Correlates of unprotected sexual intercourse among women who inject drugs or who have sexual partners who inject drugs in St Petersburg, Russia

Abstract

Objectives To assess risk for unintended pregnancy, this study describes the correlates of unprotected sexual intercourse (UPSI) among women who inject illicit drugs or who have sexual partners who inject drugs in St Petersburg, Russia. Methods Data from a cross-sectional survey and biological test results collected between 2005 and 2008 from 202 Russian women (143 drug injectors and 59 non-drug injectors) were analysed. Multivariate regression was used to investigate the correlates of UPSI occurring at the women’s last sexual act. Independent variables included socio-demographics, age at sexual debut, first sexual encounter perceived as involuntary, number of pregnancies and number of children for which the participant is the primary caretaker, heavy sporadic drinking (i.e. consuming more than five drinks in 2 hours at least twice a month), at-risk drinking per the Alcohol Use Disorder Identification Test (AUDIT-C) score, and sexually transmitted infections (HIV-1, syphilis serology, Chlamydia trachomatis and Neisseria gonorrheae). Results Sixty-seven percent of women reported UPSI at last intercourse. UPSI was independently associated with heavy sporadic drinking [odds ratio (OR) 2.8, 95% CI 1.2–6.6] and having been pregnant (OR 2.25, 95% CI 1.1–4.6). Conclusions Despite the high risk for HIV acquisition or transmission and unintended pregnancy, condom use among the study population is low. Programmes to investigate and improve contraceptive use, including condom use, among this vulnerable group of women are needed. Such programmes may require identifying and targeting female reproductive health concerns and problem drinking, particularly heavy sporadic drinking, rather than conventional measures of alcohol misuse.

Association between Pregnancy and Active Injection Drug Use and Sex Work among Women Injection Drug Users in Saint Petersburg, Russia

“…Thirty percent of currently pregnant WIDUs found out about their pregnancies after 12 weeks of gestation, eliminating the opportunity to cease drug use during the first trimester or legally terminate the pregnancy. Other studies conducted in Saint Petersburg have demonstrated that WIDUs need comprehensive intervention programs aimed at primary, secondary, and tertiary prevention of HIV infection; 30 , 31 prevention of unplanned and unwanted pregnancies; 11 , 12 and assistance in changing risk behaviors in pregnant WIDUs.…”

“…Age and education were found to be important confounders in other studies. 12 Little is known about parental status as a potential confounder of the association between pregnancy and active injection drug use and/or sex work, but some evidence indicates it might be a confounder. 23 , 24 All potential covariates were associated both with exposure and the outcomes in bivariate analyses and met the criteria for being potential confounders according to constructed directed acyclic graphs (DAGs).…”

“…One such study’s finding was that only 22 % of WIDUs in Saint Petersburg reported consistently using condoms. 11 This, in turn, leads to a high level of unplanned and unwanted pregnancies 11 , 12 resulting in both higher levels of pregnancy terminations 13 and increased number of births among WIDUs. 14 …”

Fertility-related research needs among women at the margins

“…[134][135][136] Low contraceptive use and high unmet need for family planning has been documented in several studies. 63,[137][138][139] Further investigation is needed, particularly into how sexual and reproductive health services and parenting skills-building can be integrated into substance use treatment programmes and other health interventions serving people who use drugs. [140][141][142] High rates of abortion have been reported among women who use drugs, some of whom are also sex workers, however, reduction in abortion-related risks and integration of family planning and post-abortion care in this population has not adequately been documented.…”

International Collaboration in HIV Prevention Research: Evidence from a Research Seminar in Russia

“…Heavy sporadic drinking in women who injected drugs or who had sexual partners who injected drugs increased the risk of unprotected sexual intercourse. 37 Recently, Dr. Abdala completed a study focused on evaluating the efficacy of an alcohol and HIV risk behavior reduction intervention among patients at sexually transmitted disease (STD) clinics in St. Petersburg.…”