Psychosocial Needs, Mental Health, and HIV Transmission Risk Behavior Among People Living With HIV/AIDS in St. Petersburg, Russia
January 15, 2004
Since 1996, HIV infections have been doubling annually in Russia, and 232,424 cases have been officially recorded. Experts, however, believe the actual number of cases probably exceeds 1 million. To date, HIV has primarily been diagnosed among MSM, IDU, commercial sex workers, and other stigmatized groups.Adapted from:
"Negative social attitudes towards marginalized populations, policies mandating the testing of 'high risk' groups, and limited legal protections based on HIV status may exacerbate stigma, increase vulnerability to discrimination, and complicate the social and psychological adjustment of persons living with HIV/AIDS," wrote the researchers.
To learn about the social, psychological, behavioral, and health care service access of HIV patients in Russia, the authors recruited a cross-sectional sample of 470 people with HIV/AIDS in St. Petersburg in 2002, using a representative sampling plan in five major St. Petersburg HIV care and service agencies. Participants answered an anonymous, self-administered questionnaire that elicited details about their social and psychological characteristics, sexual and drug use history, HIV disclosure and discrimination experiences, and risk behavior.
Researchers broke the sample down by gender (males = 275, females = 194) and constructed four mutually exclusive risk exposure subgroups: participants who were neither MSM nor IDU (64 persons); IDU who were not MSM (326); MSM who were not IDU (35); and IDU who were also MSM (39). Six participants could not be classified by injecting drug use because of missing data, and one person did not list sexual orientation.
The average age of study participants was mid-20s. Sixty percent of the study thought they had contracted HIV through sharing needles, 21 percent cited heterosexual intercourse, and 8 percent cited homosexual intercourse. Nine percent thought they contracted HIV during medical procedures or were not sure how they had become infected.
Overall, participants knew their HIV status for a mean of 25 months. Respondents most often shared information about their HIV status with family, close friends, and other HIV-positive people. Roughly half (47.9 percent) had been forced by physicians or the police to sign written acknowledgements of their HIV status. Nearly 30 percent (29.6) were refused general health care, and 20 percent were isolated from other patients in a hospital or clinic because of HIV. One in 10 had been fired from their jobs or forced to leave their family homes, and 15 percent had been refused HIV health care, dental care, or employment.
More than one-third of the sample had probable clinical depression, and most remained sexually active after learning their HIV-positive serostatus. Roughly half had unprotected sex with HIV-negative partners, and one-third of the time did not use condoms with discordant partners. A majority of IDU still shared needles.
"The development of a widescale HIV epidemic in Russia was not anticipated and the needs of persons with HIV/AIDS have not yet been well addressed," the authors concluded. "At present, only a very small number of HIV-infected persons in Russia receive advanced antiretroviral therapy regimens. It will be critical to expand the capacity of Russia's health care services infrastructure -- already in poor condition -- to cope with the additional demands of HIV/AIDS care provision and to use advanced antiretroviral drugs."
Vol. 17: P. 2367-2374; 11.07.2003; Yuri A. Amirkhanian, Jeffrey A. Kelly, Timothy L. McAuliffe