1
|
Lan CW, Scott-Sheldon LAJ, Carey KB, Johnson BT, Carey MP. Prevalence of Alcohol Use, Sexual Risk Behavior, and HIV Among Russians in High-Risk Settings: a Systematic Review and Meta-Analysis. Int J Behav Med 2017; 24:180-190. [PMID: 27730501 DOI: 10.1007/s12529-016-9596-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
PURPOSE The purpose of this study was to examine the (a) prevalence of and (b) association between alcohol, risky sex, and HIV among Russians at risk for primary or secondary HIV transmission. METHOD Electronic databases were searched to locate studies that sampled Russians, assessed alcohol use, and included either a behavioral measure of risk or a biological measure of HIV. Weighted mean (logit) effect sizes were calculated using random-effects assumptions. Moderator analyses were conducted using meta-regression. RESULTS Studies (19) sampled 12,916 Russians (M age = 29; 36 % women). Participants were recruited from clinical (52 %; e.g., sexually transmitted infection (STI) clinic, drug treatment), other high-risk community settings (32 %; e.g., sexual/drug networks), or both (16 %). Findings indicate that a substantial proportion of the participants used alcohol (77 %; 55 % heavy drinking). One half of participants reported using condoms (52 %), but only 29 % used condoms consistently. Most participants reported drinking before sex (64 %). Of the studies testing for HIV, 10 % of participants tested positive. Meta-regression analyses indicated that hazardous/harmful alcohol use was associated with increased risky behaviors (i.e., multiple partners, inconsistent condom use). CONCLUSION These findings support the need for and potential benefit of addressing alcohol use in HIV prevention programming in Russia.
Collapse
Affiliation(s)
- Chiao-Wen Lan
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
| | - Lori A J Scott-Sheldon
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA.
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA.
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA.
| | - Kate B Carey
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| | - Blair T Johnson
- Department of Psychology, University of Connecticut, Storrs, CT, USA
| | - Michael P Carey
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital, CORO West, Suite 309, 164 Summit Avenue, Providence, RI, 02906, USA
- Department of Psychiatry and Human Behavior, Alpert School of Medicine, Brown University, Providence, RI, USA
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, USA
| |
Collapse
|
2
|
Edelman EJ, Lunze K, Cheng DM, Lioznov DA, Quinn E, Gnatienko N, Bridden C, Chaisson CE, Walley AY, Krupitsky EM, Raj A, Samet JH. HIV Stigma and Substance Use Among HIV-Positive Russians with Risky Drinking. AIDS Behav 2017. [PMID: 28634662 DOI: 10.1007/s10461-017-1832-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
The link between HIV stigma with substance use is understudied. We characterized individuals with high HIV stigma and examined whether HIV stigma contributes to substance use among HIV-positive Russians reporting risky alcohol use. We analyzed data from HERMITAGE, a randomized controlled trial of 700 people living with HIV/AIDS (PLWHA) with past 6-month risky sex and risky alcohol use in St. Petersburg, Russia (2007-2011). Participants who were female and reported depressive symptoms and lower social support were more likely to endorse high HIV stigma (all p's < 0.001). In adjusted models, high HIV stigma was not significantly associated with the primary outcome unhealthy substance use and was not consistently associated with secondary substance use outcomes. Interventions to enhance social and mental health support for PLWHA, particularly women, may reduce stigma, though such reductions may not correspond to substantial decreases in substance use among this population.
Collapse
Affiliation(s)
- E Jennifer Edelman
- Yale University School of Medicine, PO Box 208025, New Haven, CT, 06520-8088, USA.
- Center for Interdisciplinary Research on AIDS, Yale University School of Public Health, New Haven, CT, USA.
| | - Karsten Lunze
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Debbie M Cheng
- Boston University School of Public Health, Boston, MA, USA
| | - Dmitry A Lioznov
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
| | - Emily Quinn
- Boston University School of Public Health, Boston, MA, USA
| | - Natalia Gnatienko
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Carly Bridden
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | | | - Alexander Y Walley
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
| | - Evgeny M Krupitsky
- First Pavlov State Medical University of St. Petersburg, St. Petersburg, Russian Federation
- St.-Petersburg Bekhterev Research Psychoneurological Institute, St. Petersburg, Russian Federation
| | - Anita Raj
- University of California - San Diego, San Diego, CA, USA
| | - Jeffrey H Samet
- Boston University School of Medicine and Boston Medical Center, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
3
|
Impact of illicit opioid use on T cell subsets among HIV-infected adults. PLoS One 2017; 12:e0176617. [PMID: 28472064 PMCID: PMC5417591 DOI: 10.1371/journal.pone.0176617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Accepted: 04/13/2017] [Indexed: 12/18/2022] Open
Abstract
Objectives Opioids have immunosuppressive properties, yet opioid effects on T cell abnormalities consistent with the immune risk phenotype among HIV-infected individuals are understudied. Methods To assess associations between illicit opioid use and T cell characteristics (CD4/CD8 ratio, memory profiles based on CD45RO and CD28 expression, and senescence based on CD57 expression), we conducted an exploratory cross-sectional analysis of Russia ARCH, a cohort of antiretroviral therapy (ART)-naïve HIV-infected individuals recruited 11/2012 to 10/2014 in St. Petersburg, Russia. The main independent variable was past 30 day illicit opioid use (yes vs. no). Secondary analyses evaluated none (0 days), intermittent (1 to 7 days), and persistent (8 to 30 days) opioid use. Outcomes were determined with flow cytometry. Analyses were conducted using linear regression models. Results Among 186 participants, 38% reported any illicit opioid use (18% intermittent and 20% persistent). Any illicit opioid use was not significantly associated with T cell characteristics. Intermittent opioid use appeared to be associated with decreased memory CD8+ T cells proportion (CD45RO+CD45RA- CD8+ T cells: adjusted mean difference [AMD] [95% CI] = -6.15 [-11.50, -0.79], p = 0.02) and borderline significant increased senescent T cells (%CD57+ of total CD28-CD8+ T cells (AMD [95% CI] = 7.70 [-0.06, 15.46], p = 0.05). Conclusions Among ART-naïve HIV-infected Russians, any illicit opioid use was not significantly associated with T cell abnormalities although intermittent illicit opioid use may be associated with CD8 T cell abnormalities. Longitudinal studies are warranted to confirm these findings given increased risk of infections and comorbidities seen among HIV-infected individuals with illicit opioid use.
Collapse
|
4
|
Gnatienko N, Han SC, Krupitsky E, Blokhina E, Bridden C, Chaisson CE, Cheng DM, Walley AY, Raj A, Samet JH. Linking Infectious and Narcology Care (LINC) in Russia: design, intervention and implementation protocol. Addict Sci Clin Pract 2016; 11:10. [PMID: 27141834 PMCID: PMC4855723 DOI: 10.1186/s13722-016-0058-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2015] [Accepted: 04/26/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Russia and Eastern Europe have one of the fastest growing HIV epidemics in the world. While countries in this region have implemented HIV testing within addiction treatment systems, linkage to HIV care from these settings is not yet standard practice. The Linking Infectious and Narcology Care (LINC) intervention utilized peer-led strengths-based case management to motivate HIV-infected patients in addiction treatment to obtain HIV care. This paper describes the protocol of a randomized controlled trial evaluating the effectiveness of the LINC intervention in St. Petersburg, Russia. METHODS/DESIGN Participants (n = 349) were recruited from the inpatient wards at the City Addiction Hospital in St. Petersburg, Russia. After completing a baseline assessment, participants were randomly assigned to receive either the LINC intervention or standard of care. Participants returned for research assessments 6 and 12 months post-baseline. Primary outcomes were assessed via chart review at HIV treatment locations. DISCUSSION LINC holds the potential to offer an effective approach to coordinating HIV care for people who inject drugs in Russia. The LINC intervention utilizes existing systems of care in Russia, minimizing adoption of substantial infrastructure for implementation. Trial Registration NCT01612455.
Collapse
Affiliation(s)
- Natalia Gnatienko
- />Clinical Addiction Research and Education (CARE) Unit, Department of Medicine, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118 USA
| | - Steve C. Han
- />Clinical Addiction Research and Education (CARE) Unit, Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118 USA
| | - Evgeny Krupitsky
- />First St. Petersburg Pavlov State Medical University, Lev Tolstoy St., 6/8, St. Petersburg, Russian Federation 197022
- />St. Petersburg Bekhterev Research Psychoneurological Institute, Bekhtereva St., 3, St. Petersburg, Russian Federation 192019
| | - Elena Blokhina
- />First St. Petersburg Pavlov State Medical University, Lev Tolstoy St., 6/8, St. Petersburg, Russian Federation 197022
| | - Carly Bridden
- />Clinical Addiction Research and Education (CARE) Unit, Department of Medicine, Section of General Internal Medicine, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118 USA
| | - Christine E. Chaisson
- />Data Coordinating Center, Boston University School of Public Health, 85 East Newton Street, 9th Floor, Boston, MA 02118 USA
| | - Debbie M. Cheng
- />Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3rd Floor, Boston, MA 02118 USA
| | - Alexander Y. Walley
- />Clinical Addiction Research and Education (CARE) Unit, Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118 USA
| | - Anita Raj
- />Department of Medicine, Division of Global Public Health, University of California-San Diego, 9500 Gilman Dr. MC 0507, San Diego, CA 92093 USA
| | - Jeffrey H. Samet
- />Clinical Addiction Research and Education (CARE) Unit, Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118 USA
- />Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118 USA
| |
Collapse
|
5
|
Edelman EJ, Cheng DM, Krupitsky EM, Bridden C, Quinn E, Walley AY, Lioznov DA, Blokhina E, Zvartau E, Samet JH. Heroin Use and HIV Disease Progression: Results from a Pilot Study of a Russian Cohort. AIDS Behav 2015; 19:1089-97. [PMID: 25413642 DOI: 10.1007/s10461-014-0948-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Opioids have immunosuppressive properties, yet their impact on HIV disease progression remains unclear. Using longitudinal data from HIV-infected antiretroviral therapy-naïve Russian individuals (n = 77), we conducted a pilot study to estimate the effect of heroin use on HIV disease progression. Heroin use was categorized based on past 30 days self-reported use at baseline, 6 and 12 months as none, intermittent or persistent. We estimated the effect of heroin use on HIV disease progression, measured as change in CD4 count from baseline to 12 months, using multivariable linear regression. Those with intermittent (n = 21) and no heroin use (n = 39) experienced mean decreases in CD4 count from baseline to 12 months (-103 and -10 cells/mm(3), respectively; adjusted mean difference (AMD) -93; 95 % CI -245, 58). Those with persistent use (n = 17) showed a mean increase of 53 cells/mm(3) (AMD 63; 95 % CI -95, 220). Future studies exploring the effects of heroin withdrawal on HIV disease progression are warranted.
Collapse
|
6
|
Samet JH, Raj A, Cheng DM, Blokhina E, Bridden C, Chaisson CE, Walley AY, Palfai TP, Quinn EK, Zvartau E, Lioznov D, Krupitsky E. HERMITAGE--a randomized controlled trial to reduce sexually transmitted infections and HIV risk behaviors among HIV-infected Russian drinkers. Addiction 2015; 110:80-90. [PMID: 25170994 PMCID: PMC4270840 DOI: 10.1111/add.12716] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 05/07/2014] [Accepted: 08/18/2014] [Indexed: 11/30/2022]
Abstract
AIMS This study assessed the effectiveness of HERMITAGE (HIV's Evolution in Russia-Mitigating Infection Transmission and Alcoholism in a Growing Epidemic), an adapted secondary HIV prevention intervention, compared with an attention control condition in decreasing sexually transmitted infections (STIs) and sex and drug risk behaviors among Russian HIV-infected heavy drinkers. DESIGN We conducted a single-blinded, two-armed, randomized controlled trial with 12-month follow-up. SETTING The study was conducted in St Petersburg, Russia. Participants were recruited from four HIV and addiction clinical sites. The intervention was conducted at Botkin Infectious Disease Hospital. PARTICIPANTS HIV-infected individuals with past 6-month risky sex and heavy alcohol consumption (n = 700) were randomized to the HERMITAGE intervention (n = 350) or an attention control condition (n = 350). INTERVENTION A Healthy Relationships Intervention stressing disclosure of HIV serostatus and condom use, adapted for a Russian clinical setting with two individual sessions and three small group sessions. MEASUREMENTS The primary outcome was incident STI by laboratory test at 12-month follow-up. Secondary outcomes included change in unprotected sex and several alcohol and injection drug use (IDU) variables. FINDINGS Participants had the following baseline characteristics: 59.3% male, mean age 30.1, 60.4% past year IDU, 15.4% prevalent STI and mean CD4 cell count 413.3/μl. Assessment occurred among 75 and 71% of participants at 6 and 12 months, respectively. STIs occurred in 20 subjects (8.1%) in the intervention group and 28 subjects (12.0%) in the control group at 12-month follow-up; logistic regression analyses found no significant difference between groups (adjusted odds ratio 0.63; 95% confidence interval = 0.34-1.18; P = 0.15). Both groups decreased unsafe behaviors, although no significant differences were found between groups. CONCLUSIONS The HERMITAGE HIV risk reduction intervention does not appear to reduce sexually transmitted infections and HIV risk behaviors in Russian HIV-infected heavy drinkers compared with attention controls.
Collapse
Affiliation(s)
- Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2 Floor, Boston, MA 02118, United States
,Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 2 Floor, Boston, MA 02118, United States
| | - Anita Raj
- Division of Global Public Health, Department of Medicine, University of California - San Diego School of Medicine, IOA Building, 10111 N. Torrey Pines Rd., San Diego, CA 92137, United States
| | - Debbie M. Cheng
- Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Avenue, 3 Floor, Boston, MA 02118, United States
| | - Elena Blokhina
- First St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russian Federation
| | - Carly Bridden
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States Data Coordinating Center
| | - Christine E. Chaisson
- Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Avenue, 3 Floor, Boston, MA, United States
| | - Alexander Y. Walley
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Avenue, 2 Floor, Boston, MA 02118, United States
| | - Tibor P. Palfai
- Department of Psychology, Boston University School, 64 Cummington Street, Boston, MA 02215, United States
| | - Emily K. Quinn
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston Medical Center, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118, United States Data Coordinating Center
| | - Edwin Zvartau
- First St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russian Federation
| | - Dmitry Lioznov
- First St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russian Federation
| | - Evgeny Krupitsky
- First St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russian Federation
,St. Petersburg Bekhterev Research Psychoneurological Institute, Bekhtereva St., 3, St. Petersburg 192019, Russian Federation
| |
Collapse
|
7
|
Pain is associated with risky drinking over time among HIV-infected persons in St. Petersburg, Russia. Drug Alcohol Depend 2014; 144:87-92. [PMID: 25220898 PMCID: PMC4252482 DOI: 10.1016/j.drugalcdep.2014.08.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 08/17/2014] [Accepted: 08/18/2014] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pain is highly prevalent among persons with HIV. Alcohol may be used to "self-medicate" pain. This study examined the association between pain and risky alcohol use over time in a cohort of HIV-infected Russian drinkers. METHODS This secondary analysis utilized longitudinal data from a randomized trial of a behavioral intervention. Subjects included HIV-infected adults who reported past 6-month risky drinking and unprotected sex and were recruited from HIV and addiction treatment sites in St. Petersburg, Russia. The main independent variable was pain that at least moderately interfered with daily living. The primary outcome was past month risky drinking amounts based on NIAAA guidelines. General estimating equations (GEE) logistic regression models were used to calculate odds ratios and 95% confidence intervals for the association between pain and risky drinking over time (i.e., baseline, 6 and 12 months), adjusting for potential confounders. RESULTS Baseline characteristics of participants (n=699) were mean age of 30 (SD ±5) years, 41% female, and 22% <9th grade education. Nearly one quarter (24%) had a CD4 cell count <200 cells/μl, and only 17% were on antiretroviral therapy. Nearly half (46%) reported at least moderate pain interference in the past month and 81% were drinking risky amounts. In adjusted longitudinal GEE models, pain was significantly associated with greater odds of reporting past month risky drinking (AOR = 1.34, 95% CI: 1.05-1.71, p value=0.02). CONCLUSIONS Among a cohort of HIV-infected Russian drinkers, pain that at least moderately interfered with daily living was associated with higher odds of reporting risky drinking amounts over time.
Collapse
|
8
|
Pecoraro A, Mimiaga M, O'Cleirigh C, Safren SA, Blokhina E, Verbitskaya E, Yaroslavtseva T, Ustinov A, Lioznov DA, Zvartau E, Krupitsky E, Woody GE. Depression, substance use, viral load, and CD4+ count among patients who continued or left antiretroviral therapy for HIV in St. Petersburg, Russian Federation. AIDS Care 2014; 27:86-92. [PMID: 25264710 DOI: 10.1080/09540121.2014.959464] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Antiretroviral therapy (ART) became more widely available in the Russian Federation in 2006 when the Global Fund made a contribution to purchase ART with a mandate to increase numbers of patients receiving it. Funds were distributed to AIDS Centers and selected hospitals, and numbers quickly increased. Though ART is highly effective for adherent patients, dropout has been a problem; thus understanding characteristics of patients who remain on ART vs. those who leave treatment may provide information to facilitate engagement. We retrospectively assessed depression, hopelessness, substance use, viral load, and CD4+ counts of 120 patients who dropped out of ART for ≥12 months (Lost-to-Care, LTCs) and 120 who continued for ≥12 months (Engaged-in-Care, EICs). As expected, LTCs had higher viral loads and depression, lower CD4+ counts, more alcohol, heroin, and injection drug use in the past 30 days. A binary logistic regression with Center for Epidemiologic Studies Depression score, Beck Hopelessness score, whether drugs/alcohol had ever prevented them from taking ART, and past 30 days' alcohol use [χ(2)(4) = 64.27, p = .0.000] correctly classified 74.5% of participants as LTC or EIC, suggesting that integrated treatment for substance use, psychiatric, and HIV could reduce dropout and improve outcomes.
Collapse
Affiliation(s)
- Anna Pecoraro
- a School of Medicine , University of Pennsylvania , Philadelphia , PA , USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Cepeda JA, Niccolai LM, Eritsyan K, Heimer R, Levina O. Moderate/heavy alcohol use and HCV infection among injection drug users in two Russian cities. Drug Alcohol Depend 2013; 132:571-9. [PMID: 23642314 PMCID: PMC3770791 DOI: 10.1016/j.drugalcdep.2013.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Revised: 03/26/2013] [Accepted: 04/03/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND In Russia, injection drug use and transmission of blood-borne pathogens such as human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are inextricably linked, however the burden of alcohol use remains unexplored among injection drug users (IDUs). METHODS Individuals who were 18 years of age and older and had injected drugs in the previous 30 days were recruited in the cities of Novosibirsk and Ivanovo by respondent driven sampling. Consenting individuals were administered a quantitative survey instrument and provided blood samples for serological testing. RESULTS In Novosibirsk and Ivanovo, 29% and 35% of respondents were categorized as moderate/heavy drinkers, respectively. Individuals reported problems related to alcohol use that affected their physical health (23%), family (55%), and induced financial hardships (43%). In the multivariate analysis, we found that methamphetamine injection in the past 12 months was a strong and significant correlate of moderate/heavy drinking in Novosibirsk (aOR=5.63 95% CI: [1.01-31.47]) and Ivanovo (aOR=3.81 95% CI: [2.20-6.62]). There was poor agreement between self-reported HCV status and HCV test results (κ=-0.05 and 0.26 in Novosibirsk and Ivanovo, respectively). IDUs who correctly knew their HCV seropositive status in Novosibirsk and IDUs who correctly knew their HCV seronegative status in Ivanovo were significantly more likely to be moderate/heavy drinkers. CONCLUSION Alcohol use is problematic among IDUs who are at high risk for HCV. Future interventions should target IDUs who are moderate/heavy drinkers in order to prevent liver complications resulting from HCV infection.
Collapse
Affiliation(s)
- Javier A Cepeda
- Yale School of Public Health, Department of Epidemiology of Microbial Diseases and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA.
| | | | | | | | | |
Collapse
|
10
|
Tsui JI, Cheng DM, Coleman SM, Blokhina E, Bridden C, Krupitsky E, Samet JH. Pain is associated with heroin use over time in HIV-infected Russian drinkers. Addiction 2013; 108:1779-87. [PMID: 23773361 PMCID: PMC4012755 DOI: 10.1111/add.12274] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To evaluate whether pain was associated with increased risk of using heroin, stimulants or cannabis among HIV-infected drinkers in Russia. DESIGN Secondary analysis of longitudinal data from the HERMITAGE study (HIV's Evolution in Russia-Mitigating Infection Transmission and Alcoholism in a Growing Epidemic), a behavioral randomized controlled trial, with data collected at baseline, 6-month and 12-month visits. SETTING Recruitment occurred at HIV and addiction treatment sites in St Petersburg, Russian Federation. PARTICIPANTS Six hundred and ninety-nine HIV-infected adult drinkers. MEASUREMENTS The primary outcome was past month illicit drug use; secondary outcomes examined each drug (heroin, stimulants and cannabis) separately. The main predictor was pain that interfered at least moderately with daily living. General estimating equations (GEE) logistic regression models were used to evaluate the association between pain and subsequent illicit drug use, adjusting for potential confounders. FINDINGS Participants reporting pain appeared to have higher odds of using illicit drugs, although the results did not reach statistical significance [adjusted odds ratio (OR) = 1.32; 95% confidence interval (CI) = 0.99, 1.76, P = 0.06]. There was a significant association between pain and heroin use (OR = 1.54; 95% CI = 1.11-2.15, P = 0.01) but not use of other drugs (OR = 0.75; 95% CI =0.40-1.40, P = 0.35 for stimulants and OR = 0.70; 95% CI = 0.45-1.07, P = 0.09 for cannabis). CONCLUSIONS HIV-infected Russian drinkers who report pain are more likely to use heroin over time than HIV-infected Russian drinkers who do not report pain. Pain may be an unrecognized risk factor for persistent heroin use with implications for HIV transmission in Russia.
Collapse
Affiliation(s)
- Judith I. Tsui
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA
| | - Debbie M. Cheng
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA,Department of Biostatistics, Boston University School of Public Health, 801 Massachusetts Ave., 3 Floor, Boston, MA 02118-2605, USA
| | - Sharon M. Coleman
- Data Coordinating Center, Boston University School of Public Health, 801 Massachusetts Ave., 3 Floor, Boston, MA 02118-2605, USA
| | - Elena Blokhina
- Institute of Pharmacology, St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russia
| | - Carly Bridden
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA
| | - Evgeny Krupitsky
- Laboratory of Clinical Pharmacology of Addictions, St. Petersburg Pavlov State Medical University, Lev Tolstoy St. 6/8, St. Petersburg 197022, Russia,Department of Addictions, Bekhterev Research Psychoneurological Institute, Bekhtereva St., 3, St. Petersburg 192019, Russia
| | - Jeffrey H. Samet
- Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, Boston University School of Medicine/Boston Medical Center, 801 Massachusetts Ave., 2 Floor, Boston, MA 02118-2605, USA,Department of Community Health Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, 2nd Floor, Boston, MA 02118-2605, USA
| |
Collapse
|
11
|
Vasquez C, Lioznov D, Nikolaenko S, Yatsishin S, Lesnikova D, Cox D, Pankovich J, Rosenes R, Wobeser W, Cooper, on behalf of the St. Peters C. Gender disparities in HIV risk behavior and access to health care in St. Petersburg, Russia. AIDS Patient Care STDS 2013; 27:304-10. [PMID: 23651108 DOI: 10.1089/apc.2013.0019] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Over 40,000 HIV-infected individuals live in St Petersburg, Russia. Population characteristics and barriers to care are largely undefined. 152 consecutive patients receiving HIV care at two sites completed a questionnaire in Spring 2011. Rates of chronic hepatitis C virus (HCV) and hepatitis B virus (HBV) infection, alcohol use, and rates of antiretroviral uptake were similar by gender. Males reported a higher history of injection drug use (80.3% vs. 48.7%; p<0.01) and tuberculosis infection (18.8% vs. 1.6%; p<0.01). Females were more likely to have had a child (63.3% vs. 31.5%; p<0.01) and be currently raising that child within their residence (49.3% vs. 15.3%; p<0.01). Unprotected sex (60.5% vs. 17.8%; p<0.01) and a history of sexually transmitted infection (37.7% vs. 20.3%; p=0.03) were more common in females. Females utilized social services more frequently (34.2% vs. 11.9%; p<0.01). There is a heavy burden of concurrent infectious disease, substance use and abuse, mental health illness, and need for social service support in this population. Important differences exist between genders in service uptake and utilization. Further evaluation of these differences may help inform the allocation of limited resources in this high HIV prevalence region of Russia.
Collapse
Affiliation(s)
| | | | | | - Sergey Yatsishin
- St. Petersburg Branch of Russian Red Cross, St. Petersburg, Russia
| | - Darya Lesnikova
- St. Petersburg Branch of Russian Red Cross, St. Petersburg, Russia
| | - David Cox
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Jim Pankovich
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
| | - Ron Rosenes
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- CTN Community Advisory Committee, Toronto, Ontario, Canada
| | - Wendy Wobeser
- CIHR Canadian HIV Trials Network, Vancouver, British Columbia, Canada
- Queen's University, Kingston, Ontario, Canada
| | | |
Collapse
|
12
|
Assari S, Yarmohmmadi Vasel M, Tavakoli M, Sehat M, Jafari F, Narenjiha H, Rafiey H, Ahmadi K. Inconsistent Condom Use among Iranian Male Drug Injectors. Front Psychiatry 2013; 4:181. [PMID: 24772093 PMCID: PMC3983495 DOI: 10.3389/fpsyt.2013.00181] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 12/13/2013] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine the prevalence and associated factors of inconsistent condom use among Iranian male injecting drug users (IDUs). MATERIALS AND METHODS Data came from the national Iranian behavioral survey of drug dependence, which sampled 7743 individuals with drug dependence, from medical centers, prisons, and streets in 29 provinces in Iran, in 2007. This study included all individuals who were male, IDUs, and were sexually active (n = 1131). The main outcome was inconsistent condom use which was assessed using a single item. A logistic regression was used to determine the association between socio-economic data, drug use data, and high risk injection behaviors with inconsistent condom use. RESULT 83.3% of sexually active IDUs (n = 965) reported inconsistent condom use. Based on the logistic regression, likelihood of inconsistent condom use was higher among those with a history of syringe sharing [Odds Ratio (OR); 1.63, 95% Confidence Interval (CI); 1.13-2.34], but lower among those with higher education levels (OR; 0.34, 95% CI; 0.14-0.82), those who mostly inject at home (OR; 0.09, 95% CI; 0.02-0.47), and those with a history of treatment (OR; 0.54, 95% CI; 0.31-0.94). CONCLUSION Because of the link between unsafe sex and risky injecting behaviors among Iranian IDUs, combined programs targeting both sexual and injection behavior may be more appropriate than programs that target sexual or injection behavior. The efficacy of combined programs should be, however, compared with traditional programs that only target sexual or injection behavior of IDUs.
Collapse
Affiliation(s)
- Shervin Assari
- Department of Health Behavior and Health Education, University of Michigan School of Public Health , Ann Arbor, MI , USA ; Center for Research on Ethnicity, Culture, and Health, University of Michigan School of Public Health , Ann Arbor, MI , USA
| | | | - Mahmood Tavakoli
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Mahmoud Sehat
- Universal Network for Health Information Dissemination and Exchange , Tehran , Iran ; Medicine and Health Promotion Institute , Tehran , Iran
| | - Firoozeh Jafari
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran
| | - Hooman Narenjiha
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran ; Center for Behavioral and Social Research, Darius Institute , Tehran , Iran
| | - Hassan Rafiey
- Substance Abuse and Dependence Research Center, University of Social Welfare and Rehabilitation Sciences , Tehran , Iran ; Center for Behavioral and Social Research, Darius Institute , Tehran , Iran
| | - Khodabakhsh Ahmadi
- Behavioral Sciences Research Center, Baqiyatallah Medical Sciences University , Tehran , Iran
| |
Collapse
|
13
|
Abstract
Nondisclosure of one's HIV infection to sexual partners obviates safer sex negotiations and thus jeopardizes HIV transmission prevention. The role of alcohol use in the disclosure decision process is largely unexplored. This study assessed the association between alcohol use and recent nondisclosure of HIV serostatus to sex partners by HIV-infected risky drinkers in St. Petersburg, Russia. Approximately half (317/605; 52.4 %) reported not having disclosed their HIV serostatus to all partners since awareness of infection. Using three separate GEE logistic regression models, we found no significant association between alcohol dependence, risky alcohol use (past 30 days), or alcohol use at time of sex (past 30 days) with recent (past 3 months) nondisclosure (AOR [95 % CI] 0.81 [0.55, 1.20], 1.31 [0.79, 2.17], 0.75 [0.54, 1.05], respectively). Alcohol use at time of sex was associated with decreased odds of recent nondisclosure among seroconcordant partners and among casual partners. Factors associated with nondisclosure were relationship with a casual partner, a serodiscordant partner, multiple sex partners, awareness of HIV diagnosis less than 1 year, and a lifetime history of sexually transmitted disease. Nondisclosure of HIV status to sex partners is common among HIV-infected Russians, however alcohol does not appear to be a predictor of recent disclosure.
Collapse
|
14
|
Levina OS, Heimer R, Odinokova V, Bodanovskaya Z, Safiullina L, Irwin KS, Niccolai LM. Sexual Partners of Street-Based Female Sex Workers in St. Petersburg, Russia: A Model of Partnership Characteristics as a Basis for Further Research. HUMAN ORGANIZATION 2012; 71:32-43. [PMID: 25741032 PMCID: PMC4346184 DOI: 10.17730/humo.71.1.9130380u68614w47] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Street-based sex work in Russia, as in many countries, carries with it a high risk for violence and the transmission of infectious diseases. The male partners of female sex workers are both cause and recipient of such risks. Because little is known about the men, we undertook a preliminary study to determine the feasibility of recruiting and interviewing them, develop typologies that describe partners, and derive hypotheses for further study and risk reduction intervention projects. We were able to conduct open-ended, qualitative interviews with street-based sex workers and, largely through these contacts, their male partners. To these data, we added interviews with social work and medical experts who engage with the sex workers. The text of interviews from 37 respondents were analyzed to identify commonly mentioned partner characteristics in five distinct domains: sociodemographics, behavioral patterns of the partners, motivations in seeking sex services, levels of partner engagement with the sex workers, and the social circumstances that moderate the engagement. Four of the five domains (all but sociodemographics) proved useful in identifying typologies that were best described as populated points in a matrix generated from the intersection of the four domains. The data were too limited to specify which of the points in the matrix are most common, but the points populated are useful in generating hypotheses for further study and in identifying potential avenues for risk reduction interventions.
Collapse
|
15
|
Roux P, Carrieri PM, Cohen J, Ravaux I, Spire B, Gossop M, Comer SD. Non-medical use of opioids among HIV-infected opioid dependent individuals on opioid maintenance treatment: the need for a more comprehensive approach. Harm Reduct J 2011; 8:31. [PMID: 22123176 PMCID: PMC3286372 DOI: 10.1186/1477-7517-8-31] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 11/28/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Opioid maintenance treatment (OMT) has a positive impact on substance use and health outcomes among HIV-infected opioid dependent patients. The present study investigates non-medical use of opioids by HIV-infected opioid-dependent individuals treated with buprenorphine or methadone. METHODS The MANIF 2000 study is a longitudinal study that enrolled a cohort of 476 HIV-infected opioid-dependent individuals. Data were collected in outpatient hospital services delivering HIV care in France. The sample comprised all patients receiving OMT (either methadone or buprenorphine) who attended at least one follow-up visit with data on adherence to OMT (N = 235 patients, 1056 visits). Non-medical use of opioids during OMT was defined as having reported use of opioids in a non-medical context, and/or the misuse of the prescribed oral OMT by an inappropriate route of administration (injection or sniffing). After adjusting for the non-random assignment of OMT type, a model based on GEE was then used to identify predictors of non-medical use of opioids. RESULTS Among the 235 patients, 144 (61.3%) and 91 (38.9%) patients were receiving buprenorphine and methadone, respectively, at baseline. Non-medical use of opioids was found in 41.6% of visits for 83% of individual patients. In the multivariate analysis, predictors of non-medical use of opioids were: cocaine, daily cannabis, and benzodiazepine use, experience of opioid withdrawal symptoms, and less time since OMT initiation. CONCLUSIONS Non-medical use of opioids was found to be comparable in OMT patients receiving methadone or buprenorphine. The presence of opioid withdrawal symptoms was a determinant of non-medical use of opioids and may serve as a clinical indicator of inadequate dosage, medication, or type of follow-up. Sustainability and continuity of care with adequate monitoring of withdrawal symptoms and polydrug use may contribute to reduced harms from ongoing non-medical use of opioids.
Collapse
Affiliation(s)
- Perrine Roux
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Patrizia M Carrieri
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Julien Cohen
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Isabelle Ravaux
- Hôpital La Conception, Service des Maladies Infectieuses, 147 boulevard Baille, 13005 Marseille, France
| | - Bruno Spire
- INSERM, U912 (SE4S), 23 rue Stanislas Torrents, 13006 Marseille, France
- Université Aix Marseille, IRD, UMR-S912, Marseille, France
- ORS PACA, Observatoire Régional de la Santé Provence Alpes Côte d'Azur, Marseille, France
| | - Michael Gossop
- King's College London, 4 Windsor Walk, London, SE5 8BB, UK
| | - Sandra D Comer
- Division on Substance Abuse, New York State Psychiatric Institute and Columbia University, NY, USA
| |
Collapse
|
16
|
|
17
|
Heimer R, White E. Estimation of the number of injection drug users in St. Petersburg, Russia. Drug Alcohol Depend 2010; 109:79-83. [PMID: 20060238 PMCID: PMC2875272 DOI: 10.1016/j.drugalcdep.2009.12.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Revised: 12/02/2009] [Accepted: 12/04/2009] [Indexed: 10/20/2022]
Abstract
The conjoined epidemics of HIV and injection drug abuse have progressed rapidly in many parts of the Russian Federation, including the City of St. Petersburg, which now has more cases of HIV than any other region in the country. Official estimates of the number of injection drug users (IDUs), which rely on official registration of IDUs, greatly underestimate their number. We have combined official statistics that register HIV cases and attribute risk to causes including injection drug use with data from a study that collected data from IDUs about their HIV serostatus and their history of HIV testing to estimate the number of IDUs in the city. We conclude that there are 83,118+/-5799 total IDUs. Since many IDUs have not been tested and even some who have been officially tested do not know their serostatus, a first step in countering the growing HIV epidemic among IDUs in St. Petersburg must be expanded access to HIV testing, prevention, and treatment that is targeted to IDUs.
Collapse
Affiliation(s)
- Robert Heimer
- Yale School of Public Health, 60 College St., PO Box 208034, New Haven, CT, USA 06520-8034.
| | | |
Collapse
|
18
|
Raj A, Cheng DM, Krupitsky EM, Levenson S, Egorova VY, Meli S, Zvartau EE, Samet JH. Binge drinking and unsafe sex: a study of narcology hospital patients from St. Petersburg, Russia. Subst Abus 2009; 30:213-22. [PMID: 19591057 DOI: 10.1080/08897070903040923] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to assess the association between binge alcohol use and unprotected sex in Russian substance users. Participants (N = 181) were narcology hospital patients assessed on demographics, alcohol use, risky sex, and sexually transmitted disease/human immunodeficiency virus (STD/HIV) diagnoses. Adjusted generalized estimating equations (GEEs) logistic regression analysis examined the association between binge drinking and same-day unprotected sex across each of the past 30 days, per participant (N = 5430 observations). Participants were age 18 to 55 years, 75% male, and 64% binge drinking. Sex trade was reported by 27%; history of STDs by 43%; and HIV by 15%. One fourth of daily observations included sex; 88% of these involved unprotected sex. Binge drinking was not associated with same-day unprotected sex (adjusted odds ratio [OR(adj)] = 1.0, 95% confidence interval [CI] = 0.7-1.4, chi(2)(1, N = 5219) = 0.01, ns). Findings document substantial HIV/STD risk and prevalence among Russian narcology patients, but no link between binge drinking and unprotected sex in this population, possibly due to very low rates of condom use generally.
Collapse
Affiliation(s)
- A Raj
- Department of Social Behavioral Sciences, Boston University of Public Health, Boston, Massachusetts 02118, USA.
| | | | | | | | | | | | | | | |
Collapse
|
19
|
Correlates of any condom use among Russian narcology patients reporting recent unprotected sex. AIDS Behav 2009; 13:310-7. [PMID: 18401698 DOI: 10.1007/s10461-008-9383-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2007] [Accepted: 03/20/2008] [Indexed: 10/22/2022]
Abstract
The purpose of this study was to assess whether HIV/sexually transmitted infection (STI) risk factors: risky sex (multiple sex partners and sex trade involvement), past HIV or STI diagnosis and substance use (at risk drinking and injection drug use) are associated with the outcome any condom use in the past 6 months among Russian narcology hospital patients. Participants (N = 178) included only those who reported unprotected sex in the past 6 months and were aged 18-55 years and 76% male. Any condom use in the past 6 months was reported by 55% of the sample. History of STIs was reported by 43% of participants; 15% were HIV-infected. Regression analyses adjusted for demographics demonstrated that those reporting multiple sex partners (OR(adj) = 4.2, 95% CI = 2.0-8.7) and sex trade involvement (OR(adj) = 2.4, 95% CI = 1.1-5.1) in the past 6 months had significantly higher odds of reporting any condom use in this same timeframe. HIV/STI and substance use were not associated with increased odds of condom use.
Collapse
|
20
|
Samet JH, Krupitsky EM, Cheng DM, Raj A, Egorova VY, Levenson S, Meli S, Bridden C, Verbitskaya EV, Kamb ML, Zvartau EE. Mitigating risky sexual behaviors among Russian narcology hospital patients: the PREVENT (Partnership to Reduce the Epidemic Via Engagement in Narcology Treatment) randomized controlled trial. Addiction 2008; 103:1474-83. [PMID: 18636998 PMCID: PMC2588416 DOI: 10.1111/j.1360-0443.2008.02251.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To assess the effectiveness of a sexual risk reduction intervention in the Russian narcology hospital setting. DESIGN, SETTING AND PARTICIPANTS This was a randomized controlled trial from October 2004 to December 2005 among patients with alcohol and/or heroin dependence from two narcology hospitals in St Petersburg, Russia. INTERVENTION Intervention subjects received two personalized sexual behavior counseling sessions plus three telephone booster sessions. Control subjects received usual addiction treatment, which did not include sexual behavior counseling. All received a research assessment and condoms at baseline. MEASUREMENTS Primary outcomes were percentage of safe sex episodes (number of times condoms were used / by number of sexual episodes) and no unprotected sex (100% condom use or abstinence) during the previous 3 months, assessed at 6 months. FINDINGS Intervention subjects reported higher median percentage of safe sex episodes (unadjusted median difference 12.7%; P = 0.01; adjusted median difference 23%, P = 0.07); a significant difference was not detected for the outcome no unprotected sex in the past 3 months [unadjusted odds ratio (OR) 1.6, 95% confidence interval (CI) 0.8-3.1; adjusted OR 1.5, 95% CI 0.7-3.3]. CONCLUSIONS Among Russian substance-dependent individuals, sexual behavior counseling during addiction treatment should be considered as one potential component of efforts to decrease risky sexual behaviors in this HIV at-risk population.
Collapse
Affiliation(s)
- Jeffrey H. Samet
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, USA,Boston University School of Public Health, Department of Social and Behavioral Sciences, MA, USA
| | - Evgeny M. Krupitsky
- St Petersburg State Pavlov Medical University, St Petersburg, Russian Federation
| | - Debbie M. Cheng
- Boston University School of Public Health, Department of Biostatistics, MA, USA
| | - Anita Raj
- Boston University School of Public Health, Department of Social and Behavioral Sciences, MA, USA
| | - Valentina Y. Egorova
- St Petersburg State Pavlov Medical University, St Petersburg, Russian Federation
| | - Suzette Levenson
- Boston University School of Public Health, Data Coordinating Center, MA, USA
| | - Seville Meli
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, USA
| | - Carly Bridden
- Boston University School of Medicine/Boston Medical Center, Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education (CARE) Unit, USA
| | - Elena V. Verbitskaya
- St Petersburg State Pavlov Medical University, St Petersburg, Russian Federation
| | - Mary L. Kamb
- Centers for Disease Control and Prevention (CDC), Division of STD Prevention, Atlanta, GA, USA
| | - Edwin E. Zvartau
- St Petersburg State Pavlov Medical University, St Petersburg, Russian Federation
| |
Collapse
|
21
|
Walley AY, Krupitsky EM, Cheng DM, Raj A, Edwards EM, Bridden C, Egorova VY, Zvartau EE, Woody GE, Samet JH. Implications of cannabis use and heavy alcohol use on HIV drug risk behaviors in Russian heroin users. AIDS Behav 2008; 12:662-9. [PMID: 17487577 PMCID: PMC2480514 DOI: 10.1007/s10461-007-9243-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Accepted: 04/16/2007] [Indexed: 11/26/2022]
Abstract
Cannabis and heavy alcohol use potentially increase HIV transmission by increasing risky drug behaviors. We studied 404 subjects entering treatment for heroin dependence, in St. Petersburg, Russia. We used the HIV Risk Assessment Battery (RAB) drug subscale to measure risky drug behavior. Although all heavy alcohol users had risky drug behaviors, their drug RAB scores did not differ from non-heavy alcohol users in unadjusted or adjusted analyses. Cannabis use was significantly associated with drug RAB scores in unadjusted analyses (mean difference 1.7 points) and analyses adjusted for age, sex, and employment (mean difference 1.3 points). When also adjusting for stimulant use, the impact of cannabis use was attenuated and no longer statistically significant (mean difference 1.1 points). Because of the central role of risky drug behaviors in the Russian HIV epidemic, it is important to understand how the use of multiple substances, including cannabis and alcohol, impacts risky drug behaviors.
Collapse
Affiliation(s)
- Alexander Y Walley
- Clinical Addiction Research and Education Unit, Section of General Internal Medicine, Department of Medicine, Boston Medical Center and Boston University School of Medicine, 91 E. Concord St., Suite 200, Boston, MA 02118, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
22
|
Tsarouk T, Thompson EA, Herting JR, Walsh E, Randell B. Culturally specific adaptation of a prevention intervention: an international collaborative research project. Addict Behav 2007; 32:1565-81. [PMID: 17197107 DOI: 10.1016/j.addbeh.2006.11.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 10/24/2006] [Accepted: 11/09/2006] [Indexed: 11/22/2022]
Abstract
This study adapted a U.S. drug use prevention program for use with Russian at-risk adolescents, and explored directions for further development of programs addressing prevention of substance abuse and other health risk behaviors including risk of HIV infection. The adaptation process was conducted in phases, initially carried out in Seattle with 23 bilingual (English-Russian) youth and then further adapted in two Moscow schools with 44 "typical" youth. In the final phase, program adaptation for the Russian at-risk adolescents was achieved by conducting a pilot test of the adapted program lessons with Moscow at-risk adolescents (n=10), who met criteria of poor school performance and/or truancy. Observations and experience were used throughout to adapt and refine the program for at-risk youth. Modifications were made to represent more accurately colloquial Russian and to capture teen experiences common to Russian culture. Both U.S. and Russian youth characterized the lessons as engaging and valuable. They also expressed a need to learn about sexuality, drug use, and health; peer and romantic relationships; and problem-solving strategies.
Collapse
Affiliation(s)
- Tatiana Tsarouk
- Reconnecting Youth Prevention Research Program, Department of Psychosocial and Community Health, University of Washington School of Nursing, 9709 3rd Avenue, NE, Suite 510, Seattle, WA, 98115, USA.
| | | | | | | | | |
Collapse
|
23
|
Moran D, Jordaan JA. HIV/AIDS in Russia: determinants of regional prevalence. Int J Health Geogr 2007; 6:22. [PMID: 17553136 PMCID: PMC1904189 DOI: 10.1186/1476-072x-6-22] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 06/06/2007] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND The motivation for this paper is to inform the selection of future policy directions for tackling HIV/AIDS in Russia. The Russian Federation has more people living with HIV/AIDS than any other country in Europe, and nearly 70% of the known infections in Eastern Europe and Central Asia. The epidemic is particularly young, with 80% of those infected aged less than thirty, and no Russian region has escaped the detection of infections. However, measures to address the epidemic in Russia have been hampered by late recognition of the scale of the problem, poor data on HIV prevalence, potentially counterproductive narcotics legislation, and competing health priorities. An additional complication has been the relative lack of research into the spatial heterogeneity of the Russian HIV/AIDS epidemic, investigating the variety of prevalence rates in the constituent regions and questioning assumptions about the links between the epidemic and the circumstances of post-Soviet transformation. In the light of these recent developments, this paper presents research into the determinants of regional HIV prevalence levels in Russia. RESULTS Statistical empirical research on HIV and other infectious diseases has identified a variety of factors that influence the spread and development of these diseases. In our empirical analysis of determinants of HIV prevalence in Russia at the regional level, we identify factors that are statistically related to the level of HIV prevalence in Russian regions, and obtain some indication of the relative importance of these factors. We estimate an empirical model that includes factors which describe economic and socio-cultural characteristics. CONCLUSION Our analysis statistically identifies four main factors that influence HIV prevalence in Russian regions. Given the different nature of the factors that we identify to be of importance, we conclude that successful HIV intervention policies will need to be multidisciplinary in nature. Finally, we stress that further research is needed to obtain a better understanding of the statistical relations that we have identified; our empirical findings can serve as an important guide in these future research efforts, as they indicate which processes play an important role in regional HIV/AIDS prevalence rates in contemporary Russia.
Collapse
Affiliation(s)
- Dominique Moran
- School of Geography, Earth and Environmental Sciences, University of Birmingham, Edgbaston, Birmingham, UK
| | - Jacob A Jordaan
- Department of Economics, Free University of Amsterdam, De Boelelaan 1105, 1081 HV Amsterdam, The Netherlands
| |
Collapse
|
24
|
Krupitsky EM, Zvartau EE, Masalov DV, Tsoy MV, Burakov AM, Egorova VY, Didenko TY, Romanova TN, Ivanova EB, Bespalov AY, Verbitskaya EV, Neznanov NG, Grinenko AY, O'Brien CP, Woody GE. Naltrexone with or without fluoxetine for preventing relapse to heroin addiction in St. Petersburg, Russia. J Subst Abuse Treat 2006; 31:319-28. [PMID: 17084785 DOI: 10.1016/j.jsat.2006.05.005] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2006] [Revised: 05/12/2006] [Accepted: 05/12/2006] [Indexed: 10/24/2022]
Abstract
This randomized placebo-controlled trial tested the efficacy of oral naltrexone with or without fluoxetine for preventing relapse to heroin addiction and for reducing HIV risk, psychiatric symptoms, and outcome. All patients received drug counseling with parental or significant-other involvement to encourage adherence. Patients totaling 414 were approached, 343 gave informed consent, and 280 were randomized (mean age, 23.6 +/- 0.4 years). At 6 months, two to three times as many naltrexone patients as naltrexone placebo patients remained in treatment and had not relapsed, odds ratio (OR) = 3.5 (1.96-6.12), p < .0001. Overall, adding fluoxetine did not improve outcomes, OR = 1.35 (0.68-2.66), p = .49; however, women receiving naltrexone and fluoxetine showed a trend toward a statistically significant advantage when compared to women receiving naltrexone and fluoxetine placebo, OR = 2.4 (0.88-6.59), p = .08. HIV risk, psychiatric symptoms, and overall adjustment were markedly improved among all patients who remained on treatment and did not relapse, regardless of group assignment. More widespread use of naltrexone could be an important addition to addiction treatment and HIV prevention in Russia.
Collapse
Affiliation(s)
- Evgeny M Krupitsky
- St. Petersburg Scientific-Research Center of Addictions and Psychopharmacology, St. Petersburg, Russia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Pechansky F, Woody G, Inciardi J, Surratt H, Kessler F, Von Diemen L, Bumaguin DB. HIV seroprevalence among drug users: an analysis of selected variables based on 10 years of data collection in Porto Alegre, Brazil. Drug Alcohol Depend 2006; 82 Suppl 1:S109-13. [PMID: 16769439 DOI: 10.1016/s0376-8716(06)80017-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Data from five studies were pooled to describe associations between drug use and HIV. The Risk Assessment. Battery in Porto Alegre, Brazil, was used to collect data from 1449 subjects in 5 separate studies conducted between 1995 and 2004. The subjects were divided into categories based on their pattern of drug use: (1) injection drug users (IDUs), (2) crack smokers, (3) frequent drug users, and (4) infrequent cocaine/alcohol/marijuana users. The sample consisted primarily of young males with low education and income levels. Half of the subjects reported frequent condom use, and exchanges involving drugs, sex, and money were infrequent (although more common in groups 1 and 2). The overall seroprevalence was 20.6%, and the prevalence was different across the four groups, showing a linear decrease from group 1 (57.1%) to group 4 (11.7%). The IDU and crack-smoking groups showed similarities in their risk levels when compared with the other two groups, and individuals in group 1, 2, and 3 were more likely to report having had four or more sex partners. After controlling for all other risk factors, IDU, males having sex with males, and crack use were highly associated with HIV (OR 7.30, 95% CI: 5.10.10.40; OR 3.04, 95%CI: 1.89,4.80; OR 2.03, 95%CI: 1.40, 2.92, respectively). The findings confirm that poverty, low education, and IDU remain risk factors for HIV in Porto Alegre, Brazil, and the study identities crack smoking as a new risk factor.
Collapse
Affiliation(s)
- Flavio Pechansky
- Center for Drug and Alcohol Research, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.
| | | | | | | | | | | | | |
Collapse
|
26
|
Krupitsky EM, Zvartau EE, Lioznov DA, Tsoy MV, Egorova VY, Belyaeva TV, Antonova TV, Brazhenko NA, Zagdyn ZM, Verbitskaya EV, Zorina Y, Karandashova GF, Slavina TY, Grinenko AY, Samet JH, Woody GE. Co-morbidity of infectious and addictive diseases in St. Petersburg and the Leningrad Region, Russia. Eur Addict Res 2006; 12:12-9. [PMID: 16352898 DOI: 10.1159/000088578] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The Russian health care system is organized around specific diseases, with relatively little focus on integration across specialties to address co-morbidities. This organizational structure presents new challenges in the context of the recent epidemics of injection drug use (IDU) and HIV. This paper uses existing and new data to examine the prevalence of reported new cases of drug dependence (heroin) and HIV over time as well as associations between drug dependence and alcoholism, hepatitis B and C, and tuberculosis in the City of St. Petersburg and the Leningrad region. We found a sharp rise in reported cases of IDU beginning in 1991 and continuing until 2002/2003, followed by a sharp rise in newly reported cases of HIV. These rises were followed by a drop in new cases of HIV and drug addiction in 2002/2003 and a drop in the proportion of HIV-positive individuals with IDU as a risk factor. Infection with hepatitis B and C were common, especially among injection drug users (38 and 85%, respectively), but also in alcoholics (7 and 14%). Tuberculosis was more common in alcoholics (53%) than in persons with alcoholism and drug dependence (10%), or with drug dependence alone (4%). Though these data have many limitations, they clearly demonstrate that drug dependence and/or alcoholism, HIV, hepatitis, and tuberculosis frequently co-occur in St. Petersburg and the Leningrad Region. Prevention and treatment services across medical specialties should be integrated to address the wide range of issues that are associated with these co-morbidities.
Collapse
Affiliation(s)
- E M Krupitsky
- Scientific Research Center of Addiction and Psychopharmacology, St. Petersburg State Pavlov Medical University, St. Petersburg, Russia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Sullivan LE, Fiellin DA. Buprenorphine: Its Role in Preventing HIV Transmission and Improving the Care of HIV-Infected Patients with Opioid Dependence. Clin Infect Dis 2005; 41:891-6. [PMID: 16107991 DOI: 10.1086/432888] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2005] [Accepted: 05/22/2005] [Indexed: 11/03/2022] Open
Abstract
In the United States, approximately 25% of the 40,000 new human immunodeficiency virus (HIV) infections each year are secondary to injection drug use. Worldwide, there are an estimated 12.6 million injection drug users, and 10% of HIV infections (420,000 infections in 2003) are associated with this practice. Buprenorphine is a new medication used to treat opioid dependence that shows promise for reducing the rate of HIV transmission and improving the care of opioid-dependent patients with HIV infection. Although buprenorphine faces fewer clinical and regulatory barriers than does methadone, the optimal strategy for integration of office-based treatment of opioid dependence and HIV disease is an area of ongoing research. This review addresses the introduction of buprenorphine, in terms of public health, policy, and clinical implications for HIV-infected patients and for HIV care providers.
Collapse
Affiliation(s)
- Lynn E Sullivan
- Yale University School of Medicine, New Haven, Connecticut 06520-8025, USA.
| | | |
Collapse
|
28
|
Krupitsky EM, Horton NJ, Williams EC, Lioznov D, Kuznetsova M, Zvartau E, Samet JH. Alcohol use and HIV risk behaviors among HIV-infected hospitalized patients in St. Petersburg, Russia. Drug Alcohol Depend 2005; 79:251-6. [PMID: 16002034 PMCID: PMC1360173 DOI: 10.1016/j.drugalcdep.2005.01.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2004] [Revised: 01/03/2005] [Accepted: 01/03/2005] [Indexed: 12/18/2022]
Abstract
PURPOSE Russia has high per capita alcohol consumption and an injection-drug-use-driven HIV epidemic. However, the role of alcohol in the spread of HIV infection in Russia is largely unexplored. Thus, we assessed recent alcohol use and associated HIV risk behaviors among HIV-infected persons in St. Petersburg, Russia. METHODS We recruited HIV-infected hospitalized patients from the Botkin Infectious Disease Hospital between June 2001 and March 2002. Interviewers assessed alcohol and drug use with the addiction severity index (ASI) and sex- and drug-risk behaviors with the risk assessment battery (RAB). Lifetime abuse or dependence diagnoses for alcohol and drugs were established by a physician with addiction medicine training. RESULTS Among 201 subjects, diagnoses of abuse or dependence (AB/DEP) were common: 9% (19/201) had only alcohol AB/DEP; 39% (78/201) had alcohol and drug AB/DEP; 47% (95/201) had only drug AB/DEP; and 4% (9/201) had no diagnosis of alcohol or drug AB/DEP. Sex- and drug-risk behaviors varied significantly by substance use diagnosis. Subjects with any alcohol AB/DEP had higher sex-risk RAB scores than those with drug only AB/DEP (6.1 versus 3.9, p<.0001). Among subjects with any diagnosis of drug AB/DEP, having in addition an alcohol diagnosis was associated with unclean needle use in the last six months (33% (26/78) versus 21% (20/95), p=0.08). CONCLUSIONS Lifetime alcohol diagnoses of abuse or dependence were present in nearly one-half of hospitalized HIV-infected patients in St. Petersburg, Russia and were associated with significantly higher sex-risk behaviors and borderline significantly higher drug-risk behaviors. As HIV infection spreads rapidly in Russia and Eastern Europe, these data support the need for HIV risk-reduction interventions in alcohol abusing populations and raise the potential of benefit by addressing alcohol use in HIV-infected populations.
Collapse
Affiliation(s)
- Evgeny M Krupitsky
- St. Petersburg Scientific-Research Center of Addictions and Psychopharmacology, St. Petersburg State Pavlov Medical University, St. Petersburg 197089, Russia
| | | | | | | | | | | | | |
Collapse
|
29
|
Barassi C, Soprana E, Pastori C, Longhi R, Buratti E, Lillo F, Marenzi C, Lazzarin A, Siccardi AG, Lopalco L. Induction of murine mucosal CCR5-reactive antibodies as an anti-human immunodeficiency virus strategy. J Virol 2005; 79:6848-58. [PMID: 15890924 PMCID: PMC1112124 DOI: 10.1128/jvi.79.11.6848-6858.2005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The genital mucosa is the main site of initial human immunodeficiency virus type 1 (HIV-1) contact with its host. In spite of repeated sexual exposure, some individuals remain seronegative, and a small fraction of them produce immunoglobulin G (IgG) and IgA autoantibodies directed against CCR5, which is probably the cause of the CCR5-minus phenotype observed in the peripheral blood mononuclear cells of these subjects. These antibodies recognize the 89-to-102 extracellular loop of CCR5 in its native conformation. The aim of this study was to induce infection-preventing mucosal anti-CCR5 autoantibodies in individuals at high risk of HIV infection. Thus, we generated chimeric immunogens containing the relevant CCR5 peptide in the context of the capsid protein of Flock House virus, a presentation system in which it is possible to engineer conformationally constrained peptide in a highly immunogenic form. Administered in mice via the systemic or mucosal route, the immunogens elicited anti-CCR5 IgG and IgA (in sera and vaginal fluids). Analogous to exposed seronegative individuals, mice producing anti-CCR5 autoantibodies express significantly reduced levels of CCR5 on the surfaces of CD4+ cells from peripheral blood and vaginal washes. In vitro studies have shown that murine IgG and IgA (i) specifically bind human and mouse CD4+ lymphocytes and the CCR5-transfected U87 cell line, (ii) down-regulate CCR5 expression of CD4+ cells from both humans and untreated mice, (iii) inhibit Mip-1beta chemotaxis of CD4+ CCR5+ lymphocytes, and (iv) neutralize HIV R5 strains. These data suggest that immune strategies aimed at generating anti-CCR5 antibodies at the level of the genital mucosa might be feasible and represent a strategy to induce mucosal HIV-protective immunity.
Collapse
Affiliation(s)
- C Barassi
- Infectious Diseases Clinic, San Raffaele Scientific Institute, via S. D'Ancona 20, 20127 Milano, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|