Background: The complex phenomenon of methamphetamine injection and its association with HIV infection requires reliable knowledge at the socio-behavioral and biological nexus. We sought to describe the actual practices of manufacturing and injecting various ephedrine-based stimulants and replicate these in the laboratory to investigate HIV viability and the implications for HIV transmission in the context of behavioral norms. Methods: Drawing upon our studies in the FSU region, we employed a multi-methods approach across three domains: first, we conducted ethnographic observations of home production of stimulants and extensive discussions with injection drug users (IDUs), health researchers and HIV prevention service providers in Ukraine, Moldova, Kazakhstan and Russia; second, we manufactured stimulants in the laboratory, replicating field observations of ingredients and modes of preparation to explore their inf luence on the survival of HIV; third, we conducted a structured survey of 826 IDUs in 11 cities across the Russian Federation. Results: Ephedrine- based preparations yielded methamphetamine or methcathinone, although a range of beliefs regarding the chemistry often resulted in solutions with many impurities and with a product different from the one expected. Products were generally acidic enough to inactivate HIV upon contact, yet produce damage to veins and tissue. Behavioral correlates in our survey results demonstrate considerable regional variation in past and recent stimulant injection, syringe access and injection practices, treatment-seeking and health outcomes. Conclusions: The global growth of methamphetamine injection requires that we build knowledge base that accounts for variations in geographic and social context, and reliable approaches to support multi-dimensional, locally-informed interventions. Dr. Heimer‘s major research efforts include scientific investigation of the mortality and morbidity associated with injection drug use. Areas of investigation include syringe exchange programs, HIV and hepatitis C survival in syringes, hepatitis B vaccina- tion, overdose prevention and resuscitation, and pharmacological treatment of opiate addiction. His research combines laboratory, operational, behavioral, and struc- tural analyses to evaluate the effectiveness of intervention programs in preventing the negative medical consequences of injection drug use. Dr. Heimer is Director of the Interdisciplinary Research Methods Core at Yale’s Center for Interdisciplinary Research on AIDS (CIRA). His current work focuses on he contexts and conse- quences of drug abuse and attempts to provide health and prevention practition- ers with information needed to assist their educational and advocacy efforts. Dr. Heimer is also the Director of the Yale office of the Connecticut Emerging Infections Program. This Centers for Disease Control and Prevention-funded program is one of eleven programs nationwide that seek to assess, through popula- tion-based surveillance, the public health impact of emerging infectious diseases and to evaluate methods for their prevention and control in the community. The Yale program currently focuses on chronic liver disease (especially hepatitis C), foodborne illnesses, and respiratory illnesses and Lyme disease prevention. Dr. Heimer received his training in molecular biology and pharmacology at Columbia College (BA) and Yale University (MA, Ph.D.). He began his work on the prevention of HIV among injection drug users in 1990 with an evaluation of the city-run New Haven needle exchange program and his work on emerging infections in 1995 with studies of the tick-borne agents of human anaplasmosis and ehrlichiosis.
