Association between Pregnancy and Active Injection Drug Use and Sex Work among Women Injection Drug Users in Saint Petersburg, Russia

Voluntary Pregnancy Screening at Syringe Exchanges: A Feasibility Study

The purpose of this study was to explore the feasibility of offering voluntary pregnancy screening at syringe exchange programs using the National Implementation Research Network Hexagon Discussion and Analysis Tool. We conducted a survey among female syringe exchange clients that assessed perceived needs, values, and behavioral intentions for parenting and entering treatment if they received a positive pregnancy screen and surveys among staff and core volunteers to assess organizational fit, capacity, and needed supports. Participants and staff reported that pregnancy screening was needed at syringe exchange and that capacity needs to be expanded to provide services. Pregnancy screening at syringe exchanges holds the potential to lead to early detection of pregnancy. Early detection of pregnancy among women who inject drugs may result in improved prenatal care, including substance use treatment and treatment of infectious diseases, for women who would otherwise be unlikely to receive prenatal care.

Female Sex Workers' Experiences Selling Sex during Pregnancy and Post-Delivery in South Africa

Nearly 75 percent of female sex workers (FSWs) in Port Elizabeth, South Africa are mothers, many of whom engage in sex work during pregnancy or after delivery. We conducted in-depth interviews with 22 postpartum and 8 pregnant FSWs in Port Elizabeth. Interview guides were used to probe women's experiences, challenges, and concerns about selling sex during pregnancy and post-delivery in a high-HIV-prevalence context. Interviews were transcribed, translated, and coded using thematic analysis. FSWs experienced and feared violence by clients during pregnancy, highlighting the need for safe work environments. Further, FSWs expressed concerns about HIV acquisition and vertical transmission during the perinatal period. Physical challenges related to pregnancy affected women's ability to work. Returning to work post-delivery presented barriers to initiating and practicing exclusive breastfeeding. As a result, many FSWs practiced mixed feeding. Interventions, tailored to respond to FSW's challenges and experiences, may offer improved health outcomes in this context.

'If she gave birth to a healthy child, then she may forget about her own health': Postpartum engagement in HIV care and treatment among women living with HIV in Russia

There is a dearth of information about the factors influencing postpartum engagement in HIV treatment and care in Russia, a country with an expanding HIV epidemic and poor treatment coverage. The goal of our community-based study was to identify and explore the factors influencing engagement in care after pregnancy. We conducted in-depth interviews with 50 women living with HIV who had recently given birth, and with 20 health care and social service providers in two locations: a large metropolitan city (St. Petersburg) and a semi-urban town near the Ural Mountains. Thematic analysis led us to identify the following themes in regard to factors influencing postpartum engagement in care: feeling overwhelmed with caring for an infant; sense of responsibility for child's health and well-being; misinformation and AIDS denialism; HIV-related stigma and fear; benefits versus side-effects of ART; professional and personal support; drug and alcohol use; and structural factors. Structural factors include poverty, continued provision of ART after pregnancy, dosage, obtaining necessary documents, and distance to clinic. These findings are important to consider in developing much-needed interventions to promote women's longer-term engagement in HIV care and treatment in Russia.

Correlates of Double Risk of HIV Acquisition and Transmission Among Women who Inject Drugs in St. Petersburg, Russia

Russia continues to experience a growing HIV epidemic, and women account for an increasing proportion of new HIV diagnoses in the country. This study aims to provide up-to-date information on factors associated with unsafe sex and drug use behaviors among women who inject drugs in St. Petersburg, Russia. In this community-based sample of 500 women who inject drugs, 64% tested positive for HIV. Women reported the following: 21% reported injection risk, 22% reported sexual risk, and 18% reported double risk. Multivariable analyses using logistic multinomial regression showed that older age is associated with increased risk behaviors. Involvement in transactional sex is associated with injection risk [aOR = 1.59 (1.02, 2.48)] but protective against sexual risk [aOR = 0.11 (0.06, 0.19)]. Exposure to sexual violence is associated with increased injection risk [aOR = 1.78 (1.01, 3.14)] and double risk [aOR = 3.38 (1.50, 7.63)]. These findings indicate the need to address both the unsafe injection and sexual risks among women who inject drugs in Russia.

Correlates of Lifetime History of Purchasing Sex Services by Men in Saint Petersburg and Leningrad Oblast, Russia

Commercial sex workers (CSWs) in the Russian Federation are at high risk of HIV infection and transmission as a result of unsafe sexual and injecting behaviors. Their clients might be at increased risk of acquiring HIV; however, little is known about the population of men purchasing sex services. This study aims to investigate factors associated with a history of purchasing sex services by men in Saint Petersburg and Leningrad Oblast, Russian Federation. Data were collected as part of a cross-sectional study offering free anonymous rapid HIV testing in Saint Petersburg and Leningrad Oblast in 2014; in total, 3565 men aged 18 years and older provided information about their behaviors associated with risk of acquiring HIV during face-to-face interviews. Prevalence of CSW use in our study was 23.9%. Multivariable analyses using log-binomial regression were stratified by self-reported HIV testing during the 12 months preceding the study interview. In both strata, older age, multiple sex partners, and a history of sex with an injection drug user (IDU) were associated with an elevated prevalence ratio (PR) for history of purchasing sex services, although the strength of the association differed by strata. Among men who reported recent HIV testing, condom use (PR = 1.22, 90% confidence interval (CI) 1.0, 1.48) was associated with a history of purchasing sex services, and among men who did not report recent HIV testing, having a consistent sex partner was associated with purchasing sex services (PR = 1.23, 90% CI 1.1, 1.37). The high prevalence of CSW service use and associations found in this study raise serious concerns about potential for sexual HIV transmission and should be investigated more closely.