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Kimmel SD, Samet JH, Cheng DM, Vetrova M, Idrisov B, Rossi SL, Rateau L, Astone K, Michals A, Sisson E, Blokhina E, Milet-Carty N, Bovell-Ammon BJ, Gnatienko N, Truong V, Krupitsky E, Lunze K. Stigma and other correlates of sharing injection equipment among people with HIV in St. Petersburg, Russia. Glob Public Health 2024; 19:2296009. [PMID: 38158724 PMCID: PMC10764055 DOI: 10.1080/17441692.2023.2296009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/11/2023] [Indexed: 01/03/2024]
Abstract
Stigma that people with HIV who inject drugs experience negatively impacts HIV and substance use care, but stigma's association with sharing injection equipment is not known. This is a cross-sectional analysis of data from two studies of people with HIV reporting drug injection (N = 319) in St. Petersburg, Russia (September 2018-December 2020). We used logistic regression to examine associations between HIV stigma and substance use stigma scores (categorised into quartiles) and past 30-day equipment sharing, adjusting for demographic and clinical characteristics. Secondary analyses examined associations of arrest history and social support with sharing equipment. Almost half (48.6%) of participants reported sharing injection equipment. Among groups who did and did not share, mean HIV stigma (2.3 vs 2.2) and substance use stigma (32 vs 31) scores were similar. Adjusted analyses detected no significant associations between HIV stigma quartiles (global p-value = 0.85) or substance use stigma quartiles (global p-value = 0.51) and sharing equipment. Neither arrest history nor social support were significantly associated with sharing equipment. In this cohort, sharing injection equipment was common and did not vary based on stigma, arrest history, or social support. To reduce equipment sharing, investments in sterile injection equipment access in Russia should be prioritised over interventions to address stigma.
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Affiliation(s)
- Simeon D Kimmel
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
- Section of Infectious Diseases, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Jeffrey H Samet
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Debbie M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Marina Vetrova
- Institute of Pharmacology, Pavlov University, St. Petersburg, Russia
| | - Bulat Idrisov
- Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
| | - Sarah L Rossi
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Lindsey Rateau
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Kristina Astone
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Amy Michals
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Emily Sisson
- Department of Biostatistics, Boston University School of Public Health, Boston, USA
| | - Elena Blokhina
- Institute of Pharmacology, Pavlov University, St. Petersburg, Russia
| | - Natasha Milet-Carty
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Benjamin J Bovell-Ammon
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
- The Miriam Hospital, Lifespan, Providence, Rhode Island, USA
| | - Natalia Gnatienko
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Ve Truong
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
| | - Evgeny Krupitsky
- Institute of Pharmacology, Pavlov University, St. Petersburg, Russia
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St. Petersburg, Russia
| | - Karsten Lunze
- Section of General Internal Medicine, Boston Medical Center and Chobanian and Avedisian Boston University School of Medicine, Boston, USA
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Owczarzak J, Chien J, Tobin K, Mazhnaya A, Chernova O, Kiriazova T. A qualitative exploration of daily path and daily routine among people in Ukraine who inject drugs to understand associated harms. Subst Abuse Treat Prev Policy 2022; 17:33. [PMID: 35526038 PMCID: PMC9077869 DOI: 10.1186/s13011-022-00465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Patterns of movement, heterogeneity of context, and individual space-time patterns affect health, and individuals’ movement throughout the landscape is shaped by addiction, meeting basic needs, and maintaining relationships. Place and social context enable or constrain behavior and individuals use social networks and daily routines to accomplish individual goals and access resources.
Methods
This article explores drug use as part of daily routines and daily paths among people who inject drugs in Dnipro City, Ukraine. Between March and August 2018, we interviewed 30 people who inject drugs living in Dnipro City, Ukraine. Study participants completed a single interview that lasted between 1 and 2 hours. During the interview, participants described their daily routine and daily path using a printed map of Dnipro as a prompt. Participants were asked to draw important sites; give time estimates of arrival and departure; and annotate on the map the points, paths, and areas most prominent or important to them. Participants also described to what extent their daily routines were planned or spontaneous, how much their daily path varied over time, and how drug use shaped their daily routine.
Results
We identified 3 major types of daily routine: unpredictable, predictable, and somewhat predictable. Participants with unpredictable daily routines had unreliable sources of income, inconsistent drug suppliers and drug use site, and dynamic groups of people with whom they socialized and used drugs. Participants with predictable daily routines had reliable sources of income, a regular drug dealer or stash source, and a stable group of friends or acquaintances with whom they bought and/or used drugs. Participants with somewhat predictable daily routines had some stable aspects of their daily lives, such as a steady source of income or a small group of friends with whom they used drugs, but also experienced circumstances that undermined their ability to have a routinized daily life, such as changing drug use sites or inconsistent income sources.
Conclusions
Greater attention needs to be paid to the daily routines of people who use drugs to develop and tailor interventions that address the place-based and social contexts that contribute to drug-use related risks.
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Davitadze A, Meylakhs P, Lakhov A, King EJ. Harm reduction via online platforms for people who use drugs in Russia: a qualitative analysis of web outreach work. Harm Reduct J 2020; 17:98. [PMID: 33298081 PMCID: PMC7725218 DOI: 10.1186/s12954-020-00452-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023] Open
Abstract
Background Harm reduction services to people who use drugs (PWUD) in Russia are insufficient in terms of quantity, government endorsement, and accessibility. The situation has recently deteriorated even further because of social distancing measures of the COVID-19 pandemic. Several organizations have started to provide some harm reduction services via online platforms by web outreach. However, little is known on how online outreach services are organized and implemented. Drawing on the example of St. Petersburg-based NGO “Humanitarian Action,” we explored web outreach work in Telegram instant messenger. Methods Our data were comprised of 4 semi-structured interviews with the NGO staff and 301 cases of web outreach work with PWUD. We used thematic analysis to study the process of web outreach, harm reduction service provision, and needs of PWUD. Results Three stages of the process of web outreach work were identified: clients initiating communication, NGO workers addressing clients’ needs, and NGO workers receiving clients’ feedback. Communication proceeded in group chat or direct messages. Challenges in addressing clients’ needs happened when clients turned for help after hours, sent recorded voice messages, sent unclear messages, and/or were unwilling to transition to telephone communication. All web outreach workers reported receiving only positive feedback on their work. The needs of PWUD were categorized into two major themes, depending on whether they can be addressed fully or partially online. In cases of online only provision of services, web outreach workers helped PWUD treat minor injection drug use complications, obtain verified harm reduction information and receive general psychological support. In instances of partial online services provision, PWUD were assisted in getting treatment of severe injection drug use complications, overdoses, and in accessing offline medical, psychological, social, legal and harm reduction services. Conclusions Our research demonstrated that web outreach work is a convenient tool for delivering some harm reduction services to PWUD either partially or completely online and for recruiting new clients (including hard-to-reach PWUD that avoid attending brick-and-mortar facilities). Harm reduction organizations should consider incorporating online harm reduction services into their activities. However, further research is needed to explore relative advantages and disadvantages of online harm reduction services.
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Affiliation(s)
- Arsen Davitadze
- Centre for Health Economics, Management and Policy, National Research University - Higher School of Economics, 194100, Kantemirovstaya st. 3a, St. Petersburg, Russia
| | - Peter Meylakhs
- Centre for Health Economics, Management and Policy, National Research University - Higher School of Economics, 194100, Kantemirovstaya st. 3a, St. Petersburg, Russia.
| | - Aleksey Lakhov
- St. Petersburg Charitable Fund «Humanitarian Action», Kamennoostrovsky prospekt, 63, A, 8-N, St. Petersburg, Russia
| | - Elizabeth J King
- University of Michigan School of Public Health, 1415 Washington Heights, SPH 1, Room 3842, Ann Arbor, MI, 48104, USA
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Davitadze A, Meylakhs P, Lakhov A, King EJ. Harm reduction via online platforms for people who use drugs in Russia: A qualitative analysis of web outreach work. RESEARCH SQUARE 2020. [PMID: 32995761 PMCID: PMC7523123 DOI: 10.21203/rs.3.rs-69948/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background Harm reduction services to people who use drugs (PWUD) in Russia are insufficient in terms of quantity, government endorsement, and accessibility. The situation has recently deteriorated even further because of social distancing measures of the COVID-19 pandemic. Recently several harm reduction organizations have started to provide some harm reduction services via online platforms by web outreach. However, little is known on how online outreach services are organized and implemented. Drawing on the example of St. Petersburg-based NGO "Humanitarian Action" we explored web outreach work in Telegram instant messenger. Methods 4 semi-structured interviews with the NGO staff and 301 cases of web outreach work with PWUD comprised the dataset. The process of web outreach, service provision to PWUD, and PWUD's needs were thematically analyzed. Results Three stages of the process of web outreach work were determined: clients initiating communication, NGO workers addressing clients' needs, and NGO workers receiving clients' feedback. Communication proceeded either in group chat or in direct messages. Challenges in addressing clients' needs happened when clients turned for help in nighttime, sent recorded voice messages, sent unclear messages, and/or were unwilling to transition to telephone communication. All web outreach workers reported receiving only positive feedback on their work. PWUD's needs were categorized into two major themes, depending on whether they can be addressed fully or partially online. In cases of online only provision of services, web outreach workers helped PWUD treat minor injection drug use complications, obtain verified harm reduction information and receive general psychological support. In instances of partial online services provision, PWUD were assisted in getting treatment of severe injection drug use complications, overdoses, and in accessing offline medical, psychological, social, legal and harm reduction services. Conclusions Our research demonstrated that web outreach work is a convenient tool for delivering some harm reduction services to PWUD either partially or completely online and recruiting new clients (including hard-to-reach PWUD that avoid attending brick-and-mortar facilities). It indicates that harm reduction organizations should consider incorporating online harm reduction services into their activities. However, more research is needed to explore relative advantages and disadvantages of online harm reduction services delivery.
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Cheng S, Eck DJ, Crawford FW. Estimating the size of a hidden finite set: Large-sample behavior of estimators. STATISTICS SURVEYS 2020. [DOI: 10.1214/19-ss127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Meylakhs P, Friedman SR, Meylakhs A, Mateu-Gelabert P, Ompad DC, Alieva A, Dmitrieva A. A New Generation of Drug Users in St. Petersburg, Russia? HIV, HCV, and Overdose Risks in a Mixed-Methods Pilot Study of Young Hard Drug Users. AIDS Behav 2019; 23:3350-3365. [PMID: 30989555 DOI: 10.1007/s10461-019-02489-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Russia has a widespread injection drug use epidemic with high prevalence of HIV and HCV among people who inject drugs (PWID). We conducted a mixed methods study of young (age 18-26) hard drug users in St. Petersburg. Thirty-nine structured and 10 semi-structured interviews were conducted. No HIV cases and two HCV cases were detected among the PWID subsample (n = 29). Amphetamine and other stimulants were common (70%), opioid use was rare and episodic. Consistent condom use was 10%. No PWID reported syringe-sharing, 51% reported other drug paraphernalia sharing. Most (89%) never or rarely communicated with older (30 +) opiate users. A new cohort of drug users in St. Petersburg may have emerged, which is much safer in its injection practices compared to previous cohorts. However, risky sexual practices among this new cohort may expose them to the possibility of sexual transmission of HIV and widespread drug paraphernalia sharing to the HCV epidemic.
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Blokhina E, Krupitsky EM, Cheng DM, Walley AY, Toussova O, Yaroslavtseva T, Gnatienko N, Bridden C, Forman LS, Bendiks S, Samet JH. Evolution of illicit opioid use among people with HIV infection in St Petersburg, Russia, in the period 2004-2015. HIV Med 2019; 20:450-455. [PMID: 31034141 DOI: 10.1111/hiv.12741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVES In the late 1990s, when the current Russian opioid epidemic began, illicit opioids used in Russia consisted almost exclusively of heroin. The type of opioids used has evolved in the early 21st Century. The objective of this study was to describe the evolution of illicit opioid use among people living with HIV (PLWH) reporting recent opioid use in St Petersburg, Russia. METHODS We examined baseline data from four research studies conducted in the period 2004-2015 that included PLWH who used opioids [Partnership to Reduce the Epidemic Via Engagement in Narcology Treatment (PREVENT; 2004-2005; n = 17), HIV Evolution in Russia-Mitigating Infection Transmission and Alcoholism in a Growing Epidemic (HERMITAGE; 2007-2010; n = 281), Linking Infectious and Narcology Care (LINC; 2013-2014; n = 119) and Russia Alcohol Research Collaboration on HIV/AIDS (Russia ARCH; 2012-2015; n = 121)] and reported recent use of heroin and other opioids. RESULTS Although these studies spanned more than a decade, the participants represented similar birth cohorts; the mean age was 24.5 years in 2004 and 33.3 years in 2014. The use of opioid types, however, evolved across cohorts, with the use of any illicit drug other than heroin increasing from 6% [95% confidence interval (CI) 000.2, 29%] in PREVENT (2004-2005) to 30% (95% CI 25, 36%) in HERMITAGE (2007-2010) to 70% (95% CI 61, 78%) in LINC (2013-2014) to 77% (95% CI 68, 84%) in ARCH (2012-2015). Any heroin use consistently decreased over the 10-year period in the cohorts, from 100% (95% CI 80, 100%) in 2004-2005 to 54% (95% CI 44, 63%) in 2012-2015. CONCLUSIONS Among PLWH who use opioids in St Petersburg, Russia, illicit use of opioids other than heroin appears to be more common than heroin use.
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Affiliation(s)
- E Blokhina
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St Petersburg, Russia
| | - E M Krupitsky
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St Petersburg, Russia.,Department of Addictions, V. M. Bekhterev National Medical Research Center for Psychiatry and Neurology, St Petersburg, Russia
| | - D M Cheng
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - A Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - O Toussova
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St Petersburg, Russia
| | - T Yaroslavtseva
- Laboratory of Clinical Pharmacology of Addictions, First Pavlov State Medical University, St Petersburg, Russia
| | - N Gnatienko
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - C Bridden
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - L S Forman
- Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, Boston, MA, USA
| | - S Bendiks
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center, Boston, MA, USA
| | - J H Samet
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA.,Department of Community Health Sciences, Boston University School of Public Health, Boston, MA, USA
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Crawford FW, Wu J, Heimer R. Hidden population size estimation from respondent-driven sampling: a network approach. J Am Stat Assoc 2018; 113:755-766. [PMID: 30828120 PMCID: PMC6392194 DOI: 10.1080/01621459.2017.1285775] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 01/01/2017] [Indexed: 12/29/2022]
Abstract
Estimating the size of stigmatized, hidden, or hard-to-reach populations is a major problem in epidemiology, demography, and public health research. Capture-recapture and multiplier methods are standard tools for inference of hidden population sizes, but they require random sampling of target population members, which is rarely possible. Respondent-driven sampling (RDS) is a survey method for hidden populations that relies on social link tracing. The RDS recruitment process is designed to spread through the social network connecting members of the target population. In this paper, we show how to use network data revealed by RDS to estimate hidden population size. The key insight is that the recruitment chain, timing of recruitments, and network degrees of recruited subjects provide information about the number of individuals belonging to the target population who are not yet in the sample. We use a computationally efficient Bayesian method to integrate over the missing edges in the subgraph of recruited individuals. We validate the method using simulated data and apply the technique to estimate the number of people who inject drugs in St. Petersburg, Russia.
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Affiliation(s)
| | | | - Robert Heimer
- Department of Epidemiology of Microbial Diseases Yale School of Public Health
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Tavitian-Exley I, Maheu-Giroux M, Platt L, Heimer R, Uusküla A, Levina O, Vickerman P, Boily MC. Differences in risk behaviours and HIV status between primary amphetamines and opioid injectors in Estonia and Russia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2018; 53:96-105. [PMID: 29306786 DOI: 10.1016/j.drugpo.2017.11.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 11/14/2017] [Accepted: 11/20/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND AND OBJECTIVE People who inject drugs (PWID) account for over half of new HIV infections in Eastern Europe and central Asia, where opioids continue to be the dominant illicit drugs injected. Stimulants including amphetamines (ATS) have been associated with HIV infection risk in several settings. We sought to examine whether primary ATS injection was associated with greater HIV risk, compared to opioid injection in two European locales with significant HIV epidemics. METHODS PWID in Kohtla-Järve and St. Petersburg were recruited using respondent-driven sampling in 2012-2013. Survey data on demographic characteristics, service use, injecting and sexual risk behaviours and HIV-status (and HCV in Kohtla-Järve) were compared between primary opioid and ATS injectors using logistic regression models. RESULTS Of 591 injectors recruited in Kohtla-Järve and 811 in St. Petersburg, 195 (33%) and 27 (4%) primarily injected ATS in each city. In both cities, ATS injectors were younger than opioid injectors, initiated injection later, injected less frequently and were more likely to have been paid for sex. In both cities, PWID had high levels of multiple sex partners. In Kohtla-Järve, ATS-injectors had lower odds of back-loading and greater odds of polydrug use than opioid-injectors. In St. Petersburg, where over half of PWID reported unsafe sharing practices, ATS-injectors were less likely to report these practices. ATS-injection was negatively associated with being HIV positive in Kohtla-Järve (aOR = 0.6; 95%CI: 0.5-0.8) and St. Petersburg (aOR = 0.3; 95%CI: 0.1-0.7). ATS-injection was negatively associated with HCV-reactivity in Kohtla-Järve (aOR = 0.5; 95%CI: 0.3-0.6). CONCLUSIONS In both locations, primary ATS injection was associated with lower injecting risk behaviours, lower odds of HIV and being paid for sex compared to opioid injection. Interventions targeting the characteristics and needs of ATS injectors are needed to increase contact with services and reduce sexual and injecting risk. Harm reduction services, including sexual risk reduction, need to be expanded for all PWID in St. Petersburg.
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Affiliation(s)
- Isabel Tavitian-Exley
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom.
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montréal, Canada
| | - Lucy Platt
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Robert Heimer
- Epidemiology of Microbial Diseases, School of Public Health, Yale University, United States
| | - Anneli Uusküla
- Department of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Olga Levina
- NGO Stellit, St Petersburg, Russian Federation
| | - Peter Vickerman
- School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, United Kingdom.
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Wu J, Crawford FW, Raag M, Heimer R, Uusküla A. Using data from respondent-driven sampling studies to estimate the number of people who inject drugs: Application to the Kohtla-Järve region of Estonia. PLoS One 2017; 12:e0185711. [PMID: 29095866 PMCID: PMC5667832 DOI: 10.1371/journal.pone.0185711] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 09/18/2017] [Indexed: 11/25/2022] Open
Abstract
Estimating the size of key risk populations is essential for determining the resources needed to implement effective public health intervention programs. Several standard methods for population size estimation exist, but the statistical and practical assumptions required for their use may not be met when applied to HIV risk groups. We apply three approaches to estimate the number of people who inject drugs (PWID) in the Kohtla-Järve region of Estonia using data from a respondent-driven sampling (RDS) study: the standard "multiplier" estimate gives 654 people (95% CI 509-804), the "successive sampling" method gives estimates between 600 and 2500 people, and a network-based estimate that uses the RDS recruitment chain gives between 700 and 2800 people. We critically assess the strengths and weaknesses of these statistical approaches for estimating the size of hidden or hard-to-reach HIV risk groups.
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Affiliation(s)
- Jiacheng Wu
- Department of Biostatistics, University of Washington, Seattle, WA, United States of America
| | - Forrest W. Crawford
- Department of Biostatistics, Yale School of Public Health, New Haven, CT, United States of America
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, CT, United States of America
- Yale School of Management, New Haven, CT, United States of America
| | - Mait Raag
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
| | - Robert Heimer
- Department of Epidemiology of Microbial Disease and the Center for Interdisciplinary Research on AIDS, Yale School of Public Health, New Haven, CT, United States of America
| | - Anneli Uusküla
- Institute of Family Medicine and Public Health, University of Tartu, Tartu, Estonia
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Artzrouni M, Leonenko VN, Mara TA. A syringe-sharing model for the spread of HIV: application to Omsk, Western Siberia. MATHEMATICAL MEDICINE AND BIOLOGY-A JOURNAL OF THE IMA 2017; 34:15-37. [PMID: 26489760 DOI: 10.1093/imammb/dqv036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Accepted: 09/21/2015] [Indexed: 11/12/2022]
Abstract
A system of two differential equations is used to model the transmission dynamics of human immunodeficiency virus between 'persons who inject drugs' (PWIDs) and their syringes. Our vector-borne disease model hinges on a metaphorical urn from which PWIDs draw syringes at random which may or may not be infected and may or may not result in one of the two agents becoming infected. The model's parameters are estimated with data mostly from the city of Omsk in Western Siberia. A linear trend in PWID prevalence in Omsk could only be fitted by considering a time-dependent version of the model captured through a secular decrease in the probability that PWIDs decide to share a syringe. A global sensitivity analysis is performed with 14 parameters considered random variables in order to assess their impact on average numbers infected over a 50-year projection. With obvious intervention implications the drug injection rate and the probability of syringe-cleansing are the only parameters whose coefficients of correlations with numbers of infected PWIDs and infected syringes have an absolute value close to or larger than 0.40.
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Meylakhs P, Aasland A, Grønningsæter A. "Until people start dying in droves, no actions will be taken": perception and experience of HIV-preventive measures among people who inject drugs in northwestern Russia. Harm Reduct J 2017; 14:33. [PMID: 28583120 PMCID: PMC5460345 DOI: 10.1186/s12954-017-0162-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 05/24/2017] [Indexed: 12/03/2022] Open
Abstract
Background The HIV epidemic among people who inject drugs (PWID) in Russia continues to spread. This exploratory study examines how HIV-prevention measures are perceived and experienced by PWID in the northwestern region of Russia. Methods Purposive sampling was used to obtain a variety of cases that could reflect possible differences in perception and experience of HIV-prevention efforts. We conducted 22 semi-structured interviews with PWID residing in the Arkhangelsk and St. Petersburg regions. Results The main sources of prevention information on HIV for PWID were media campaigns directed to the general population. These campaigns were effective with regard to communicating general knowledge on HIV but were ineffective in terms of risk behavior change. The subjects generally had trust in medical professionals and their advice but did not follow prevention recommendations. Most informants had no or very little prior contact with harm reduction services. On the level of attitudes towards HIV prevention efforts, we discovered three types of fatalism among PWID: “personal fatalism” - uselessness of HIV prevention efforts, if one uses drugs; “prevention-related fatalism” - prevention programs are low effective, because people do not pay attention to them before they get infected; “state-related fatalism” – the lack of belief that the state is concerned with HIV prevention issues. Despite this fatalism the participants opined that NGOs would do a better job than the state as they are “really working” with risk groups. Conclusions As HIV prevention campaigns targeted at the general population and prevention advice received from medical professionals are not sufficiently effective for PWID in terms of risk behavior change, prevention programs, such as community-based and peer-based interventions specifically tailored to the needs of PWID are needed, which can be achieved by a large expansion of harm reduction services in the region. Personal communication should be a crucial element in such interventions in addition to harm reduction materials provision. Training programs, peer outreach, and culture-change interventions which try to alter widespread fatalistic norms or attitudes towards their health are especially needed, since this study indicates that fatalism is a major barrier for behavior change.
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Affiliation(s)
- Peter Meylakhs
- International Centre for Health Economics, Management and Policy, National Research University-Higher School of Economics, 194100, Kantemirovstaya st. 3a, St. Petersburg, Russia
| | - Aadne Aasland
- Norwegian Institute for Urban and Regional Research (NIBR), Oslo and Akershus University College of Applied Sciences, Norway, Holbergs gate 1, 0166, Oslo, Norway.
| | - Arne Grønningsæter
- Fafo Institute for Labour and Social Research in Oslo, Norway, Borggata 2B, 0608, Oslo, Norway
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Desrosiers A, Blokhina E, Krupitsky E, Zvartau E, Schottenfeld R, Chawarski M. Psychiatric symptoms, quality of life, and HIV status among people using opioids in Saint Petersburg, Russia. Drug Alcohol Depend 2017; 172:60-65. [PMID: 28130990 PMCID: PMC5408353 DOI: 10.1016/j.drugalcdep.2016.12.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 12/07/2016] [Accepted: 12/07/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The Russian Federation is experiencing a very high rate of HIV infection among people who inject drugs (PWID). However, few studies have explored characteristics of people with co-occurring opioid use disorders and HIV, including psychiatric symptom presentations and how these symptoms might relate to quality of life. The current study therefore explored a.) differences in baseline psychiatric symptoms among HIV+ and HIV- individuals with opioid use disorder seeking naltrexone treatment at two treatment centers in Saint Petersburg, Russia and b.) associations between psychiatric symptom constellations and quality of life. METHODS Participants were 328 adults enrolling in a randomized clinical trial evaluating outpatient treatments combining naltrexone with different drug counseling models. Psychiatric symptoms and quality of life were assessed using the Brief Symptom Inventory and The World Health Organization Quality of Life-BREF, respectively. RESULTS Approximately 60% of participants were HIV+. Those who were HIV+ scored significantly higher on BSI anxiety, depression, psychoticism, somatization, paranoid ideation, phobic anxiety, obsessive-compulsive, and GSI indexes (all p<0.05) than those HIV-. A K-means cluster analysis identified three distinct psychiatric symptom profiles; the proportion of HIV+ was significantly greater and quality of life indicators were significantly lower in the cluster with the highest psychiatric symptom levels. CONCLUSION Higher levels of psychiatric symptoms and lower quality of life indicators among HIV+ (compared to HIV-) individuals injecting drugs support the potential importance of combining interventions that target improving psychiatric symptoms with drug treatment, particularly for HIV+ patients.
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Affiliation(s)
| | | | - Evgeny Krupitsky
- First Pavlov State Medical University,St.-Petersburg Bekhterev Research Psychoneurological Institute
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14
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Idrisov B, Murphy SM, Morrill T, Saadoun M, Lunze K, Shepard D. Implementation of methadone therapy for opioid use disorder in Russia - a modeled cost-effectiveness analysis. Subst Abuse Treat Prev Policy 2017; 12:4. [PMID: 28107824 PMCID: PMC5248462 DOI: 10.1186/s13011-016-0087-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 12/23/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Opioid agonist therapy using methadone, an effective treatment of opioid use disorders (OUD) for people who inject drugs (PWID), is recommended by the World Health Organization as essential to curtail the growing HIV epidemic. Yet, despite increasing prevalence of OUD and HIV, methadone therapy has not yet been implemented in Russia. The aim of this modeling study was to estimate the cost-effectiveness of methadone therapy for Russian adults with a diagnosed OUD. METHODS/DESIGN We modeled the projected program implementation costs and estimated disability-adjusted life years (DALYs) averted over a 10-year period, associated with the provision of methadone therapy for a hypothetical, unreplenished cohort of Russian adults with an OUD (n = 249,000), in comparison to the current therapies at existing addiction treatment facilities. Our model compared four distinct scenarios of treatment coverage in the cohort ranging from 3.1 to 55%. RESULTS Providing methadone therapy to as few as 3.1% of adults with an OUD amounted to an estimated almost 50,000 DALYs averted over 10 years at a cost of just over USD 17 million. Further expanding service coverage to 55% resulted in an estimated almost 900,000 DALYs averted, at a cost of about USD 308 million. CONCLUSION Our study indicated that implementing opioid agonist therapy with methadone to treat OUD at existing facilities in Russia is highly cost-effective.
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Affiliation(s)
- Bulat Idrisov
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118 USA
| | - Sean M. Murphy
- Department of Health Policy and Administration, Washington State University, Spokane, WA 99202 USA
| | - Tyler Morrill
- Schneider Institutes for Health Policy Heller School, Brandeis University, Waltham, MA 02454 USA
| | - Mayada Saadoun
- Schneider Institutes for Health Policy Heller School, Brandeis University, Waltham, MA 02454 USA
| | - Karsten Lunze
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118 USA
| | - Donald Shepard
- Schneider Institutes for Health Policy Heller School, Brandeis University, Waltham, MA 02454 USA
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15
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Kiriazova T, Lunze K, Raj A, Bushara N, Blokhina E, Krupitsky E, Bridden C, Lioznov D, Samet JH, Gifford AL. "It is easier for me to shoot up": stigma, abandonment, and why HIV-positive drug users in Russia fail to link to HIV care. AIDS Care 2016; 29:559-563. [PMID: 27871198 DOI: 10.1080/09540121.2016.1259451] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Many HIV-positive people who inject drugs (PWID) globally are not receiving HIV care. This represents a major challenge among key populations to end the global HIV epidemic. This qualitative study explored the process and associated barriers of linking HIV-positive PWID who are in addiction treatment to HIV care in St. Petersburg, Russia. We conducted three focus groups and seven semi-structured interviews with participants in the LINC ("Linking Infectious and Narcology Care") project at addiction and HIV hospitals in St. Petersburg. The sample consisted of 25 HIV-infected patients with opioid dependence and seven health-care providers, including addiction and infectious disease physicians and case managers. A variety of intertwining factors influence effective engagement of PWID with HIV treatment. Stigma, problematic patient-provider relationships, and fragmented health care were the main challenges for HIV care initiation by PWID, which were further exacerbated by injection drug use. Effective linkage of PWID to HIV care requires acknowledging and addressing stigma's role and different perspectives of patients and providers.
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Affiliation(s)
- Tetiana Kiriazova
- a Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit , Boston University School of Medicine/Boston Medical Center , Boston , MA , USA.,b Ukrainian Institute on Public Health Policy , Kyiv , Ukraine
| | - Karsten Lunze
- a Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit , Boston University School of Medicine/Boston Medical Center , Boston , MA , USA
| | - Anita Raj
- c Department of Medicine, Division of Global Public Health , University of California-San Diego School of Medicine , La Jolla , CA , USA
| | - Natalia Bushara
- d First St. Petersburg Pavlov State Medical University , St. Petersburg , Russian Federation
| | - Elena Blokhina
- d First St. Petersburg Pavlov State Medical University , St. Petersburg , Russian Federation
| | - Evgeny Krupitsky
- d First St. Petersburg Pavlov State Medical University , St. Petersburg , Russian Federation.,e St. Petersburg Bekhterev Research Psychoneurological Institute , St. Petersburg , Russian Federation
| | - Carly Bridden
- a Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit , Boston University School of Medicine/Boston Medical Center , Boston , MA , USA
| | - Dmitry Lioznov
- d First St. Petersburg Pavlov State Medical University , St. Petersburg , Russian Federation
| | - Jeffrey H Samet
- a Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit , Boston University School of Medicine/Boston Medical Center , Boston , MA , USA.,f Department of Community Health Sciences , Boston University School of Public Health , Boston , MA , USA
| | - Allen L Gifford
- g Department of Health Law, Policy, and Management , Boston University School of Public Health , Boston , MA , USA.,h Boston University School of Medicine, Section of General Internal Medicine , Boston , MA , USA.,i Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital , Bedford , MA , USA
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16
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Abstract
Respondent-driven sampling (RDS) is a chain-referral method for sampling members of hidden or hard-to-reach populations, such as sex workers, homeless people, or drug users, via their social networks. Most methodological work on RDS has focused on inference of population means under the assumption that subjects' network degree determines their probability of being sampled. Criticism of existing estimators is usually focused on missing data: the underlying network is only partially observed, so it is difficult to determine correct sampling probabilities. In this article, the author shows that data collected in ordinary RDS studies contain information about the structure of the respondents' social network. The author constructs a continuous-time model of RDS recruitment that incorporates the time series of recruitment events, the pattern of coupon use, and the network degrees of sampled subjects. Together, the observed data and the recruitment model place a well-defined probability distribution on the recruitment-induced subgraph of respondents. The author shows that this distribution can be interpreted as an exponential random graph model and develops a computationally efficient method for estimating the hidden graph. The author validates the method using simulated data and applies the technique to an RDS study of injection drug users in St. Petersburg, Russia.
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17
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Yakhnich L, Michael K. Trajectories of Drug Abuse and Addiction Development Among FSU Immigrant Drug Users in Israel. JOURNAL OF CROSS-CULTURAL PSYCHOLOGY 2016. [DOI: 10.1177/0022022116660764] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
This qualitative study explores the trajectories of drug abuse and addiction development among former Soviet Union (FSU) immigrant users. It is based on in-depth interviews with 19 Russian-speaking recovering addict counselors employed in Israeli addiction treatment centers. The interview analysis yielded two main trajectories: one of abuse deterioration and the other of abuse initiation in the context of coping with immigration. The core issue that characterizes both trajectories is the immigrant users’ sense of loneliness. Participation in treatment appears as a path for regaining their sense of belonging. Implications for prevention and treatment based on the interviewees’ reflections, as well as on extant literature, are discussed.
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18
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Calabrese SK, Burke SE, Dovidio JF, Levina OS, Uusküla A, Niccolai LM, Heimer R. Internalized HIV and Drug Stigmas: Interacting Forces Threatening Health Status and Health Service Utilization Among People with HIV Who Inject Drugs in St. Petersburg, Russia. AIDS Behav 2016; 20:85-97. [PMID: 26050155 DOI: 10.1007/s10461-015-1100-4] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services.
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Affiliation(s)
- Sarah K Calabrese
- Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA.
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA.
| | - Sara E Burke
- Department of Psychology, Yale University, New Haven, CT, USA
| | - John F Dovidio
- Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
- Department of Psychology, Yale University, New Haven, CT, USA
| | | | - Anneli Uusküla
- Department of Public Health, University of Tartu, Tartu, Estonia
| | - Linda M Niccolai
- Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
| | - Robert Heimer
- Yale School of Public Health, Yale University, 135 College Street, Suite 358, New Haven, CT, 06510, USA
- Center for Interdisciplinary Research on AIDS, Yale University, New Haven, CT, USA
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19
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Girchenko P, Ompad DC, Kulchynska R, Bikmukhametov D, Dugin S, Gensburg L. Correlates of Lifetime History of Purchasing Sex Services by Men in Saint Petersburg and Leningrad Oblast, Russia. J Urban Health 2015; 92:1105-16. [PMID: 26446875 PMCID: PMC4675736 DOI: 10.1007/s11524-015-9990-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- P Girchenko
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Room 131, Rensselaer, NY, 12144-3456, USA. .,New York State International Training and Research Program, New York, NY, USA.
| | - D C Ompad
- Global Institute of Public Health, New York University, New York, NY, USA.,Center for Drug Use and HIV Research, New York University, New York, NY, USA.,Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA
| | - R Kulchynska
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Room 131, Rensselaer, NY, 12144-3456, USA.,New York State International Training and Research Program, New York, NY, USA
| | - D Bikmukhametov
- Department of Internal Medicine #1, Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Neubrandenburg, Germany
| | - S Dugin
- Fund for Social and Medical Programs Humanitarian Action, Saint Petersburg, Russian Federation
| | - L Gensburg
- Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Room 131, Rensselaer, NY, 12144-3456, USA
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20
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Lunze K, Lunze FI, Raj A, Samet JH. Stigma and Human Rights Abuses against People Who Inject Drugs in Russia--A Qualitative Investigation to Inform Policy and Public Health Strategies. PLoS One 2015; 10:e0136030. [PMID: 26305697 PMCID: PMC4549320 DOI: 10.1371/journal.pone.0136030] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 07/29/2015] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION Drug policing practices in the Russian Federation (Russia) are often punitive and have been shown to be associated with HIV risk behaviors among people who inject drugs (PWID). Less is known about strategies to address the problem in that setting, where substance use stigma is highly persistent. A better understanding of forms, causes and consequences of drug policing in Russia could inform drug policy in a context of substantial policy resistance. This qualitative study's goal is to characterize the phenomenon of police involvement with Russian PWID and to explore strategies for drug policing in the Russian country context. METHODS Using a semi-structured interview guide, we collected data from a purposive sample of 23 key informants including PWID, police officers, and experts from civil society and international organizations in Russia. We used a thematic analysis approach to inductively generate new insight into the phenomenon of police involvement and potential strategies to address it. RESULTS Policing practices involving PWID include unjustified arrests, planting of false evidence and extrajudicial syringe confiscations, and often constitute human rights violations. Russian PWID personally experienced police violence as ubiquitous, taking on various forms such as beating, unjustified arrests, verbal harassment, and coercion. The persistent societal stigma dehumanizes PWID, and such stigmatization facilitates police abuse. To address stigma and overcome the PWID-police adversity, study participants suggested fostering a mutual understanding between the police and public health sectors. CONCLUSIONS Participants describe substantial human rights violations as part of policing illicit drug use in Russia. Police should include principles of effective prevention of substance use and HIV risk reduction in their trainings. Alignment of public safety and public health goals could address drug use-related risks and HIV prevention among key populations in Russia.
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Affiliation(s)
- Karsten Lunze
- Boston University School of Medicine, Boston, MA, United States of America
- * E-mail:
| | - Fatima I. Lunze
- Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Anita Raj
- Division of Global Public Health, Department of Medicine, University of California at San Diego School of Medicine, San Diego, CA, United States of America
| | - Jeffrey H. Samet
- Boston University School of Medicine, Boston, MA, United States of America
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21
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Dukhovlinova E, Masharsky A, Toussova O, Verevochkin S, Solovyeva T, Meringof M, Paintsil E, White E, Barbour R, Heimer R, Kozlov A. Two Independent HIV Epidemics in Saint Petersburg, Russia Revealed by Molecular Epidemiology. AIDS Res Hum Retroviruses 2015; 31:608-14. [PMID: 25417740 DOI: 10.1089/aid.2014.0150] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
The HIV epidemic in Russia, one of the world's fastest growing, has been concentrated mostly among people who inject drugs (PWID). We sought to explore the epidemiology of the epidemic in St. Petersburg by sampling from the highest risk groups of PWID and men who have sex with men (MSM) and use viral sequencing data to better understand the nature of the city's epidemic. Serological testing confirmed an HIV prevalence among PWID in excess of 40%. All but 1 of 110 PWID whose blood samples were tested for genetic diversity were infected by subtype A virus, specifically by the AFSU strain. The remaining person was infected with a CRF-06cpx recombinant. Analysis of pairwise genetic distance among all PWID studied revealed an average of 3.1% sequence divergence, suggesting clonal introduction of the AFSU strain and/or constraints on sequence divergence. The HIV prevalence was less than 10% among MSM. All 17 sequences from HIV-infected MSM were found to be a clade B virus with a much higher average sequence diversity of 15.7%. These findings suggest two independent epidemics with little overlap between the two highest at-risk populations, which will require different HIV prevention approaches.
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Affiliation(s)
- Elena Dukhovlinova
- The Biomedical Center, Saint Petersburg, Russian Federation
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | | | - Olga Toussova
- The Biomedical Center, Saint Petersburg, Russian Federation
| | - Sergei Verevochkin
- The Biomedical Center, Saint Petersburg, Russian Federation
- Saint Petersburg State Polytechnical University, Saint Petersburg, Russian Federation
| | | | - Maria Meringof
- The Biomedical Center, Saint Petersburg, Russian Federation
| | | | - Edward White
- School of Public Health, Yale University, New Haven, Connecticut
| | - Russell Barbour
- School of Public Health, Yale University, New Haven, Connecticut
| | - Robert Heimer
- School of Public Health, Yale University, New Haven, Connecticut
| | - Andrei Kozlov
- The Biomedical Center, Saint Petersburg, Russian Federation
- Saint Petersburg State Polytechnical University, Saint Petersburg, Russian Federation
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22
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Cepeda JA, Niccolai LM, Lyubimova A, Kershaw T, Levina O, Heimer R. High-risk behaviors after release from incarceration among people who inject drugs in St. Petersburg, Russia. Drug Alcohol Depend 2015; 147:196-202. [PMID: 25496706 PMCID: PMC4297682 DOI: 10.1016/j.drugalcdep.2014.11.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2014] [Revised: 11/16/2014] [Accepted: 11/20/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Injection drug use, infectious disease, and incarceration are inextricably linked in Russia. We aimed to identify factors associated with time to relapse (first opioid injection after release from prison) and using a non-sterile, previously used syringe at relapse in a sample of people who inject drugs in St. Petersburg. METHODS We collected data on time from release to relapse among individuals with a history of incarceration, a subsample of a larger study among people who inject drugs. Proportional hazards and logistic regression were used to identify factors associated with time to relapse and injection with a non-sterile previously used syringe at relapse, respectively. RESULTS The median time to relapse after release was 30 days. Factors that were independently associated with relapsing sooner were being a native of St. Petersburg compared to not being native (AHR: 1.64; 95% CI 1.15-2.33), unemployed at relapse compared to employed (AHR: 4.49; 95% CI 2.96-6.82) and receiving a previous diagnosis of HBV and HCV compared to no previous diagnosis (AHR: 1.49; 95% CI 1.03-2.14). Unemployment at relapse was also significant in modeling injection with a non-sterile, previously used syringe at relapse compared to those who were employed (AOR: 6.80; 95% CI 1.96-23.59). CONCLUSIONS Unemployment was an important correlate for both resuming opioid injection after release and using a non-sterile previously used syringe at relapse. Linkage to medical, harm reduction, and employment services should be developed for incarcerated Russian people who inject drugs prior to release.
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Affiliation(s)
- Javier A. Cepeda
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT, USA,Center for Interdisciplinary Research on AIDS, 135 College Street, New Haven, CT, USA,corresponding author. Address: 60 College Street, New Haven, CT 06511, Phone: (203) 764-4333,
| | - Linda M. Niccolai
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT, USA,Center for Interdisciplinary Research on AIDS, 135 College Street, New Haven, CT, USA
| | | | - Trace Kershaw
- Center for Interdisciplinary Research on AIDS, 135 College Street, New Haven, CT, USA,Department of Social and Behavioral Sciences, Yale School of Public Health, 60 College Street, New Haven, CT, USA
| | - Olga Levina
- NGO Stellit, 3 Mira Street, St. Petersburg, Russia
| | - Robert Heimer
- Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT, USA,Center for Interdisciplinary Research on AIDS, 135 College Street, New Haven, CT, USA
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23
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Li L, Assanangkornchai S, Duo L, McNeil E, Li J. Risk behaviors, prevalence of HIV and hepatitis C virus infection and population size of current injection drug users in a China-Myanmar border city: results from a Respondent-Driven Sampling Survey in 2012. PLoS One 2014; 9:e106899. [PMID: 25203256 PMCID: PMC4159231 DOI: 10.1371/journal.pone.0106899] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Accepted: 08/10/2014] [Indexed: 02/06/2023] Open
Abstract
Background Injection drug use has been the major cause of HIV/AIDS in China in the past two decades. We measured the prevalences of HIV and hepatitis C virus (HCV) prevalence and their associated risk factors among current injection drug users (IDUs) in Ruili city, a border region connecting China with Myanmar that has been undergoing serious drug use and HIV spread problems. An estimate of the number of current IDUs is also presented. Methods In 2012, Chinese IDUs who had injected within the past six months and aged ≥18 years were recruited using a respondent-driven sampling (RDS) technique. Participants underwent interviews and serological testing for HIV, HBV, HCV and syphilis. Logistic regression indentified factors associated with HIV and HCV infections. Multiplier method was used to obtain an estimate of the size of the current IDU population via combining available service data and findings from our survey. Results Among 370 IDUs recruited, the prevalence of HIV and HCV was 18.3% and 41.5%, respectively. 27.1% of participants had shared a needle/syringe in their lifetime. Consistent condom use rates were low among both regular (6.8%) and non-regular (30.4%) partners. Factors independently associated with being HIV positive included HCV infection, having a longer history of injection drug use and experience of needle/syringe sharing. Participants with HCV infection were more likely to be HIV positive, have injected more types of drugs, have shared other injection equipments and have unprotected sex with regular sex partners. The estimated number of current IDUs in Ruili city was 2,714 (95% CI: 1,617–5,846). Conclusions IDUs may continue to be a critical subpopulation for transmission of HIV and other infections in this region because of the increasing population and persistent high risk of injection and sexual behaviours. Developing innovative strategies that can improve accessibility of current harm reduction services and incorporate more comprehensive contents is urgently needed.
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Affiliation(s)
- Lei Li
- Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
- * E-mail:
| | - Lin Duo
- HIV/AIDS Asia Regional Program Yunnan Management Office, Kunming, Yunnan, P.R. China
| | - Edward McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkla, Thailand
| | - Jianhua Li
- Yunnan Institute of Drug Abuse, Kunming, Yunnan, P.R. China
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24
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Zheluk A, Quinn C, Hercz D, Gillespie JA. Internet search patterns of human immunodeficiency virus and the digital divide in the Russian Federation: infoveillance study. J Med Internet Res 2013; 15:e256. [PMID: 24220250 PMCID: PMC3841350 DOI: 10.2196/jmir.2936] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 10/18/2013] [Accepted: 10/22/2013] [Indexed: 12/31/2022] Open
Abstract
Background Human immunodeficiency virus (HIV) is a serious health problem in the Russian Federation. However, the true scale of HIV in Russia has long been the subject of considerable debate. Using digital surveillance to monitor diseases has become increasingly popular in high income countries. But Internet users may not be representative of overall populations, and the characteristics of the Internet-using population cannot be directly ascertained from search pattern data. This exploratory infoveillance study examined if Internet search patterns can be used for disease surveillance in a large middle-income country with a dispersed population. Objective This study had two main objectives: (1) to validate Internet search patterns against national HIV prevalence data, and (2) to investigate the relationship between search patterns and the determinants of Internet access. Methods We first assessed whether online surveillance is a valid and reliable method for monitoring HIV in the Russian Federation. Yandex and Google both provided tools to study search patterns in the Russian Federation. We evaluated the relationship between both Yandex and Google aggregated search patterns and HIV prevalence in 2011 at national and regional tiers. Second, we analyzed the determinants of Internet access to determine the extent to which they explained regional variations in searches for the Russian terms for “HIV” and “AIDS”. We sought to extend understanding of the characteristics of Internet searching populations by data matching the determinants of Internet access (age, education, income, broadband access price, and urbanization ratios) and searches for the term “HIV” using principal component analysis (PCA). Results We found generally strong correlations between HIV prevalence and searches for the terms “HIV” and “AIDS”. National correlations for Yandex searches for “HIV” were very strongly correlated with HIV prevalence (Spearman rank-order coefficient [rs]=.881, P≤.001) and strongly correlated for “AIDS” (rs=.714, P≤.001). The strength of correlations varied across Russian regions. National correlations in Google for the term “HIV” (rs=.672, P=.004) and “AIDS” (rs=.584, P≤.001) were weaker than for Yandex. Second, we examined the relationship between the determinants of Internet access and search patterns for the term “HIV” across Russia using PCA. At the national level, we found Principal Component 1 loadings, including age (-0.56), HIV search (-0.533), and education (-0.479) contributed 32% of the variance. Principal Component 2 contributed 22% of national variance (income, -0.652 and broadband price, -0.460). Conclusions This study contributes to the methodological literature on search patterns in public health. Based on our preliminary research, we suggest that PCA may be used to evaluate the relationship between the determinants of Internet access and searches for health problems beyond high-income countries. We believe it is in middle-income countries that search methods can make the greatest contribution to public health.
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Affiliation(s)
- Andrey Zheluk
- Menzies Centre for Health Policy, The University of Sydney, University of Sydney NSW, Australia.
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Mills HL, White E, Colijn C, Vickerman P, Heimer R. HIV transmission from drug injectors to partners who do not inject, and beyond: modelling the potential for a generalized heterosexual epidemic in St. Petersburg, Russia. Drug Alcohol Depend 2013; 133:242-7. [PMID: 23692991 PMCID: PMC4113725 DOI: 10.1016/j.drugalcdep.2013.04.028] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Revised: 04/16/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND HIV infection is prevalent among drug injectors in St. Petersburg and their non-injecting heterosexual partners (PIDUs). There are fears that sexual transmission of HIV from IDUs to PIDUs may portend a self-sustaining, heterosexual epidemic in Russia. METHODS Our model combines a network model of sexual partnerships of IDUs and non-IDUs to represent sexual transmission of HIV and a deterministic model for parenteral transmission among IDUs. Behavioural parameters were obtained from a survey of St. Petersburg IDUs and their sexual partners. We based our model fits on two scenarios for PIDU prevalence in 2006 (5.6% and 15.1%, calculated excluding and including HCV co-infected PIDUs respectively) and compared predictions for the general population HIV prevalence. RESULTS Results indicate that sexual transmission could sustain a non-IDU HIV epidemic. The model indicates that general population prevalence may be greater than current estimates imply. Parenteral transmission drives the epidemic and the PIDU bridge population plays a crucial role transferring infection to non-IDUs. The model indicates that the high PIDU prevalence is improbable because of the high risk behaviour this implies; the lower prevalence is possible. CONCLUSION The model implies that transmission through PIDUs will sustain a heterosexual epidemic, if prevalence among IDUs and PIDUs is as high as survey data suggest. We postulate that current estimates of population prevalence underestimate the extent of the HIV epidemic because they are based on the number of registered cases only. Curtailing transmission among injectors and PIDUs will be vital in controlling heterosexual transmission.
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Affiliation(s)
- Harriet L Mills
- Department of Infectious Disease Epidemiology, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London W2 1PG, United Kingdom.
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Incorporating the service multiplier method in respondent-driven sampling surveys to estimate the size of hidden and hard-to-reach populations: case studies from around the world. Sex Transm Dis 2013; 40:304-10. [PMID: 23486495 DOI: 10.1097/olq.0b013e31827fd650] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Estimating the sizes of populations at highest risk for HIV is essential for developing and monitoring effective HIV prevention and treatment programs. We provide several country examples of how service multiplier methods have been used in respondent-driven sampling surveys and provide guidance on how to maximize this method's use. METHODS Population size estimates were conducted in 4 countries (Mauritius- intravenous drug users [IDU] and female sex workers [FSW]; Papua New Guinea-FSW and men who have sex with men [MSM]; Thailand-IDU; United States-IDU) using adjusted proportions of population members reporting attending a service, project or study listed in a respondent-driven sampling survey, and the estimated total number of population members who visited one of the listed services, projects, or studies collected from the providers. RESULTS The median population size estimates were 8866 for IDU and 667 for FSW in Mauritius. Median point estimates for FSW were 4190 in Port Moresby and 8712 in Goroka, Papua New Guinea, and 2,126 for MSM in Port Moresby and 4200 for IDU in Bangkok, Thailand. Median estimates for IDU were 1050 in Chiang Mai, Thailand, and 15,789 in 2005 and 15,554 in 2009 in San Francisco. CONCLUSION Our estimates for almost all groups in each country fall within the range of other regional and national estimates, indicating that the service multiplier method, assuming all assumptions are met, can produce informative estimates. We suggest using multiple multipliers whenever possible, garnering program data from the widest possible range of services, projects, and studies. A median of several estimates is likely more robust to potential biases than a single estimate.
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Shaboltas AV, Skochilov RV, Brown LB, Elharrar VN, Kozlov AP, Hoffman IF. The feasibility of an intensive case management program for injection drug users on antiretroviral therapy in St. Petersburg, Russia. Harm Reduct J 2013; 10:15. [PMID: 24006958 PMCID: PMC3844607 DOI: 10.1186/1477-7517-10-15] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 08/28/2013] [Indexed: 11/29/2022] Open
Abstract
Background The majority of HIV-infected individuals requiring antiretroviral therapy (ART) in Russia are Injection Drug Users (IDU). Substitution therapy used as part of a comprehensive harm reduction program is unavailable in Russia. Past data shows that only 16% of IDU receiving substance abuse treatment completed the course without relapse, and only 40% of IDU on ART remained on treatment at 6 months. Our goal was to determine if it was feasible to improve these historic outcomes by adding intensive case management (ICM) to the substance abuse and ART treatment programs for IDU. Methods IDU starting ART and able to involve a “supporter” who would assist in their treatment plan were enrolled. ICM included opiate detoxification, bi-monthly contact and counseling with the case, weekly group sessions, monthly contact with the “supporter” and home visits as needed. Full follow- up (FFU) was 8 months. Stata v10 (College Station, TX) was used for all analysis. Descriptive statistics were calculated for all baseline demographic variables, baseline and follow-up CD4 count, and viral load. Median baseline and follow-up CD4 counts and RNA levels were compared using the Kruskal-Wallis test. The proportion of participants with RNA < 1000 copies mL at baseline and follow-up was compared using Fisher’s Exact test. McNemar’s test for paired proportions was used to compare the change in proportion of participants with RNA < 1000 copies mL from baseline to follow-up. Results Between November 2007 and December 2008, 60 IDU were enrolled. 34 (56.7%) were male. 54/60 (90.0%) remained in FFU. Overall, 31/60 (52%) were active IDU at enrollment and 27 (45%) were active at their last follow-up visit. 40/60 (66.7%) attended all of their ART clinic visits, 13/60 (21.7%) missed one or more visit but remained on ART, and 7/60 (11.7%) stopped ART before the end of FFU. Overall, 39/53 (74%) had a final 6–8 month HIV RNA viral load (VL) < 1000 copies/mL. Conclusions Despite no substitution therapy to assist IDU in substance abuse and ART treatment programs, ICM was feasible, and the retention and adherence of IDU on ART in St. Petersburg could be greatly enhanced by adding ICM to the existing treatment programs.
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Affiliation(s)
- Alla V Shaboltas
- St, Petersburg St, University, Universitetskaya nab, 7/9, St,Petersburg, Russia.
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Hoffman IF, Latkin CA, Kukhareva PV, Malov SV, Batluk JV, Shaboltas AV, Skochilov RV, Sokolov NV, Verevochkin SV, Hudgens MG, Kozlov AP. A peer-educator network HIV prevention intervention among injection drug users: results of a randomized controlled trial in St. Petersburg, Russia. AIDS Behav 2013; 17:2510-20. [PMID: 23881187 DOI: 10.1007/s10461-013-0563-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Irving F Hoffman
- Division of Infectious Diseases, Department of Medicine, UNC Hospitals, University of North Carolina, CB # 7030, Chapel Hill, NC, 27599, USA.
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Fedorova EV, Skochilov RV, Heimer R, Case P, Beletsky L, Grau LE, Kozlov AP, Shaboltas AV. Access to syringes for HIV prevention for injection drug users in St. Petersburg, Russia: syringe purchase test study. BMC Public Health 2013; 13:183. [PMID: 23452390 PMCID: PMC3616994 DOI: 10.1186/1471-2458-13-183] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2012] [Accepted: 02/19/2013] [Indexed: 11/10/2022] Open
Abstract
Background The HIV epidemic in Russia is concentrated among injection drug users (IDUs). This is especially true for St. Petersburg where high HIV incidence persists among the city’s estimated 80,000 IDUs. Although sterile syringes are legally available, access for IDUs may be hampered. To explore the feasibility of using pharmacies to expand syringe access and provide other prevention services to IDUs, we investigated the current access to sterile syringes at the pharmacies and the correlation between pharmacy density and HIV prevalence in St. Petersburg. Methods 965 pharmacies citywide were mapped, classified by ownership type, and the association between pharmacy density and HIV prevalence at the district level was tested. We selected two districts among the 18 districts – one central and one peripheral – that represented two major types of city districts and contacted all operating pharmacies by phone to inquire if they stocked syringes and obtained details about their stock. Qualitative interviews with 26 IDUs provided data regarding syringe access in pharmacies and were used to formulate hypotheses for the pharmacy syringe purchase test wherein research staff attempted to purchase syringes in all pharmacies in the two districts. Results No correlation was found between the density of pharmacies and HIV prevalence at the district level. Of 108 operating pharmacies, 38 (35%) did not sell syringes of the types used by IDUs; of these, half stocked but refused to sell syringes to research staff, and the other half did not stock syringes at all. Overall 70 (65%) of the pharmacies did sell syringes; of these, 49 pharmacies sold single syringes without any restrictions and 21 offered packages of ten. Conclusions Trainings for pharmacists need to be conducted to reduce negative attitudes towards IDUs and increase pharmacists’ willingness to sell syringes. At a structural level, access to safe injection supplies for IDUs could be increased by including syringes in the federal list of mandatory medical products sold by pharmacies.
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Salganik MJ, Fazito D, Bertoni N, Abdo AH, Mello MB, Bastos FI. Assessing network scale-up estimates for groups most at risk of HIV/AIDS: evidence from a multiple-method study of heavy drug users in Curitiba, Brazil. Am J Epidemiol 2011; 174:1190-6. [PMID: 22003188 PMCID: PMC3208143 DOI: 10.1093/aje/kwr246] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
One of the many challenges hindering the global response to the human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) epidemic is the difficulty of collecting reliable information about the populations most at risk for the disease. Thus, the authors empirically assessed a promising new method for estimating the sizes of most at-risk populations: the network scale-up method. Using 4 different data sources, 2 of which were from other researchers, the authors produced 5 estimates of the number of heavy drug users in Curitiba, Brazil. The authors found that the network scale-up and generalized network scale-up estimators produced estimates 5–10 times higher than estimates made using standard methods (the multiplier method and the direct estimation method using data from 2004 and 2010). Given that equally plausible methods produced such a wide range of results, the authors recommend that additional studies be undertaken to compare estimates based on the scale-up method with those made using other methods. If scale-up-based methods routinely produce higher estimates, this would suggest that scale-up-based methods are inappropriate for populations most at risk of HIV/AIDS or that standard methods may tend to underestimate the sizes of these populations.
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Affiliation(s)
- Matthew J Salganik
- Department of Sociology and Office of Population Research, Princeton University, Princeton, NJ 08544, USA.
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Cepeda JA, Odinokova VA, Heimer R, Grau LE, Lyubimova A, Safiullina L, Levina OS, Niccolai LM. Drug network characteristics and HIV risk among injection drug users in Russia: the roles of trust, size, and stability. AIDS Behav 2011; 15:1003-10. [PMID: 20872063 PMCID: PMC3112286 DOI: 10.1007/s10461-010-9816-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
We investigated the influence of drug network characteristics including trust, size, and stability on HIV risk behaviors and HIV testing among injection drug users (IDUs) in St. Petersburg, Russia. Overall, male and female IDUs who reported having high levels of trust in their drug networks were significantly more likely to share syringes than those with lower levels of trust (OR [95% CI]) 2.87 [1.06, 7.81] and 4.89 [1.05, 21.94], respectively). Male and female IDUs in larger drug networks were more likely to share syringes than those in smaller networks (4.21 [1.54, 11.51] and 4.80 [1.20, 19.94], respectively). Characteristics that were significantly associated with not having been HIV tested included drug network instability among men and larger network size among women. High trust, large size, and instability were positively and significantly associated with syringe sharing and not having been HIV tested. Effectiveness of interventions in Russia to reduce the risk of HIV infection may be enhanced if network characteristics are addressed.
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Affiliation(s)
- Javier A Cepeda
- Department of Epidemiology and Public Health, Yale School of Public Health, 60 College Street, New Haven, CT 06520, USA.
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