Individual-level, network-level and city-level factors associated with HIV prevalence among people who inject drugs in eight Russian cities: a cross-sectional study.

OBJECTIVES: To ascertain HIV prevalence among people who inject drug (injection drug users (IDUs)) in the Russian Federation and identify explanations for the disparity in different cities. DESIGN: Cross-sectional survey with serological testing for HIV and hepatitis C virus prevalent infections. SETTING: 8 Russian cities-Irkutsk, Omsk, Chelyabinsk, Yekaterinburg, Naberezhnye Chelny, Voronezh, Orel and St Petersburg. PARTICIPANTS: In 2007-2009 active IDUs were recruited by respondent-driven sampling with a target sample size of 300 or more in each city. MAIN OUTCOME MEASURES: Participants were administered a questionnaire covering sociodemographics, injection risk and protective behaviours, sexual behaviours, HIV knowledge, experiences with drug treatment and harm reduction programmes and social networks. Participants were tested for HIV and hepatitis C by enzyme immunoassay. Data were analysed to identify individual-level, network-level and city-level characteristics significantly associated with HIV prevalence. Factors significant at p≤0.1 were entered into a hierarchical regression model to control for multicollinearity. RESULTS: A total of 2596 active IDUs were recruited, interviewed and tested for HIV and hepatitis C virus infection. HIV prevalence ranged from 3% (in Voronezh) to 64% (in Yekaterinburg). Although individual-level and network-level variables explain some of the difference in prevalence across the eight cities, the over-riding variable that seems to account for most of the variance is the emergence of commercial, as opposed to homemade, heroin as the predominant form of opioid injected. CONCLUSIONS: The expansion of commercial heroin markets to many Russian cities may have served as a trigger for an expanding HIV epidemic among IDUs in that country.

'In different situations, in different ways': male sex work in St. Petersburg, Russia.

We conducted a qualitative study of male sex work in St. Petersburg Russia with a focus on social vulnerabilities, HIV-risk perception and HIV-related behaviours. In-depth interviews were conducted with individuals knowledgeable about male sex work through their profession and with male sex workers themselves. Male sex work involves a variety of exchanges, including expensive vacations, negotiated monetary amounts or simply access to food. Methods of finding clients included the Internet, social venues (e.g. gay clubs and bars) and public places (e.g. parks). Use of the Internet greatly facilitated male sex work in a variety of ways. It was used by both individuals and agencies to find clients, and appeared to be increasing. Men often reported not being professionally connected to other male sex workers and limited disclosure about their work. Many were aware of the work-related risks to personal safety, including violence and robbery by clients. Perceived risk for HIV was mostly abstract and several exceptions to condom use with clients were noted. Alcohol use was reported as moderate but alcohol was consumed frequently in association with work. These data suggest that the most salient risks for male sex workers include professional isolation, threats to personal safety, limited perceived HIV risk and sub-optimal levels of condom use.

Clients of street-based female sex workers and potential bridging of HIV/STI in Russia: results of a pilot study.

In Russia, sexual transmission of HIV is increasing and street-based female sex workers (FSW) have a high HIV prevalence, but the role of male clients of FSW in HIV transmission and bridging to the general population has not been studied. Sixty-two male clients completed structured interviews during February-March of 2010 in St. Petersburg Russia. Descriptive analyses focused on condom use with different types of sex partners, substance use, and STI/HIV testing histories. The median lifetime and past 12 month numbers of FSW partners were 10 and 3, respectively. A majority of clients (74%) reported having non-FSW partners during the past 12 months, and nearly half (47%) reported having regular sex partners. Consistent condom use was reported in 61% of relationships with FSW partners and in 43% of relationships with non-FSW partners. A majority of clients (58%) was classified as active or potential bridgers based on having both FSW and non-FSW partners and reporting inconsistent condom use with their non-FSW partners. A majority (61%) also reported concurrent partnerships with FSW and non-FSW partners. Nearly half (48%) of last contacts with FSW partners involved consumption of alcohol by the client. Noninjection and injection drug use in the past 30 days were reported by 15% and 7% of clients, respectively. Twenty-nine percent reported history of a sexually transmitted infection (STI) and 74% reported a previous HIV test; active/potential bridgers were significantly less likely than unlikely bridgers to have ever been tested for HIV. These data signal the potential for HIV/STI transmission among male clients of street-based FSW in St. Petersburg Russia due to their variety of partner types, sub-optimal condom use, and concurrent partnerships. Larger studies are needed to confirm these findings, further explore the roles of alcohol and drug use, and identify effective strategies and interventions for HIV prevention.