Sex Work, Drug Use, HIV Infection, and Spread of Sexually Transmitted Infections in Moscow, Russian Federation
January 4, 2006
The Russian Federation has high rates of HIV-1 infection and a growing epidemic of other STDs. Highest rates of HIV infection are in major cities such as Moscow, where new cases are moving beyond the initial core group of injecting drug users (IDUs) into the heterosexual population through bridge groups such as sex workers and non-IDUs who have sex with people who do and do not inject drugs.
The authors conducted a cross-sectional survey from January 2001 through April 2002 in the only juvenile detention facility in Moscow, homeless detention facilities, and the largest remand setting in central Moscow. People newly admitted to the facilities during the study period were invited to participate. Inclusion criteria were 15-17 years old for juveniles and 18-45 for other detainees. Exclusion criteria included refusal to participate, inability to understand or answer questions, being in the facility for more than 48 hours (for juveniles and homeless people) and being under the influence of any substance including alcohol.
The researchers studied 200 girls and 201 boys at a juvenile center, 202 women and 200 men at homeless detention facilities, and 202 women at a remand center. Seventy-nine percent (160) of the women at the remand center were sex workers. The authors recruited 61 male subjects at the remand center instead of the intended 200 because there were too few sober men in the setting.
Serum and urine samples from participants revealed that 91 (51 percent) of the homeless women had syphilis. Testing found at least one bacterial sexually transmitted infection in 97 (58 percent) of juvenile detainees, 120 (64 percent) of women at the remand center, and 133 (75 percent) of homeless women.
Seven women (4 percent) at the remand center had HIV. Of those, five reported sex work. Among adolescent male detainees with HIV seroprevalence (n=5 [3 percent]), two reported injecting drug use. Both female HIV-positive juvenile detainees reported sex work, and one acknowledged injecting drugs. Of the four HIV-positive homeless women (2 percent), three acknowledged sex work; none reported injecting drugs.
"Compared with other groups, relatively high HIV seropositivity was noted in remand female detainees (a subpopulation consisting mainly of sex workers), boys in juvenile detention, and homeless women," the authors stated. "The recorded rates of HIV infection are 30-120 times higher than those obtained from current HIV screening in the general population and only slightly lower than the reported rate for injecting drug users in Moscow (5.9 percent in 2001)."
"The highly prevalent sexual risk behaviors, sexually transmitted infections, injecting drug use, and the overlap between sex work and use of injected drugs in homeless people, female sex workers, and juvenile detainees in Moscow are alarming and could facilitate further explosive growth of the epidemics of HIV and sexually transmitted infections," the report states.
"Our findings highlight the urgent need for interventions such as screening for sexually transmitted and HIV infections, counseling, and health education both within and beyond correctional settings. Focus should be on women and young people at risk and the overlap between sex work and injecting drug use," the investigators concluded.
07.02.2005; Vol. 366: P. 57-60; A. Shakarishvili; L.K. Dubovskaya; I.S. Zohrabyan; J.S. St. Lawrence; S.O. Aral; L.G. Dugasheva; S.A. Okan; J.S. Lewis; K.A. Parker; C.A. Ryan; LIBRA Project Investigation Team
This article was provided by CDC National Prevention Information Network. It is a part of the publication CDC HIV/Hepatitis/STD/TB Prevention News Update.