1
|
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.
Collapse
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
| |
Collapse
|
2
|
Luoma JB, Rossi SL, Sereda Y, Pavlov N, Toussova O, Vetrova M, Bendiks S, Kiriazova T, Krupitsky E, Lioznov D, Blokhina E, Lodi S, Lunze K. An acceptance-based, intersectional stigma coping intervention for people with HIV who inject drugs-a randomized clinical trial. THE LANCET REGIONAL HEALTH. EUROPE 2023; 28:100611. [PMID: 37180745 PMCID: PMC10173263 DOI: 10.1016/j.lanepe.2023.100611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 02/09/2023] [Accepted: 02/22/2023] [Indexed: 05/16/2023]
Abstract
Background People with HIV who inject drugs experience intersecting forms of stigma that adversely impact care access. This RCT aimed to evaluate effects of a behavioral intersectional stigma coping intervention on stigma and care utilization. Methods We recruited 100 participants with HIV and past-30-day injection drug use at a non-governmental harm reduction organization in St. Petersburg, Russia, and randomized them 1:2 to receive usual services only or an additional intervention of three weekly 2-h group sessions. Primary outcomes were change in HIV and substance use stigma scores at one month after randomization. Secondary outcomes were initiation of antiretroviral treatment (ART), substance use care utilization, and changes in frequency of past-30-days drug injection at six months. The trial was registered as NCT03695393 at clinicaltrials.gov. Findings Participant median age was 38.1 years, 49% were female. Comparing 67 intervention and 33 control group participants recruited October 2019-September 2020, the adjusted mean difference (AMD) in change in HIV and substance use stigma scores one month after baseline were 0.40, (95% CI: -0.14 to 0.93, p = 0.14) and -2.18 (95% CI: -4.87 to 0.52, p = 0.11), respectively. More intervention participants than control participants initiated ART (n = 13, 20% vs n = 1, 3%, proportion difference 0.17, 95% CI: 0.05-0.29, p = 0.01) and utilized substance use care (n = 15, 23% vs n = 2, 6%, proportion difference 0.17, 95% CI: 0.03-0.31, p = 0.02). The adjusted median difference in change in injecting drug use frequency 6 months after baseline was -3.33, 95% CI: -8.51 to 1.84, p = 0.21). Five not intervention-related serious adverse events (7.5%) occurred in the intervention group, one (3.0%) serious adverse event in the control group. Interpretation This brief stigma-coping intervention did not change stigma manifestations or drug use behaviors in people with HIV and injection drug use. However, it seemed to reduce stigma's impact as an HIV and substance use care barrier. Funding R00DA041245, K99DA041245, P30AI042853.
Collapse
Affiliation(s)
- Jason B. Luoma
- Portland Psychotherapy Clinic, Research, and Training Center, 3700 North Williams Avenue, Portland, OR, 97227, USA
| | - Sarah L. Rossi
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118, USA
| | - Yuliia Sereda
- Ukrainian Institute on Public Health Policy, Kyiv, Ukraine
| | - Nikolai Pavlov
- Life in Balance Psychotherapy Clinic, 137 Roncesvalles Avenue, Suite 208, Toronto, ON, M6R 2L2, Canada
| | - Olga Toussova
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
| | - Marina Vetrova
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
| | - Sally Bendiks
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118, USA
| | | | - Evgeny Krupitsky
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
- V.M. Bekhterev National Medical Research Center for Psychiatry and Neurology, Bekhtereva St., 3, St. Petersburg, 192019, Russian Federation
| | - Dmitry Lioznov
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
- Smorodintsev Research Institute of Influenza, 15/17, Prof. Popov Street, St. Petersburg, 197376, Russian Federation
| | - Elena Blokhina
- Pavlov University, L'va Tolstogo St., 6-8, St. Petersburg, 197022, Russian Federation
| | - Sara Lodi
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3 Floor, Boston, MA, 02118, USA
| | - Karsten Lunze
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Clinical Addiction Research and Education (CARE) Unit, 801 Massachusetts Avenue, 2 Floor, Boston, MA, 02118, USA
- Boston University Chobanian & Avedisian School of Medicine, 72 E Concord St, Boston, MA, 02118, USA
| |
Collapse
|
3
|
Behavioral patterns of people who use synthetic psychostimulants: Results of a qualitative study in St. Petersburg, Russia. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2022; 107:103790. [PMID: 35849936 DOI: 10.1016/j.drugpo.2022.103790] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 06/30/2022] [Accepted: 07/01/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Russia, like many other places, is currently experiencing a proliferation of new psychoactive substances, many of which are psychostimulants. In St. Petersburg, these appear to be mostly congeners of cathinone. We sought to obtain qualitative data to better understand the impact on the health and behaviors of people who use drugs (PWUD) by recruiting individuals who reported recent use of psychostimulants. METHODS In-depth qualitative data on current drug use and its effects were collected through thirty interviews (n=30) and two focus groups (n=10: five male, five female). The interviews and focus groups also provided data on the social contexts of drug use including sexual behaviors and associated medical issues. Secondary data about online drug purchases were obtained from a source that accesses and analyzes darknet purchases. Qualitative data were initially coded using a priori codes developed on the basis of the interview guide, and then data were coded again inductively based on emergent findings from the data. Thematic analysis was carried out using OpenCode 4.0 qualitative data analysis software. RESULTS Thematic analysis of the interviews and focus groups identified distinct differences in behavior patterns between older, more experienced PWUD and a "new generation" of PWUD. Routes of initiation of drug use and sexual behaviors associated with drug use differed, but both groups reported high levels of unsafe injection and sexual behaviors. In interpreting the texts and purchasing data, we have attempted to anticipate how the drug use patterns can influence HIV transmission. CONCLUSIONS The emergence of a new class of psychostimulant drugs presents new threats to the health of drug users and new opportunities to intervene to reduce those risks. The information obtained may assist HIV/AIDS prevention specialists and drug user support groups in their efforts to decrease unsafe drug use and sexual behaviors.
Collapse
|
4
|
Peterman NJ, Palsgaard P, Vashi A, Vashi T, Kaptur BD, Yeo E, Mccauley W. Demographic and Geospatial Analysis of Buprenorphine and Methadone Prescription Rates. Cureus 2022; 14:e25477. [PMID: 35800815 PMCID: PMC9246456 DOI: 10.7759/cureus.25477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Background The medical community continues to seek to understand both the causes and consequences of opioid use disorder (OUD). The recent 2019 public release of the Automation of Reports and Consolidated Orders System (ARCOS) database from the years 2006 to 2012 provides a unique opportunity to analyze a critical period of the opioid epidemic with unprecedented data granularity. Objectives This study aims to use the ARCOS dataset to (1) determine significant contributory variables to opioid overdose death rates, (2) determine significant contributory variables to the relative prescription of buprenorphine and methadone, and (3) evaluate the existence of statistically significant geospatial clusters in buprenorphine and methadone prescription rates. Methods This study utilizes multiple databases, including the Centers for Disease Control and Prevention (CDC) Wide-ranging Online Data for Epidemiologic Research (WONDER), the Drug Enforcement Administration (DEA) prescription drug data, and the United States (US) Census demographics, to examine the relationship between the different treatments of OUD. Linear regressions are used to determine significant contributory factors in overdose rate and the buprenorphine-to-methadone ratio. Geospatial analysis is used to identify geographic clusters in opioid overdoses and treatment patterns. Results Methadone prescriptions, racial demographics, and poverty were found to significantly correspond to opioid overdose death rates (p < 0.05). Buprenorphine prescriptions were not found to be significant (p = 0.20). Opioid overdoses, metro character, racial categorization, and education were found to significantly correspond to the ratio of buprenorphine to methadone prescribed (p < 0.05). Cluster analysis demonstrated different geospatial distributions in the prescriptions of buprenorphine and methadone (p < 0.05). Conclusion Historically, methadone prescriptions have been higher in areas with high overdose rates. Buprenorphine and methadone prescribing patterns have historically demonstrated different geographic trends.
Collapse
|
5
|
Rostam-Abadi Y, Gholami J, Noroozi A, Ansari M, Baheshmat S, Hamzehzadeh M, Ghadirzadeh MR, Vahdani B, Ekhtiari H, Mojtabai R, Rahimi-Movaghar A. Public health risks associated with methadone in Iran: A systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 100:103529. [PMID: 34826790 DOI: 10.1016/j.drugpo.2021.103529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 09/25/2021] [Accepted: 10/30/2021] [Indexed: 12/26/2022]
Abstract
BACKGROUND There has been a marked growth in methadone maintenance treatment (MMT) in Iran in the past two decades with positive health outcomes. We conducted a systematic review of studies on the prevalence of non-prescribed methadone use, methadone use disorder, and methadone-related poisoning and mortality in Iran. METHODS We searched International and Iranian databases up to May 2020 and contacted relevant experts. The pooled proportions were estimated through random-effects model. Methadone-related adverse outcomes were evaluated over time. RESULTS Sixty-five studies were included. The pooled estimates of non-prescribed methadone use in the last 12-month were 2.7% (95%CI: 0.9-5.4) and 0.1% (95%CI: 0.03-0.2) in the male and female general population, respectively. Among people who use drugs, 8.4% reported daily non-prescribed use in 2018. Four heterogeneous studies in drug treatment centers reported the existence of treatment-seeking for methadone use disorder. Methadone was responsible for 10.4% (95%CI: 4.5-18.3) of cases of acute poisoning in adults and 16.0% (95%CI: 9.3-24.1) in children. Methadone was reported as a cause of death in 53.5% of substance-related deaths referred to the Legal Medicine Organization while being the only cause in 35.8% of all cases. CONCLUSION Non-prescribed use of methadone in the general population is much less than opiates and some other available prescription opioids, like tramadol. However, notwithstanding the large and successful MMT program in Iran, increasing trends in methadone-related poisoning and deaths pose serious public health concerns. There is an urgent need to explore these fatal and non-fatal poisoning cases and implement policies to curb the harms associated with methadone use.
Collapse
Affiliation(s)
- Yasna Rostam-Abadi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Jaleh Gholami
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Mina Ansari
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran
| | - Shahab Baheshmat
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | - Marziyeh Hamzehzadeh
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran; Department of Neuroscience and Addiction Studies, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, Iran
| | | | - Bita Vahdani
- Center for Disease Affairs and Transplant, Ministry of Health, Tehran, Iran
| | - Hamed Ekhtiari
- Laureate Institute for Brain Research, Tulsa, Oklahoma, USA
| | - Ramin Mojtabai
- Department of Mental Health, Bloomberg School of Public Health and Department of Psychiatry, Johns Hopkins University, Baltimore, Maryland, USA
| | - Afarin Rahimi-Movaghar
- Iranian National Center for Addiction Studies (INCAS), Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
6
|
Lilja M. Russian Political Discourse on Illegal Drugs: A Thematic Analysis of Parliamentary Debates. Subst Use Misuse 2021; 56:1010-1017. [PMID: 33818285 DOI: 10.1080/10826084.2021.1906275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Since the beginning of the twenty first century, there has been an intensified political debate about drugs in Russia. The drug problem is now regarded as one of the country's most serious problems and as an issue of top priority for the Russian government. Objectives: The aim of this qualitative study is to explore how illegal drugs are discussed in Russian political discourse. Methods: The material includes an analysis of 177 speeches made in the lower house of the Russian parliament, the Russian State Duma, between 2014 and 2018. The data were analyzed using qualitative content analysis (CDA). Results: In general, the study found that the debate about the drug problem was characterized by consensus, and there were small differences between the Deputy members in their understanding of the problem. Three main understandings of the drug problem were identified: (1) Illegal drugs as an increasing problem in Russia, (2) Drugs as an external threat, and (3) A need for a more repressive drug policy. Conclusion: There was a general consensus about how the drug problem should be regarded among the politicians, with a focus on a war on drugs and an absence of harm reduction ideas.
Collapse
Affiliation(s)
- My Lilja
- Department of Criminology, Malmö University, Malmo, Sweden
| |
Collapse
|
7
|
Parry SJ, Thornicroft G. The Syndemic Approach in relation to Clinical Practice and Research in Psychiatry. CONSORTIUM PSYCHIATRICUM 2020; 1:3-6. [PMID: 39006903 PMCID: PMC11240133 DOI: 10.17650/2712-7672-2020-1-2-3-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Indexed: 07/16/2024] Open
Abstract
The syndemic framework goes beyond the concept of comorbidity and considers how diseases interact within their wider environmental context, along with social and political factors, to mutually exacerbate negative outcomes. The syndemic approach enhances the way mental disorders are understood in terms of their aetiology, treatment and prognosis and therefore influences the direction of clinical practice, policy development and research priorities in the field of psychiatry. Using a syndemic framework to develop mental health policy globally can help address the mental health treatment gap in countries where resources are limited. In Russia, identified syndemics have been of particular relevance to mental disorders and further research using a syndemic framework will continue to build upon the strong background of integrated mental healthcare currently provided.
Collapse
Affiliation(s)
| | - Graham Thornicroft
- Centre for Global Mental Health and Centre for Implementation Science, Institute of Psychiatry, Psychology and Neuroscience, King's College London
| |
Collapse
|
8
|
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.
Collapse
|
9
|
The prevalence of non-fatal overdose among people who inject drugs: A multi-stage systematic review and meta-analysis. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 73:172-184. [DOI: 10.1016/j.drugpo.2019.07.030] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/15/2019] [Accepted: 07/15/2019] [Indexed: 12/13/2022]
|
10
|
Abstract
PURPOSE OF REVIEW To explore the consequences of policies implemented in the Russian Federation in response to syndemic of HIV-1 and opioid use disorder and compare the responses to the concomitant syndemic in rural America. RECENT FINDINGS The syndemic spread has not been reduced by policies implemented by the Russian government, which continues to underfund harm reduction efforts to reduce HIV transmission, refuses to approve evidence-based opioid agonist treatments for opioid use disorder, and relies on criminal justice and abstinence approaches to control illicit opioids. When effective measures have been undertaken locally, the lessons learned have not been transferred to other parts of the country and local programs have been allowed to wither. As in many parts of rural America, Russia has experienced intertwined epidemics of opioid misuse and HIV-1 that continue to expand. The expansion has been facilitated by adoption of policies that run contrary to medical and public health evidence.
Collapse
Affiliation(s)
- Robert Heimer
- Department of Epidemiology of Microbial Diseases and Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, 06520-8034, USA.
| |
Collapse
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Plavinskiy SL, Ladnaya NN, Zaytseva EE, Barinova AN. HIV PREVALENCE AMONG VULNERABLE GROUPS IN RUSSIA - RESULTS OF AN INTEGRATED BIO-BEHAVIORAL SURVEY. JOURNAL OF MICROBIOLOGY EPIDEMIOLOGY IMMUNOBIOLOGY 2018. [DOI: 10.36233/0372-9311-2018-6-10-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Aim. Of the study is to assess HIV prevalence in the vulnerable groups namely injecting drug users (IDU), sex workers (SW), and men who have sex with men (MSM) in some of the largest Russian regiоnal capitals mostly affected by HIV infection. Materials and methods. The study involved 3744 persons from vulnerable groups enrolled by respondent-driven sampling (RDS) or time-location sampling (TLS). The study was undertaken in seven regions of the Russian Federation: Moscow, St.-Petersburg, Yekaterinburg, Krasnoyarsk, Kemerovo, Tomsk and Perm. All participants were interviewed using specially designed questionnaire and then tested for HIV. The retrospective cohort method was applied to evaluate the number of new HIV cases among respondents. Results. HIV prevalence in IDUs ranged from 48.10% [95% confidence interval (CI)=42.20.54.10%] in Krasnoyarsk and 75.20% [95%CI=69.90.80.60%] in Kemerovo. HIV prevalence among sex workers varied from 2.32% [95%CI=0.49.4.17%] in St. Petersburg to 15.01% [95%CI=11.46.18.56%] in Perm. HIV prevalence among MSM ranged from 7.10% [95%CI=4.10.10.10%] in Moscow to 22.80% [95%CI=17.90.27.70%] in St.-Petersburg. Conclusion. The number of new HIV infections estimated by the retrospective cohort method indicated rapid spread of HIV infection among IDUs in all cities except St.-Petersburg, relatively high HIV growth rates among MSM ranging from 1.6% per year [95%CI=0.1... 3.1%] to 4.6% per year [95%CI=0.0... 11%] and 12.3% annual HIV growth rate [95%CI=0.0... 28.3%] among sex workers. Generally, the situation in the studied groups remained adverse and called for more intensive prevention activities in vulnerable populations.
Collapse
|
13
|
Tavitian-Exley I, Boily MC, Heimer R, Uusküla A, Levina O, Maheu-Giroux M. Polydrug Use and Heterogeneity in HIV Risk Among People Who Inject Drugs in Estonia and Russia: A Latent Class Analysis. AIDS Behav 2018; 22:1329-1340. [PMID: 28699018 PMCID: PMC5878835 DOI: 10.1007/s10461-017-1836-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Non-medical drug injection is a major risk factor for HIV infection in Russia and Estonia. Multiple drug use (polydrug) has further been associated with increased harms. We compared HIV, injecting and sexual risk associated with polydrug use among people who injected drugs (PWID) in 2012–2013 in Kohtla-Järve (Estonia, n = 591) and St Petersburg (Russia, n = 811). Using latent class analysis, we identified five (poly)drug classes, the largest consisting of single-drug injectors among whom an opioid was the sole drug injected (56% of PWID). The four remaining polydrug classes included polydrug-polyroute injectors who injected and used opiates and stimulants (9%), opiate-stimulant poly-injectors who injected amphetamine-type-stimulants with a primary opiate (7%) and opiate-opioid poly-injectors who injected opioids and opiates (16%). Non-injection stimulant co-users were injectors who also used non-injection stimulants (12%). In multivariable multinomial regressions, all four polydrug classes were associated with greater injection risks than single-drug injection, while opiate-stimulant and opiate-opioid poly-injection were also associated with having multiple sex partners. Riskier behaviours among polydrug-injectors suggest increased potential for transmission of blood-borne and sexually-transmitted infections. In addition to needles/syringes provision, services tailored to PWID drug and risk profiles, could consider drug-appropriate treatment and sexual risk reduction strategies to curb HIV transmission.
Collapse
Affiliation(s)
- Isabel Tavitian-Exley
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk place, London, W21PG, UK.
| | - Marie-Claude Boily
- Department of Infectious Disease Epidemiology, Imperial College London, Norfolk place, London, W21PG, UK.
| | - Robert Heimer
- Epidemiology of Microbial Diseases, School of Public Health, Yale University, New Haven, USA
| | - Anneli Uusküla
- Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Olga Levina
- NGO Stellit, St Petersburg, Russian Federation
| | - Mathieu Maheu-Giroux
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montréal, Canada
| |
Collapse
|
14
|
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.
Collapse
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.
| |
Collapse
|