People with HIV in HAART-Era Russia: Transmission Risk Behavior Prevalence, Antiretroviral Medication-Taking, and Psychosocial Distress
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Russia has seen one of the world’s fastest-growing HIV epidemics. Transmission risk behavior, HAART-taking, and psychosocial distress of the growing population of Russian people living with HIV (PLH) in the HAART era are understudied. Participants of a systematically-recruited cross-sectional sample of 492 PLH in St. Petersburg completed measures of sexual and drug injection practices, adherence, perceived discrimination, and psychosocial distress. Since learning of their status, 58% of participants had partners of HIV-negative or unknown serostatus (mean = 5.8). About 52% reported unprotected intercourse with such partners, with 30% of acts unprotected. Greater perceived discrimination predicted lower condom use. A 47% of IDU PLH still shared needles, predicted by having no primary partner, lower education, and more frequently-encountered discrimination. Twenty-five percentage of PLH had been refused general health care, 11% refused employment, 7% fired, and 6% forced from family homes. Thirty-nine percentage of participants had probable clinical depression, 37% had anxiety levels comparable to psychiatric inpatients, and social support was low. Of the 54% of PLH who were offered HAART, 16% refused HAART regimens, and 5% of those on the therapy took less than 90% of their doses. Comprehensive community services for Russian PLH are needed to reduce AIDS-related psychosocial distress and continued HIV transmission risk behaviors. Social programs should reduce stigma and discrimination, and promote social integration of affected persons and their families.
KeywordsAcquired immunodeficiency syndrome Russia Sexual behavior Needle sharing Mental health HAART adherence
Conduct of this research and preparation of the paper were supported by grants P30-MH52776 and R24-MH082471 from the U.S. National Institute of Mental Health. The authors thank the study participants and also Anastasia G. Kuyanova, Rudolph A. Amirkhanian, Maria Donskaya, and Roman A. Khoursine at ICART; Aza G. Rakhmanova, Svetlana V. Zhukova, Irina D. Yevseyeva, and Vladislav N. Koryagin at the Botkin Hospital for Infectious Diseases; Natalya V. Bodosova, Elena V. Stepanova, Olga V. Koltsova, and Olga N. Leonova at the AIDS Center, Infectious Disease Hospital #10 and PLH self-support groups in St. Petersburg; and Ruzanna Aleksanyan, Timothy L. McAuliffe, Tom Lytle, Anton M. Somlai, David W. Seal, Steven D. Pinkerton, Michelle Anderson-Lamb, and Allan C. Hauth at the Medical College of Wisconsin for their assistance in the research.
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