Alcohol use and HIV risk behaviors among HIV-infected hospitalized patients in St. Petersburg, Russia

Abstract

Purpose: Russia has high per capita alcohol consumption and an injection-drug-use-driven HIV epidemic. However, the role of alcohol in the spread of HIV infection in Russia is largely unexplored. Thus, we assessed recent alcohol use and associated HIV risk behaviors among HIV-infected persons in St. Petersburg, Russia. Methods:We recruited HIV-infected hospitalized patients from the Botkin Infectious Disease Hospital between June 2001 and March 2002. Interviewers assessed alcohol and drug use with the addiction severity index (ASI) and sex-and drug-risk behaviors with the risk assessment battery (RAB). Lifetime abuse or dependence diagnoses for alcohol and drugs were established by a physician with addiction medicine training.Results: Among 201 subjects, diagnoses of abuse or dependence (AB/DEP) were common: 9% (19/201) had only alcohol AB/DEP; 39% (78/201) had alcohol and drug AB/DEP; 47% (95/201) had only drug AB/DEP; and 4% (9/201) had no diagnosis of alcohol or drug AB/DEP. Sex-and drugrisk behaviors varied significantly by substance use diagnosis. Subjects with any alcohol AB/DEP had higher sex-risk RAB scores than those with drug only AB/DEP (6.1 versus 3.9, p < .0001). Among subjects with any diagnosis of drug AB/DEP, having in addition an alcohol diagnosis was associated with unclean needle use in the last six months (33% (26/78) versus 21% (20/95), p = 0.08).Conclusions: Lifetime alcohol diagnoses of abuse or dependence were present in nearly one-half of hospitalized HIV-infected patients in St. Petersburg, Russia and were associated with significantly higher sex-risk behaviors and borderline significantly higher drug-risk behaviors. As HIV infection spreads rapidly in Russia and Eastern Europe, these data support the need for HIV risk-reduction interventions in alcohol abusing populations and raise the potential of benefit by addressing alcohol use in HIV-infected populations.

Drug Abuse in People Living with HIV in the Era of Highly Active Antiretroviral Therapy: A Systematic Review and Meta-Analysis

“…Furthermore, alcohol abuse was not considered in estimating the prevalence of drug abuse in some of the included studies. In fact, 16 of the 31 studies reporting prevalence estimates of drug abuse assessed alcohol abuse separately [17,22,23,28,36,39,[42][43][44]58,60,63,66,73,76,85], which may potentially suggest that the pooled prevalence of drug abuse in our study population of HIV-infected patients is likely to be underestimated. The dearth of studies reporting abuse of nicotine and over-the-counter medications (such as non-steroidal anti-inflammatory drugs and cold and cough medicines) precluded estimates of the prevalence of these potential drugs of abuse among people living with HIV.…”

Asociación entre el consumo de alcohol y la infección por virus de inmunodeficiencia humana

“…Una revisión sistemática previa ha demostrado que el alcohol produce cambios conductuales que pueden favorecer la exposición de riesgo de las personas, tanto varones como mujeres, especialmente en su sexualidad 21 . Inclusive, el consumo de alcohol puede potenciar el efecto de otras drogas como la cocaína o el crack, lo que puede potenciar las conductas de riesgo 22 , y disminuir la práctica de sexo seguro en las personas de diversas orientaciones sexuales 23 . Asimismo, otros estudios han mostrado que la ingesta de grandes cantidades de alcohol está asociada a falla en la adherencia a tratamiento de largo plazo como es el caso del VIH 4 , por lo que es necesaria la aplicación de otras estrategias para evitar el desarrollo de formas resistentes del virus 24 .…”

The global economic burden of alcohol: a review and some suggestions

“…unprotected sex, multiple sex worker partners) (e.g. 63,64), which is in turn a risk factor for STDs (65)(66)(67)(68)(69). As discussed at length above, though, the difficulty lies in teasing out the causal link from a multitude of simple associational data.…”