There is nearly no other country in the world where HIV spreads out as rapidly as in Russia. In the heart of Russia’s epidemic are extraordinarily large numbers of young people who inject drugs. According to the World Health Organisation (WHO), there were more than 340,000 registered injecting drug users in the Russian Federation at the end of 2004, although the actual number of injectors could be four to ten times as high.
The epidemic is now becoming more mature. Most addicts are sexually active and, if HIV-infected, they can transmit the virus sexually to their casual or regular partners. Studies in Togliatti and Nizhny Novgorod found that more than 80 per cent of male drug injectors did not use condoms regularly. Also, alcohol use is highly pervasive in Russia, and has been associated with sexual HIV risk-taking behavior. The WHO reported that by 2001 six per cent of registered HIV infections were related to sexual transmission; by 2004, that proportion had grown to 25 per cent.
In the current issue of the journal Adddiction Jeffrey Samet, MD, chief of the Section of General Internal Medicine at Boston University School of Medicine and Boston Medical Center, concludes that sexual behaviour should be considered an important component among Russian substance-dependent people, in order to decrease risky sexual behaviour. "A behavioral intervention to reduce unsafe sex is an essential component to HIV prevention, and is critical in the absence of a cure or vaccine", he writes.
Researchers compared the current method used to decrease unsafe sexual behavior with the Russian Partnership to Reduce the Epidemic Via Engagement in Narcology Treatment (PREVENT) intervention program. Participants were HIV-positive and negative, and were assigned to either the PREVENT program or the standard addiction treatment.
PREVENT sessions occurred at the hospital and involved obtaining HIV test results, discussion of personal risk and creation of a behavioral change plan. Interventionists provided test results and explained the risk reduction plan to promote safe sex that included using condoms, building sexual-negotiation skills, developing positive attitudes regarding safe sex and emphasizing alcohol and drugs role in impairing judgment. After patients were discharged from the hospital, telephone updates took place for three months. Interventionists checked in and updated participants' personal long-term risk reduction goals and plans.
Participants assigned to the standard addiction treatment program received the usual addiction treatment at the hospital, including HIV testing, but no sexual behavior counseling. Those known to be HIV-infected or who tested positive received a 20-minute HIV post-test counseling session with the study interventionists. This session included creating risk reduction goals and a referral to an HIV care program. Subjects were contacted for study check ups, but not counseled. Both participants of the standard addiction treatment and PREVENT program received condoms upon leaving the hospital.
The researchers found that when comparing the two forms of intervention, participants of the PREVENT program had a higher percentage of safe sex than did the standard addiction participants at the six month follow-up visits. "Both control and intervention groups had improvements in the percentage of safe sex occurrences, restraining from unprotected sex and increasing condom use between baseline and the three month follow-up. While the intervention group maintained or improved their safe sex behaviors at the six month follow-up, the standard addiction treatment group worsened," said Samet.
The Russian PREVENT trial demonstrates that an HIV intervention program targeting the sexual behaviors of alcohol and drug users is feasible in inpatient substance abuse treatment settings, and is effective in increasing safe sex.
Photo: CDC/ C. Goldsmith, P. Feorino, E. L. Palmer, W. R. McManus