Individual-level, network-level and city-level factors associated with HIV prevalence among people who inject drugs in eight Russian cities: a cross-sectional study

Abstract

ObjectivesTo ascertain HIV prevalence among people who inject drug (injection drug users (IDUs)) in the Russian Federation and identify explanations for the disparity in different cities.DesignCross-sectional survey with serological testing for HIV and hepatitis C virus prevalent infections.Setting8 Russian cities—Irkutsk, Omsk, Chelyabinsk, Yekaterinburg, Naberezhnye Chelny, Voronezh, Orel and St Petersburg.ParticipantsIn 2007–2009 active IDUs were recruited by respondent-driven sampling with a target sample size of 300 or more in each city.Main outcome measuresParticipants were administered a questionnaire covering sociodemographics, injection risk and protective behaviours, sexual behaviours, HIV knowledge, experiences with drug treatment and harm reduction programmes and social networks. Participants were tested for HIV and hepatitis C by enzyme immunoassay. Data were analysed to identify individual-level, network-level and city-level characteristics significantly associated with HIV prevalence. Factors significant at p≤0.1 were entered into a hierarchical regression model to control for multicollinearity.ResultsA total of 2596 active IDUs were recruited, interviewed and tested for HIV and hepatitis C virus infection. HIV prevalence ranged from 3% (in Voronezh) to 64% (in Yekaterinburg). Although individual-level and network-level variables explain some of the difference in prevalence across the eight cities, the over-riding variable that seems to account for most of the variance is the emergence of commercial, as opposed to homemade, heroin as the predominant form of opioid injected.ConclusionsThe expansion of commercial heroin markets to many Russian cities may have served as a trigger for an expanding HIV epidemic among IDUs in that country.

Hepatitis C virus seroprevalence among people who inject drugs and factors associated with infection in eight Russian cities

“…We started with the hypothesis that HCV prevalence levels and factors associated with higher prevalence would be similar to our previously published findings for HIV-1 [13]. Our analysis showed that HCV seroprevalence was associated with HIV-1 seroprevalence at both the individual and city level.…”

“…Five have populations of more than one million inhabitants; the others have between 350,000 and 700,000 inhabitants. Observations from previous studies [14-17] and from our analysis of the distribution of HIV-1 among the PWID recruited as part of this study together suggest that individual risks, social networks, and city-to-city differences in drug markets all have influenced the epidemic situation of HIV among Russian PWID populations [13]. Observations also suggest that the same individual-, network-, and city-level factors might have influenced the spread of HCV and contributed to variations in HCV prevalence.…”

“…Surveillance was carried out by administering a questionnaire and testing serosamples for HIV-1 and HCV [13]. The eight cities are geographically and demographically diverse.…”

Two Independent HIV Epidemics in Saint Petersburg, Russia Revealed by Molecular Epidemiology

“…Acute HIV-1 infection is associated with a high viral load and thus an increased likelihood of transmission. It is known that within the network PWID in St. Petersburg do share syringes and injection paraphernalia frequently, 15,24,25 allowing the infection of the PWID network members to occur very rapidly after HIV-1 acquisition and viral load spike of a single member of this network. The homogeneous acute infection as a source of the epidemic may explain the low diversity of the virus circulating in the population.…”

“…11 The HIV prevalence among PWID increased linearly from 2% in 1998 to 30% in 2003, and reached 59% in the most recent studies. [12][13][14][15][16] Respondentdriven sampling (RDS), a chain referral sampling method commonly used to reach hidden populations, has become the most popular method to recruit samples of PWID and MSM in Russia. 17,18 These populations have been studied separately; however, little is known about crossover between these groups.…”