RESUMEN
The number of HIV cases attributed to heterosexual contact and the proportion of women among HIV positive individuals has increased worldwide. Russia is a country with the highest rates of newly diagnosed HIV infections in the region, and the infection spreads beyond traditional risk groups. While young women are affected disproportionately, knowledge of HIV risk behaviors in women in the general population remains limited. The objectives of this study were to identify patterns of behaviors that place women of childbearing age at high risk for HIV transmission and determine whether socio-demographic characteristics and alcohol use are predictive of the risk pattern. A total of 708 non-pregnant women, aged between 18 and 44 years, who were at risk for an alcohol-exposed pregnancy were enrolled in two regions in Russia. Participants completed a structured interview focused on HIV risk behaviors, including risky sexual behavior and alcohol and drug use. Latent class analysis was utilized to examine associations between HIV risk and other demographic and alcohol use characteristics and to identify patterns of risk among women. Three classes were identified. 34.93% of participants were at high risk, combining their risk behaviors, e.g., having multiple sexual partners, with high partner's risk associated with partner's drug use (class I). Despite reporting self-perceived risk for HIV/STI, this class of participants was unlikely to utilize adequate protection (i.e., condom use). The second high risk class included 13.19% of participants who combined their risky sexual behaviors, i.e., multiple sexual partners and having STDs, with partner's risk that included partner's imprisonment and partner's sex with other women (class II). Participants in this class were likely to utilize protection/condoms. Finally, 51.88% of participants were at lower risk, which was associated primarily with their partners' risk, and these participants utilized protection (class III). The odds of being in class I compared with class III were 3.3 (95% CI [1.06, 10.38]) times higher for those women who had Alcohol Use Disorders Identification Test scores ≥ 8 than those who had lower scores, and were 3.9 (95% CI [1.69, 8.97]) times higher for those who used alcohol before sex than those who did not. In addition, women who drank more days per week were 1.36 times more likely to be in class II than in class III. The study informs prevention by identifying specific population groups and targets for interventions. Alcohol use is a significant predictor and an overarching factor of HIV risk in women. Since at-risk drinking is common among young Russian women, alcohol risk reduction should be an essential component of HIV prevention efforts.
Asunto(s)
Consumo de Bebidas Alcohólicas/efectos adversos , Condones/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Heterosexualidad , Asunción de Riesgos , Conducta Sexual , Adolescente , Adulto , Consumo de Bebidas Alcohólicas/epidemiología , Estudios Transversales , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/transmisión , Humanos , Embarazo , Factores de Riesgo , Federación de Rusia/epidemiología , Sexo Seguro , Parejas Sexuales , Enfermedades de Transmisión Sexual/prevención & control , Adulto JovenRESUMEN
A 2006 survey of street youth at pre-mapped street youth locations in St. Petersburg, Russia, found extremely high HIV seroprevalence (37.4%) among 313 street youth aged 15-19 years of age, strongly associated with injection drug use, which was reported by 50.6% of participants. In response, multi-sectoral social support and prevention measures were instituted. In 2012, we conducted a follow-up survey of 15- to 19-year-old street youth using the same study procedures as in 2006. Of 311 participants, 45 (14.5%) reported injection drug use; 31 participants (10.0%, 95% confidence interval, 6.0%-16.2%) were HIV-seropositive . Predictors independently associated with HIV seropositivity included injection drug use (adjusted prevalence ratio 53.1) and transactional sex (adjusted prevalence ratio 1.3). None of the 178 participants aged 15-17 years were HIV-positive. Thirty of 31 (96.8%) HIV-seropositive individuals reported injection drug use. Street youth in St Petersburg had a 73% decrease in HIV seroprevalence from 2006 to 2012, primarily due to decreased initiation of injection drug use. This marked reduction in the HIV epidemic among street youth occurred after implementation of extensive support programs and socio-economic improvements.
Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/epidemiología , Infecciones por VIH/epidemiología , Jóvenes sin Hogar/estadística & datos numéricos , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adolescente , Estudios Transversales , Femenino , Seroprevalencia de VIH , Humanos , Masculino , Prevalencia , Federación de Rusia/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
Russia has one of the fastest rising rates of HIV among women in the world. This study sought to identify key factors in HIV transmission among women in Russia. Data were collected as part of a larger clinical trial to prevent alcohol-exposed pregnancies (AEP). Women at risk for an AEP were recruited at women's clinics; 708 women, aged 18-44 (M = 29.04 years), completed HIV risk surveys. Structural Equation Modeling was used to test the relationships between alcohol use and sex behavior constructs with HIV/STI risk. While the model indicated that multiple factors are involved in women's HIV/STI risk, the independent alcohol use variable explains 20 % of the variance in women's HIV/STI risk. The findings suggest that alcohol use directly and indirectly predicts HIV/STI risk among women, and its effect is mediated by alcohol use before sex.
Asunto(s)
Consumo de Bebidas Alcohólicas/epidemiología , Alcoholismo/epidemiología , Consumo Excesivo de Bebidas Alcohólicas/epidemiología , Infecciones por VIH/epidemiología , Sexo Inseguro/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Medición de Riesgo , Federación de Rusia/epidemiología , Conducta Sexual/estadística & datos numéricos , Enfermedades de Transmisión Sexual/epidemiología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
HIV transmission is a major health concern. Global efforts are necessary to control the spread of infection. International collaborative studies in countries with high rates of new infections are essential for increasing knowledge on the behavioral, social, and biomedical aspects of HIV/AIDS and HIV transmission. Statistics indicate a growing HIV epidemic in Russia. There are alarming proportions of new cases attributed to heterosexual contact, and HIV is increasingly affecting people in the general population who are not part of any traditional high-risk group. Despite recent advances in HIV prevention, data on effective behavioral prevention approaches are limited. There is minimal evidence to suggest which types of prevention will be effective in reducing the risk for HIV transmission among people at risk in the general population. This article presents a review and discussion of an international research seminar, HIV Prevention Research: Evidence-Based Behavioral Approaches. Local and international interdisciplinary researchers gathered for the purposes of exchanging research results and information about ongoing studies, identifying gaps in knowledge, and discussing promising prevention strategies. The overarching goal was to advance HIV prevention research through scientific integration. The seminar provided an excellent platform for building research capacity in interdisciplinary HIV research in Russia and integrating research efforts with the international research community to contribute to HIV prevention research throughout the world.
Asunto(s)
Terapia Conductista/métodos , Transmisión de Enfermedad Infecciosa/prevención & control , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Cooperación Internacional , Investigación Biomédica/tendencias , Salud Global , Infecciones por VIH/transmisión , HumanosRESUMEN
We evaluated the efficacy of a peer-educator network intervention as a strategy to reduce HIV acquisition among injection drug users (IDUs) and their drug and/or sexual networks. A randomized controlled trial was conducted in St. Petersburg, Russia among IDU index participants and their risk network participants. Network units were randomized to the control or experimental intervention. Only the experimental index participants received training sessions to communicate risk reduction techniques to their network members. Analysis includes 76 index and 84 network participants who were HIV uninfected. The main outcome measure was HIV sero-conversion. The incidence rates in the control and experimental groups were 19.57 (95 % CI 10.74-35.65) and 7.76 (95 % CI 3.51-17.19) cases per 100 p/y, respectively. The IRR was 0.41 (95 % CI 0.15-1.08) without a statistically significant difference between the two groups (log rank test statistic X(2) = 2.73, permutation p value = 0.16). Retention rate was 67 % with a third of the loss due to incarceration or death. The results show a promising trend that this strategy would be successful in reducing the acquisition of HIV among IDUs.
Asunto(s)
Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Educación en Salud , Grupo Paritario , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/epidemiología , Serodiagnóstico del SIDA , Adulto , Western Blotting , Comunicación , Estudios Transversales , Ensayo de Inmunoadsorción Enzimática , Femenino , Estudios de Seguimiento , Seronegatividad para VIH , Humanos , Masculino , Conducta de Reducción del Riesgo , Federación de Rusia , Apoyo Social , Sexo Inseguro/prevención & control , Sexo Inseguro/estadística & datos numéricosRESUMEN
We examined the association of individual demographic and behavioral attributes, partnership (dyad) and social network characteristics with unprotected sex in the heterosexual dyads of IDUs in St. Petersburg, Russia. Of the individual-level characteristics female gender and younger age; and of the dyad-level characteristics sharing injecting equipment, social exposure to the sex partner ("hanging out with" or seeing each other daily), and both partners self-reporting being HIV infected were associated with unprotected sex. Although self-reported HIV discordant couples were less likely to engage in unprotected sex, it was reported in over half of self-reported HIV discordant relationships. This study highlights the intertwining of sexual risk and injecting risk, and the importance of sero-sorting based on perceived HIV status among IDU sexual partnerships in St. Petersburg, Russia. A combination of social network and dyad interventions may be appropriate for this population of IDUs, especially for IDUs who are both injecting and sex partners, supported by free and confidential rapid HIV testing and counseling services to provide a comprehensive response to the wide-spread HIV epidemic among IDUs in St. Petersburg.
Asunto(s)
Infecciones por VIH/transmisión , Heterosexualidad/psicología , Parejas Sexuales/psicología , Sexo Inseguro/psicología , Adulto , Distribución por Edad , Consumidores de Drogas/psicología , Consumidores de Drogas/estadística & datos numéricos , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Compartición de Agujas/psicología , Asunción de Riesgos , Federación de Rusia/epidemiología , Distribución por Sexo , Apoyo Social , Abuso de Sustancias por Vía Intravenosa/complicaciones , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto JovenRESUMEN
In this study, we investigated how individual attributes, dyad characteristics and social network characteristics may influence engaging in receptive syringe sharing, distributive syringe sharing and sharing cookers in injecting partnerships of IDUs in St Petersburg, Russia. We found that all three levels were associated with injecting equipment sharing, and that dyad characteristics were modified by characteristics of the social network. Self-reported HIV discordance and male gender concordance played a role in the risk of equipment sharing. Dyad interventions may not be sufficient to reduce injecting risk in IDU partnerships, but a combination of dyad and network interventions that target both IDU partnerships and the entire IDU population may be more appropriate to address injecting risk among IDUs.
Asunto(s)
Compartición de Agujas/estadística & datos numéricos , Apoyo Social , Abuso de Sustancias por Vía Intravenosa/epidemiología , Adulto , Áreas de Influencia de Salud , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Prevalencia , Factores de Riesgo , Asunción de Riesgos , Federación de Rusia/epidemiología , Distribución por SexoRESUMEN
AIMS: To assess among injecting drug users (IDUs) in St. Petersburg, Russia, the urban environment, social norms and individual correlates of unsafe injecting. METHODS: Between December 2004 and January 2007, 446 IDUs were interviewed in St. Petersburg, Russia. RESULTS: Prevalence of HCV was 96% and HIV 44%. 17% reported receptive syringe sharing after an HIV-infected IDU, 49% distributive syringe sharing, 76% sharing cookers, 73% sharing filters and 71% syringe-mediated drug sharing when not all syringes were new. Urban environmental characteristics correlated with sharing cookers and syringe-mediated sharing, and social norms correlated with receptive and distributive syringe sharing and sharing cookers. Individual correlates included cleaning used syringes (all 5 dependent variables) and self-report of HIV infection (receptive and distributive syringe sharing). CONCLUSION: HIV status disclosure is an unreliable but frequently used HIV prevention method among IDUs in St. Petersburg, who reported alarmingly high levels of injecting equipment sharing. Voluntary counseling and testing should be widely available for this population. Ethnography is needed to assess the effectiveness of the syringe cleaning process. Prevention interventions need to be ongoing among IDUs in St. Petersburg, and should incorporate urban environmental factors and social norms, which may involve peer education and social network interventions.