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ESCALATING HIV AND HEPATITIS C RATES AND RISK BEHAVIOUR AMONG IDUs IN RUSSIA: RESULTS OF THE CANADA AIDS RUSSIA PROJECT
L Calzavara1, A Yakovlev3, T Nikitina4, G Volkova2, M Michalchenko2, V Orekhovsky1, V Saldahna2
1HIV Social, Behavioural and Epidemiological Studies Unit, University of Toronto, Toronto, Ontario; 2Canada AIDS Russia Project (CARP), St Petersburg, Russia; 3Botkin Hospital, St Petersburg, Russia; 4Provincial AIDS Centre, Kaliningrad, Russia
Objectives: To identify the risk factors for HIV and HCV among IDUs in Russia; and implications for interventions.
Methods: As part of the skills-building objective of the Canada AIDS Russia Project, in June 2000, 9 focus group discussions were held with male and female IDUs (N=63) recruited through service organizations in the cities of St Petersburg and Kaliningrad. Information on prevalence and determinants of risk, access to services/health care, and prevention was collected using questionnaires and discussion sessions. Quantitative data were entered in SAS for descriptive analysis, and the focus groups were audiotaped, transcribed, and analyzed for common themes.
Results: Participants ranged from 16 to 50 years of age (mean=25); 49% were females, 49% were HIV+, and 56% were HCV+. Mean age first injected was 18 years (range 12-46). Heroin was the most commonly used drug (93%). Unsafe injecting was common. Over 70% injected 6+ times/week, 73% reported sharing needles, and 85% shared with 2+. Multiple partners and unprotected sex were common. 70% reported 2+ partners in the last year, and 66% never or rarely used condoms. 18% had exchanged sex for money, drugs or goods. Risk behaviour among known-infected is high, and discrimination leads to low disclosure. Methadone is illegal. Needle exchanges are limited and fear of arrest further limits access. 33% had been arrested for drug use.
Conclusions: Russia currently has one of the highest rates of HIV transmission. The number of registered cases quadrupled to over 80,000 in the last two years. 90% of new cases are among the estimated 2 million IDUs. Urgently needed action is hindered by failure to understand the seriousness of the “new” IDU problem, the lack of resources, and punitive attitudes toward IDUs. The transfer of Western resources, skills, and lessons learned are essential in assisting Russia deal with its IDU-related problems.