecting \u201csalts\u201d was significantly associated with a greater number of injections per day (adjusted relative risk [aRR] = 1.59, 95% confidence interval [CI] = 1.30\u22121.95) but lower odds of using syringe service programmes in the past 6 months (adjusted odds ratio [aOR] = 0.20, 95% CI = 0.12\u22120.32). Injecting \u201csalts\u201d was also significantly associated with lower odds of condomless sex in the past 6 months (aOR = 0.42, 95% CI = 0.24\u22120.76) and greater odds of having ever heard of pre\u2010exposure prophylaxis (aOR = 4.80, 95% CI = 2.61\u22128.83).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>(PWID) people who inject drugs who inject \u201csalts\u201d are a potentially emergent group with increased HIV acquisition risk in Kyrgyzstan. Targeted outreach bundled with comprehensive harm reduction and pre\u2010exposure prophylaxis services are needed to prevent transmission of HIV and other blood\u2010borne viruses.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jia2.26247","type":"journal-article","created":{"date-parts":[[2024,7,9]],"date-time":"2024-07-09T06:09:07Z","timestamp":1720505347000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["A cross\u2010sectional assessment of injection of \u201csalts\u201d and HIV transmission\u2010related behaviours among a cohort of people who inject drugs in Kyrgyzstan"],"prefix":"10.1002","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6575-3017","authenticated-orcid":false,"given":"Rebecca","family":"Kennedy","sequence":"first","affiliation":[{"name":"School of Medicine University of California San Diego  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zachary","family":"Bouck","sequence":"additional","affiliation":[{"name":"Centre on Drug Policy Evaluation Unity Health Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Werb","sequence":"additional","affiliation":[{"name":"School of Medicine University of California San Diego  La Jolla California USA"},{"name":"Centre on Drug Policy Evaluation Unity Health Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ainura","family":"Kurmanalieva","sequence":"additional","affiliation":[{"name":"AIDS Foundation\u2010East West in the Kyrgyz Republic  Bishkek Kyrgyzstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Blyum","sequence":"additional","affiliation":[{"name":"School of Medicine University of California San Diego  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalya","family":"Shumskaya","sequence":"additional","affiliation":[{"name":"AIDS Foundation\u2010East West in the Kyrgyz Republic  Bishkek Kyrgyzstan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas L.","family":"Patterson","sequence":"additional","affiliation":[{"name":"Department of Psychiatry University of California San Diego  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0304-3172","authenticated-orcid":false,"given":"Javier A.","family":"Cepeda","sequence":"additional","affiliation":[{"name":"Bloomberg School of Public Health Johns Hopkins University  Baltimore Maryland USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5371-3229","authenticated-orcid":false,"given":"Laramie R.","family":"Smith","sequence":"additional","affiliation":[{"name":"School of Medicine University of California San Diego  La Jolla California USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,7,8]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11920-019-1038-8"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11904-014-0202-3"},{"key":"e_1_2_12_4_1","unstructured":"SagyndykovnaS RafikovaU.Bio behavior survey among people who inject drugs in the Kyrgyz Republic.Republic AIDS Center and CDC;2021."},{"key":"e_1_2_12_5_1","unstructured":"UNAIDS.Kyrgyzstan | UNAIDS [Internet]. 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