“Until people start dying in droves, no actions will be taken”: perception and experience of HIV-preventive measures among people who inject drugs in northwestern Russia

Abstract

BackgroundThe HIV epidemic among people who inject drugs (PWID) in Russia continues to spread. This exploratory study examines how HIV-prevention measures are perceived and experienced by PWID in the northwestern region of Russia.MethodsPurposive sampling was used to obtain a variety of cases that could reflect possible differences in perception and experience of HIV-prevention efforts. We conducted 22 semi-structured interviews with PWID residing in the Arkhangelsk and St. Petersburg regions.ResultsThe main sources of prevention information on HIV for PWID were media campaigns directed to the general population. These campaigns were effective with regard to communicating general knowledge on HIV but were ineffective in terms of risk behavior change. The subjects generally had trust in medical professionals and their advice but did not follow prevention recommendations. Most informants had no or very little prior contact with harm reduction services. On the level of attitudes towards HIV prevention efforts, we discovered three types of fatalism among PWID: “personal fatalism” - uselessness of HIV prevention efforts, if one uses drugs; “prevention-related fatalism” - prevention programs are low effective, because people do not pay attention to them before they get infected; “state-related fatalism” – the lack of belief that the state is concerned with HIV prevention issues. Despite this fatalism the participants opined that NGOs would do a better job than the state as they are “really working” with risk groups.ConclusionsAs HIV prevention campaigns targeted at the general population and prevention advice received from medical professionals are not sufficiently effective for PWID in terms of risk behavior change, prevention programs, such as community-based and peer-based interventions specifically tailored to the needs of PWID are needed, which can be achieved by a large expansion of harm reduction services in the region. Personal communication should be a crucial element in such interventions in addition to harm reduction materials provision. Training programs, peer outreach, and culture-change interventions which try to alter widespread fatalistic norms or attitudes towards their health are especially needed, since this study indicates that fatalism is a major barrier for behavior change.

A New Generation of Drug Users in St. Petersburg, Russia? HIV, HCV, and Overdose Risks in a Mixed-Methods Pilot Study of Young Hard Drug Users

“…Following Mannheim (42) and Golub, Johnson and Dunlap (18), we call these new cohorts of young hard drug users part of a “generation” because they shared the “same formative experiences” in adolescence that were quite distinct from those that the previous “heroin generation” had to live through – social stability vs. anomie, relative prosperity vs. abject poverty, functioning of social institutions (though very imperfect) vs. collapse of established social institutions, mature drug markets and recent history of widespread drug use vs. unsaturated drug markets and lack of recent drug use epidemics, and, importantly, high prevalence of HIV/AIDS among older PWID and awareness thereof vs. almost total absence of HIV and lack of understanding of its importance for PWID in Russia in the beginning of “heroin generation” drug careers (44). Further studies must explicate these and other aspects of different social contexts for different generations of drug users in Russia.…”

Methodological issues in qualitative research on HIV prevention: an integrative review

“…We investigated subjects’ experiences with these preventive methods and practices at the interface with different social groups, such as heterosexual men 13 , 36 , 37 , 38 ; men who have sex with men (MSM) 25 , 30 , 39 , 40 , 41 , 42 , 43 ; women 26 , 33 , 44 , 45 , 46 ; African-Americans 21 ; women over 50 years 19 , 24 ; young people (cisgender, transgender, MSM) 16 , 27 , 34 , 35 , 40 , 47 , 48 ; and sex workers 23 , 29 , 45 . Still at the interface with preventive measures, some studies have analyzed issues related to vulnerability 15 , 22 , 49 ; explained risk behavior as the central object for analysis 14 , 31 , 35 , 39 , 42 , 47 , 50 , 51 , 52 ; masculinity 12 , 27 , 28 , 36 ; gender 22 , 50 and sexuality 16 , 43 , 53 , 54 ; and social support networks 41 .…”

“…As for the production of empirical data, the most used data production techniques in the research were in-depth interviews with a semi-structured guide 12 , 13 , 14 , 15 , 21 , 24 , 25 , 26 , 27 , 29 , 31 , 32 , 33 , 36 , 37 , 40 , 43 , 44 , 46 , 48 , 51 and focus groups 30 , 34 , 35 , 50 , 53 , often combined in studies 23 , 28 , 38 , 41 , 43 , 45 , 47 , 52 or narrative interviews 12 , 19 . Anthropologically-oriented studies used field diaries as a tool for collecting information, along with other strategies, such as semi-structured interviews 19 , 22 , 39 , 54 .…”

Molecular epidemiology of HIV-1 in Oryol Oblast, Russia

“…The activity aimed at limiting transmission among PWIDs in Oryol/Russia is mainly focused on education and rehabilitation; substitution therapy programmes are not implemented ( Idrisov et al. 2017 ; Meylakhs, Aasland, and Grønningsæter 2017 ; Cepeda et al. 2018 ).…”