RESUMEN
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.