Risky sex and drug use are common among HIV-positive people in Russia, investigators report in AIDS and Behavior. Discrimination was a common experience, and
there was a high prevalence of depression and anxiety.
“Policies and public health programs for PLH [people living
with HIV] need to focus on comprehensive strategies to address continuing
transmission risk behaviors as well as improve…psychological well-being [and]
social circumstances,” comment the study’s authors.
Russia has one of the fastest growing HIV epidemics in the
world, and it is estimated that as many as 940,000 people in the country
(1.1% of the population) are HIV-positive.
However, little is known about the transmission risk
behaviours, mental health characteristics, and levels of adherence to
antiretroviral therapy among Russia’s HIV-positive patients.
St Petersburg is an epicentre of the epidemic in Russia, and
in 2008-09 investigators from the city conducted a cross sectional study that
included 492 HIV-positive adults.
These patients completed questionnaires enquiring about
their demographics, disclosure of HIV, experience of perceived discrimination,
sexual and drug use behaviour, use of HIV therapy and adherence, and mental
The patients had a mean age of 30, and 53% reported they
were in employment. The overwhelming majority (86%) reported that they were
exclusively heterosexual, and the patients had been living with diagnosed HIV
infection for a mean of 58 months.
There were high rates of disclosure to family members (80%),
close friends (76%), or other people with HIV (68%).
However, reported discrimination was common. A fifth of
patients reported that they had been tested for HIV without their consent. Moreover,
a quarter of patients reported that they had been refused medical care, including
9% who said that they had been refused general health care because of their HIV
status. In addition, 12% of respondents said that they had been forced by the
police or their physician to sign a written statement declaring their
HIV-positive status, “a procedure used to create evidence that may form the
basis for criminal charges against those suspected of putting others at risk”.
Many reported that they had experienced discrimination in
the workplace. Approximately 11% had been refused a job because they were
HIV-positive, 7% said they had been dismissed from employment because of their
status, and 6% stated that they had been forced by family members to leave
their homes due to their infection.
Mental health distress was common. Clinical depression was
present in 39% of individuals and 37% had anxiety levels comparable to those
found in psychiatric inpatients.
“Levels of depression, anxiety, and poor social support in
this sample…were high and prevalent. Reports of discrimination were also common
and show that AIDS-related stigma remains high in Russia,” comment the authors.
Unprotected sex with a partner of the opposite sex who was
HIV-negative or of an unknown status was reported by 58% of individuals. Higher
rates of sexual risk behaviour (71%) were present in men who have sex with men.
Overall, approximately one-third of all acts of anal or vaginal sex were
Greater experience of perceived HIV-related discrimination
was associated with poorer condom use (p = 0.012).
A history of injecting drug use was reported by 346 people, and 52% of these
individuals said they had injected in the past three months. Needle sharing was
reported by 47% of these patients.
Sharing needles was associated with not having a primary
partner, lower levels of education, and experiencing discrimination (all p <
“These findings demonstrate the need to implement programs
designed to encourage…risk reduction for infected persons seen in HIV clinical,
social support, or other care service programs,” write the investigators.
Antiretroviral therapy had been offered to 54% of the
patients. Two-thirds of these individuals were taking treatment, 18% were
waiting to start, and 16% had declined. The median duration of therapy was a
little under 20 months.
Not being offered HIV therapy was associated with shorter
duration of HIV infection (p < 0.01), and depression (p < 0.01). Poor
mental health was also associated with a refusal to start taking antiretroviral
therapy (p < 0.01).
Reported adherence was high: 90% of patients had an
adherence level of at least 90%.“However, we relied on self-reports of adherence for only a
2-day period, and self-report data can reflect an underreporting of socially
undesirable responses,” caution the investigators. Heroin use in the past three months was associated with
poorer adherence (p < 0.01).
Concerned by their findings, the authors conclude: “It is
imperative that PLH in Russia should receive improved and tailored services to
reduce HIV transmission risk behaviors and improve life quality.”