HIV testing and access to HIV medical care among people who inject drugs and their intimate partners in Kazakhstan.

BACKGROUND: Growing rates of HIV and high rates of injection drug use in Kazakhstan call for examining access to testing and treatment among people who inject drugs and their intimate partners. OBJECTIVES: We examine how access to health and drug treatment services as well as risk environment factors are associated with ever being tested for HIV and ever receiving any general HIV medical care among 728 male and female intimate partners where at least one partner injects drugs. METHODS: Multivariate random effects logistic regression with random effects for couple were conducted to examine associations between access to health and drug treatment services, risk environment factors, and HIV testing and HIV medical care outcomes. RESULTS: Analyses indicate that accessing needle exchange services and having a regular physician were associated both with access to HIV testing and HIV medical care. Receiving drug treatment was associated with accessing HIV testing but not HIV medical care. Being arrested and charged with a criminal offense was also associated with accessing HIV testing but not HIV medical care. CONCLUSIONS/IMPORTANCE: Study findings highlight the need for increased scale-up of HIV testing efforts, as well as integrated HIV treatment and care in Kazakhstan.

Depression Among People Who Inject Drugs and Their Intimate Partners in Kazakhstan.

This paper examines individual, social, and structural factors associated with depression among 728 people who inject drugs (PWID) and their intimate partners in Kazakhstan, with separate multivariate models by gender. Depression scores were higher on average among participants of both genders who recently experienced sexual intimate partner violence, food insecurity, and who had lower levels of self-rated health. Among females, higher depression scores were associated with experiencing childhood sexual abuse, lower levels of social support, and not having children. Findings highlight a need to incorporate gender differences and factors associated with depression in designing mental health services for PWID in Kazakhstan.

HIV among injection drug users and their intimate partners in Almaty, Kazakhstan.

This paper examines prevalence rates of HIV, HCV, and syphilis among a sample of injecting drug users (IDUs) and their heterosexual intimate partners (N = 728) from Almaty, Kazakhstan. The study uses baseline data from Project Renaissance, a couple-based HIV prevention intervention delivered to a couple where one or both partners are IDUs. HIV prevalence rates among female and male IDUs were 28 %. Among the full sample, 75 % had HCV, and 13 % tested positive for the syphilis antibody test. Only 10 % of the sample ever visited a needle exchange program. One-fourth (25.3 %) had never been tested for HIV. One-quarter of those who tested positive were unaware of their status. Being HIV positive was associated with a history of incarceration, being an IDU, and having access to needle exchange programs. The findings call for increasing efforts to improve access to HIV testing, prevention, treatment, and care for IDUs in Almaty, Kazakhstan.

Computerized intervention to prevent drug use among at-risk adolescents in Central Asia: Preliminary family-level findings from a pilot mixed methods trial.

BACKGROUND: The rapidly growing rates of HIV infection in Kazakhstan are largely driven by injection drug use. The study adapts a family-focused evidence-based HIV and substance use prevention intervention for at-risk adolescents from communities in Almaty that have been greatly affected by heroin trade and use. METHODS: This NIDA-funded pilot feasibility trial included 181 at-risk adolescents (ages 14-17) recruited through local schools and 181 of their parents or other adult family members. To be eligible, youth had to reside in city areas with high drug exposure and have at least one personal or family risk factor (e.g., substance-using family members or friends, parental criminal history). In addition to the standard school-based health education program on drug use and HIV, intervention arm adolescent-caregiver dyads received three pilot computerized sessions focused on caregiver-adolescent communication, support and monitoring. Adolescents and caregivers completed ACASI surveys in Russian at baseline, 3- and 6-month follow-ups and a subsample from the treatment group (n = 24 dyads) also participated in post-intervention focus group interviews. RESULTS: At 6-month follow-up, small effect sizes were detected for parenting practices as the key theoretical mediating variable. Intervention arm participants reported a reduction in harsh discipline practices (Cohen's d= -.35, p = .026), an increase in positive and supportive parenting (d = 0.26, p = .042), and a decline in poor monitoring (according to caregivers d = -0.23, p = .137 and adolescents d = -0.25, p = .113). Post-intervention focus groups provided examples of how the intervention content allowed caregivers to reconnect with their children and get more involved in each other's lives. CONCLUSION: In middle-income countries like Kazakhstan, interventions that integrate family involvement approaches and utilize interactive technologies may represent an engaging and potentially effective tool with high fidelity and easy scalability to reduce substance use and other risk-taking behaviors among at-risk youth.

Factors associated with self-rated health among migrant workers: results from a population-based cross-sectional study in Almaty, Kazakhstan.

OBJECTIVES: To determine factors associated with SRH among migrant workers in Almaty, Kazakhstan. METHODS: In 2007, 805 vendors were screened. Approximately half were eligible (n =450), defined as at least 18 years old, a worker/owner in a randomly selected stall, having traveled 2 + hours outside of Almaty within the past year, and being an internal/external migrant. 28 non-migrants were excluded, leaving 422 participants. Logistic regression was used to examine the relationship between SRH, mental health, and psychosocial problems. RESULTS: Approximately 46% reported having poor or fair SRH. Clinical depression (OR 0.859, 95% CI 0.342-2.154), alcohol problems (OR 1.169, 95% CI 0.527-2.593), and legal status (OR 0.995, 95% CI 0.806-1.229) were not significantly associated with SRH, nor was exposure to interpersonal violence among women (OR 1.554, 95% CI 0.703-3.435). After adjusting for key variables, only ethnicity and social support were found to be significantly protective against poor or fair SRH. CONCLUSIONS: SRH was not a comprehensive health measure for these Central Asian migrant workers. More specific questions are needed to identify mental illness and interpersonal violence.

Mental health and migration: depression, alcohol abuse, and access to health care among migrants in Central Asia.

One-fifth of Kazakhstan's population is labor migrants working in poor conditions with limited legal rights. This paper examines self-rated health, mental health and access to health care among migrant workers. Using geo-mapping, a random sample of internal and external migrant market workers was selected in Almaty (N = 450). We used survey logistic regression adjusted for clustering of workers within stalls. Almost half of participants described their health as fair or poor and reported not seeing a doctor when needed, 6.2% had clinical depression and 8.7% met criteria for alcohol abuse. Female external migrants were at higher risk for poor health and underutilization of health services. High mobility was associated with depression among internal migrants and with alcohol abuse among female migrant workers. This study demonstrates the urgent need to address health and mental health needs and improve access to health care among labor migrants in Central Asia.

HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: implications for HIV prevention, research, and policy.

BACKGROUND: Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, which has historically been driven by injection drug use, but is more recently being fueled by heterosexual transmission. METHODS: This paper examines HIV and HCV infection, as well as sexual and drug-related risks among female partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics. RESULTS: The prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partners of MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Less than one-fifth of all female participants had access to HIV education and services or harm reduction programs. Although high rates of non-injection drug use and sexual risk behaviors were found among both FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIV seropositive (aRR=3.03; 95% CI=1.78, 5.18) and HCV seropositive than non-IDU females (aRR=6.05; 95% CI=4.05, 9.04), were more likely to have used alcohol or drugs before sex (aRR=1.67; 95% CI=1.40, 2.00), and were more likely to have used sedatives, barbiturates, tranquilizers, sleeping pills, or painkillers that were not prescribed by a physician (aRR=17.45; 95% CI=8.01, 38.01). CONCLUSION: Given the spread of the HIV epidemic to heterosexual partners in Kazakhstan, more attention is needed in research, prevention, and policies regarding female partners of male injection drug users.

Effects of a couple-based intervention to reduce risks for HIV, HCV, and STIs among drug-involved heterosexual couples in Kazakhstan: a randomized controlled trial.

OBJECTIVE: Project Renaissance is a randomized controlled trial of an HIV/hepatitis C virus (HCV)/sexually transmitted infection (STI) prevention intervention conducted in Almaty, Kazakhstan. We hypothesized that couples assigned to the intervention of interest will have lower incidence of HIV, HCV, STIs, rates of unprotected sex, and unsafe injection over the 12-month follow-up period compared with those assigned to an attention control arm. DESIGN: A total of 300 couples (600 participants) where one or both partners reported injecting drugs in the past 90 days were randomized to 1 of 2 arms: (1) a 5-session HIV/HCV/STI prevention intervention (risk reduction: RR) or (2) a 5-session Wellness Promotion (WP) intervention. RESULTS: Over the 12-month follow-up period, assignment to RR compared with WP significantly lowered the incidence of HCV infection by 69% [incidence rate ratios (IRR) = 0.31, 95% (CI) confidence interval: 0.10 to 0.90, P = 0.031]. Although differences were not statistically significant, RR participants had a lower incidence of HIV infection by 51% (IRR = 0.49, 95% CI: 0.16 to 1.48, P = 0.204) and any STI by 37% (IRR = 0.63, 95% CI: 0.21 to 1.93, P = 0.418) than WP participants. RR participants reported significantly fewer numbers of unprotected vaginal sex acts with their study partners (IRR = 0.58, 95% CI: 0.36 to 0.93, P = 0.024) and more consistent condom use (odds ratios = 2.30, 95% CI: 1.33 to 4.00, P = 0.003) over the entire follow-up period compared with WP participants. CONCLUSIONS: Project Renaissance demonstrated a significant effect for biological and behavioral endpoints. Findings draw attention to an HIV/HCV/STI prevention intervention strategy that can be scaled up for drug-involved couples in harm reduction programs, drug treatment, and criminal justice settings.

Couple-based HIV prevention for injecting drug users in Kazakhstan: a pilot intervention study.

This pilot randomized controlled trial in Kazakhstan aimed to adapt and test the feasibility of a couple-based HIV/STI risk-reduction intervention (CHSR) for couples who are injecting drug users (IDUs). The study examined the preliminary effects of the intervention versus an attentional control wellness promotion (WP) condition on HIV risk behavioral outcomes among 40 couples who are IDUs (n = 80 participants). Compared with WP participants, CHSR participants were significantly more likely to increase condom use and decrease unsafe injection acts at the 3-month follow-up. This pilot trial demonstrates the feasibility and preliminary effects of the CHSR in reducing drug-related and sexual HIV risks.