Double jeopardy--drug and sex risks among Russian women who inject drugs: initial feasibility and efficacy results of a small randomized controlled trial

Abstract

BackgroundWith HIV prevalence estimated at 20% among female injecting drug users (IDUs) in St. Petersburg, Russia, there is a critical need to address the HIV risks of this at-risk population. This study characterized HIV risks associated with injecting drug use and sex behaviors and assessed the initial feasibility and efficacy of an adapted Woman-Focused intervention, the Women's CoOp, relative to a Nutrition control to reduce HIV risk behaviors among female IDUs in an inpatient detoxification drug treatment setting.MethodWomen (N = 100) were randomized into one of two one-hour long intervention conditions--the Woman-Focused intervention (n = 51) or a time and attention-matched Nutrition control condition (n = 49).ResultsThe results showed that 57% of the participants had been told that they were HIV-positive. At 3-month follow-up, both groups showed reduced levels of injecting frequency. However, participants in the Woman-Focused intervention reported, on average, a lower frequency of partner impairment at last sex act and a lower average number of unprotected vaginal sex acts with their main sex partner than the Nutrition condition.ConclusionThe findings suggest that improvements in sexual risk reduction are possible for these at-risk women and that more comprehensive treatment is needed to address HIV and drug risks in this vulnerable population.

Preventing blood-borne virus infection in people who inject drugs in the UK: systematic review, stakeholder interviews, psychosocial intervention development and feasibility randomised controlled trial

“…'model injection and sexual risk reduction behaviors with their risk network members' 74 and 'demonstration and rehearsal of syringe cleaning and condom application'); 70 and enablement (increasing means/reducing barriers, e.g. 'women created a personalized risk reduction plan', 75 'goal-setting for HIV risk reduction and outreach' 76 and 'a short role play was then used to help her identify barriers to safer injection' 77 ). Gail Gilchrist and Davina Swan independently determined the intervention functions of the intervention conditions, with differences in intervention function coding resolved through discussion.…”

“…Twenty-four trials were included in the meta-analysis. 22,[68][69][70][71][72][73]75,76,81,82,173,175,179,180,182,186,188,189,[192][193][194][195]197 The reasons for excluding eight trials from the meta-analysis were not providing the number of PWID for control and intervention groups at follow-up, 84,174,176,177,196 only providing risk ratios, 178 outcome combined HIV infections with sexually transmitted infections 77 and data for 'unsafe injection practices' were presented only at baseline. 74 …”

“…Incomplete outcome data was the most common risk of bias found in the trials included in the review, but selective outcome reporting also contributed to potential risk of bias for some trials. Other potential sources of bias included altering randomisation protocols depending on the number of participants enrolled on a particular day; 182 statistically significant differences between groups at baseline in the injecting subscale; 173 variation in the TAU group across sites; 68 possible crossover contamination between groups; 69,75,179,180,182,194 a high proportion of excluded individuals with the excluded individuals differing significantly to those included; 71 and large variations reported in the follow-up period. …”

“…69 Trials included in the systematic review compared psychosocial interventions with usual care (n = 4), 22,68,178,195 education or information (n = 9), 70,76,77,175,176,180,188,196,197 HIV infection testing and counselling (n = 5), 69,82,84,192,193 interventions of lesser time or intensity with OST (n = 12) [72][73][74]81,173,174,177,179,182,190,194 and without OST (n = 2). 71,186 Of the 32 interventions delivered in the RCTs included in the systematic review, most (n = 14) were delivered to individual participants, 22,68,70,71,75,77,81,173,175,178,192,[195][196][197] eight were delivered to groups of participants 69...…”

“…In total, 12,840 participants (35% female, range 0-100%) were enrolled in the trials; the majority were PWID (84.5%) (the proportion of participants enrolled in the trials who were PWID ranged from 16% to 100%). The majority (n = 18) of trials were conducted in the USA, 22,68,[70][71][72]76,81,84,174,176,177,179,182,186,189,193,195,196 three were conducted in Russia, 74,75,194 two were conducted in Canada, 175,178 two were conducted in Vietnam, 82,180 one was conducted in Kazakhstan, 73 one was conducted in Georgia, 188 one was conducted in Australia, 197 one was conducted in the UK, 173 one was conducted in Mexico, 77 one was conducted in Puerto Rico 192 and one was conducted in both the USA and Thailand. 69 Trials included in the systematic review compared psychosocial interventions with usual care (n = 4), 22,68,178,195 education or information (n = 9), 70,76,77,175,176,180,188,…”