Mobilizing individual social capital resources for HIV care support: results of a pilot intervention in St. Petersburg,Russia

ABSTRACT

Half of HIV-positive persons in Russia are on antiretroviral therapy (ART), and only 27% are virally suppressed. A feasibility pilot intervention to mobilize social capital resources for HIV care support was conducted in St. Petersburg. Out-of-care or ART-nonadherent HIV-positive persons (n?=?24) attended a five-session intervention to increase access social capital resources (i.e., family, friends, or providers) to mobilize supports for entering care, initiating care, and adhering to ART. HIV care indicators were assessed at baseline, an immediate followup (FU-1), and 6-month followup (FU-2) points. At FU-1, participants more frequently discussed their care experiences with others, verifying the intervention’s mechanism of action. Participants increased in scales of medication taking adherence (p?=?0.002, FU-1; p?=?0.011, FU-2), self-efficacy (p?=?0.042; FU-1), and outcome expectancies (p?=?0.016, FU-2). Among persons not on ART, HIV Medication Readiness scale scores increased at FU-1 (p?=?0.032) but became attenuated at FU-2. Participants tended to more frequently keep care appointments (79%, baseline to 90%, FU-1, p?=?0.077); to have undetectable viral load (54%, baseline to 74%, FU-2; p?=?0.063); and to have fewer past-month days with delayed or incomplete medication doses (7.8, baseline to 4.2, FU-1; p?=?0.084). This novel social capital intervention is promising for improving HIV care-related outcomes and warrants a full-scale evaluation.     

Reconstructing the Temporal Origin and the Transmission Dynamics of the HIV Subtype B Epidemic in St. Petersburg,Russia

The HIV/AIDS epidemic in Russia is among the fastest growing in the world. HIV epidemic burden is non-uniform in different Russian regions and diverse key populations. An explosive epidemic has been documented among people who inject drugs (PWID) starting from the mid-1990s, whereas presently, the majority of new infections are linked to sexual transmission. Nationwide, HIV sub-subtype A6 (previously called A_FSU) predominates, with the increasing presence of other subtypes, namely subtype B and CRF063_02A. This study explores HIV subtype B sequences from St. Petersburg, collected from 2006 to 2020, in order to phylogenetically investigate and characterize transmission clusters, focusing on their evolutionary dynamics and potential for further growth, along with a socio-demographic analysis of the available metadata. In total, 54% (107/198) of analyzed subtype B sequences were found grouped in 17 clusters, with four transmission clusters with the number of sequences above 10. Using Bayesian MCMC inference, tMRCA of HIV-1 subtype B was estimated to be around 1986 (95% HPD 1984–1991), whereas the estimated temporal origin for the four large clusters was found to be more recent, between 2001 and 2005. The results of our study imply a complex pattern of the epidemic spread of HIV subtype B in St. Petersburg, Russia, still in the exponential growth phase, and in connection to the men who have sex with men (MSM) transmission, providing a useful insight needed for the design of public health priorities and interventions.     

HIV seroprevalence in street youth, St. Petersburg, Russia

BACKGROUND: Reliable data on HIV infection among Russian street youth are unavailable. The purpose of this study was to assess HIV seroprevalence among street youth in St Petersburg and to describe social, sexual, and behavioral characteristics associated with HIV infection. METHODS: A cross-sectional assessment conducted during January-May 2006 included city-wide mapping of 41 street youth locations, random selection of 22 sites, rapid HIV testing for all consenting 15-19-year-old male and female street youth at these sites, and an interviewer-administered survey. Adjusted odds ratios (AOR) were calculated using logistic regression, accounting for intracluster homogeneity. RESULTS: Of 313 participants, 117 (37.4%, 95% confidence interval 26.1-50.2%) were HIV infected. Subgroups with the highest seroprevalences included double orphans (64.3%), those with no place to live (68.1%), those previously diagnosed with a sexually transmitted infection (STI; 70.5%), those currently sharing needles (86.4%), and those currently using inhalants (60.5%) or injection drugs (78.6%), including Stadol (82.3%) or heroin (78.1%). Characteristics independently associated with HIV infection included injecting drugs (AOR 23.0), sharing needles (AOR 13.3), being a double or single orphan (AOR 3.3 and 1.8), having no place to live (AOR 2.4), and being diagnosed with a STI (AOR 2.1). Most HIV-infected street youth were sexually active (96.6%), had multiple partners (65.0%), and used condoms inconsistently (80.3%). DISCUSSION: Street youth aged 15-19 years in St Petersburg, Russia, have an extraordinarily high HIV seroprevalence. In street youth who are injection drug users, HIV seroprevalence is the highest ever reported for eastern Europe and is among the highest in the world.     

婚前青年性病艾滋病防治知识态度信念行为及干预研究

目的 探索婚前青年性病艾滋病防治知识、态度、信念及行为(KABP)状况并评价其干预效果,为开展健康促进工作提供科学依据。方法 2000年3月～2001年9月,在石河子市对到妇幼保健院做婚前检查的1 392名男女青年发调查表,匿名答卷,经健康教育干预后1周,969人用同样问卷回答,以评价干预效果。调查人员经统一培训、统一方法进行质量控制。结果婚前青年对性病艾滋病防治一般知识回答的正确率比较高;干预后对安全套的作用、艾滋病疫苗或治疗药物及消毒常识的知晓程度有显著提高;防治态度也有所改善,但正确率比较低;愿意使用及相信能正确使用安全套的得到显著提高。结论 应加强对婚前青年性观念及性行为道德教育,加强宣传安全套的正确使用和提高其使用率,有的放矢地开展健康教育及健康促进是迫切需要的。     

Association between HIV/AIDS knowledge and stigma towards people living with HIV/AIDS in Botswana

In Botswana, an estimated 350 000 people live with HIV/AIDS. HIV/AIDS testing rates are low, suggesting that many other people remain undiagnosed. Stigma related to HIV/AIDS is prevalent and contributes to low testing rates and under-diagnosis of the virus. Identifying factors that contribute to stigma, such as insufficient or inaccurate knowledge of HIV/AIDS, may be critical in increasing early identification and treatment. This cross-sectional study used nationally representative data from the 2013 Botswana AIDS Impact Survey (BAIS) IV to examine the relationship between HIV/AIDS knowledge and stigmatising attitudes toward people living with HIV/AIDS (PLWHA). The mean (standard error) for stigma towards PLWHA score and HIV/AIDS knowledge score were 0.99 (0.02) and 5.90 (0.03) respectively. HIV/AIDS knowledge score and stigma towards PLWHA score were strongly positively correlated r (4,4045) = 0.415, p < 0.001). After adjusting for potential confounders, HIV/AIDS knowledge score significantly predicted stigma towards PLWHA score [coefficient β (95% CI)] [?0.25 (?0.29, ?0.20), p < 0.001]. These findings imply that programmes and interventions that increase HIV/AIDS knowledge may reduce the pervasive apprehension, blame, and stigmatising attitude held towards PLWHA in Botswana.     

部队医务人员掌握艾滋病知识情况调查

目的 了解医务人员掌握艾滋病知识的程度,为制订部队医务人员艾滋病教育和训练规划提供依据。方法 于1999年5～6月用试卷考核的方法对部队47个医疗单位的870名医务人员进行了艾滋病知识调查。结果 (1)对艾滋病的一般知识,如HIV/AIDS的名称、三种传播途径等掌握较好,回答的正确率都在90％以上。(2)对专业性较强的艾滋病知识如HIV的抵抗力,窗口期、有效的预防措施等掌握稍差,回答的正确率是60％～70％。(3)艾滋病检测和职业性防护知识严重缺乏,只有少数人约30％～40％能够正确回答。(4)文化程度和专业技术职务对回答问题的正确率无显著性差异,而不同的医院类别和临床科室的医务人员对某些问题的回答有显著性差别(P<0.005)。结论 经过近二年的宣传和学习,医务人员的艾滋病知识水平有了较大的提高。增加宣传的范围和深度、强调针对性和实用性是今后军队艾滋病宣传工作应该注意的问题。     

Women at Risk of HIV/STD: The Importance of Male Partners as Barriers to Condom Use

Women's perceptions of power in their relationship with their main partner, control over condom use, concerns about potential partner retribution, condom requests, and condom use were assessed by interviewing a group of women attending two urban public clinics for sexually transmitted diseases in Alabama. Only 5% reported that they had no control over condom use by their partner. Fears of catastrophic partner reactions to condom use requests (sexual coercion, abuse, or abandonment) and experiences of partner objections were also uncommon. Women did not perceive themselves to be powerless. Inconsistent condom use was associated with wanting condom use but not asking and with perceived consequences of relationship loss, however, most power-related measures, including physical abuse, were not related to condom use in the 30 days prior to the interview.     

Psychosocial needs, mental health, and HIV transmission risk behavior among people living with HIV/AIDS in St Petersburg, Russia

OBJECTIVES: The number of new HIV infections in Russia has doubled annually since 1996. A total of 232 424 HIV infections have been officially recorded but the actual number probably exceeds one million. Very little is known about the social, psychological, behavioral, and health care service access of persons living with HIV in Russia. DESIGN: A cross-sectional sample of 470 persons with HIV/AIDS recruited in 2002 using a representative sampling plan in major St. Petersburg HIV care and service agencies. METHODS: Participants completed anonymous self-administered questionnaires that elicited detailed information about social and psychological characteristics, HIV serostatus disclosure and discrimination experiences, and risk practices since learning of their HIV positive status. RESULTS: Most participants were young (mean age, 25.3 years), knew of their HIV positive status for about 2 years, and had histories of injecting drug use as well as sexual risk behavior. A large proportion reported encountering discrimination including being forced to sign documents acknowledging their HIV status (47.9%), refusal of general health care (29.6%), being fired from their jobs (9.9%), and being forced from their family homes (9.0%). Over one-third had probable clinical depression. Most remained sexually active since learning of their HIV positive serostatus, approximately half engaged in unprotected sex with HIV negative partners, and condoms were not used one-third of the time with discordant partners. A majority of injecting drug users in the sample still shared needles. CONCLUSIONS: HIV-infected persons in Russia experience a wide range of social, psychological, and care access problems. Improved services are urgently needed for persons living with HIV/AIDS in Russia.     

Microsporidiosis and Cryptosporidiosis in HIV/AIDS Patients in St. Petersburg, Russia: Serological identification of microsporidia and Cryptosporidium parvum in sera samples from HIV/AIDS patients

To determine seroprevalence of the opportunistic organisms Cryptosporidium parvum and microsporidia (Encephalitozoon cuniculi, E. intestinalis, E. hellem, and Enterocytozoon bieneusi) in Russian HIV/AIDS patients, we evaluated 46 sera from HIV/AIDS patients from the S.P. Botkin Clinical Infectious Diseases Hospital, St. Petersburg, Russia. Five (10.9%) sera were seropositive for E. cuniculi and 19 (41.3%) were positive for C. parvum by ELISA. By IFAT, 6 (13.0%) sera were seropositive for E. bieneusi, 4 (8.7%) for E. intestinalis, and 9 (19.6%) for E. hellem. This study is the first report to estimate the prevalence of infection with Cryptosporidium and microsporidia among Russian HIV/AIDS patients.     

Comparison of satisfaction with care between two different models of HIV care delivery in St. Petersburg,Russia

Prior to 2010, medical care for people living with HIV/AIDS was provided at an outpatient facility near the center of St. Petersburg. Since then, HIV specialty clinics have been established in more outlying regions of the city. The study examined the effect of this decentralization of HIV care on patients’ satisfaction with care in clinics of St. Petersburg, Russia. We conducted a cross-sectional study with 418 HIV-positive patients receiving care at the St. Petersburg AIDS Center or at District Infectious Disease Departments (centralized and decentralized models, respectively). Face-to-face interviews included questions about psychosocial characteristics, patient's satisfaction with care, and clinic-related patient experience. Abstraction of medical records provided information on patients’ viral load. To compare centralized and decentralized models of care delivery, we performed bivariate and multivariate analysis. Clients of District Infectious Disease Departments spent less time in lines and traveling to reach the clinic, and they had stronger relationships with their doctor. The overall satisfaction with care was high, with 86% of the sample reporting high level of satisfaction. Nevertheless, satisfaction with care was strongly and positively associated with the decentralized model of care and Patient–Doctor Relationship Score. Patient experience elements such as waiting time, travel time, and number of services used were not significant factors related to satisfaction. Given the positive association of satisfaction with decentralized service delivery, it is worth exploring decentralization as one way of improving healthcare services for people living with HIV/AIDS.     

Knowledge of HIV/AIDS and attitudes towards people living with HIV among the general staff of a public university in Malaysia

Stigma and discrimination towards people living with HIV have been widely documented, and have extended their impact into the workplace. Stigmatising attitudes towards people living with HIV (PLHIV) in the workplace significantly hinder HIV prevention efforts and indirectly affect national development. This cross-sectional study was designed to determine the level of knowledge about HIV and AIDS and assess attitudes towards PLHIV among the general staff of Universiti Putra Malaysia (UPM), as well as to identify factors that are associated with it. Self-administered questionnaires were posted to a total of 344 general staff from six randomly selected faculties, and they were a given a week to return the questionnaires. The response rate was 38%. Data were analysed using Pearson's correlation, independent t-test and multiple linear regression. The respondents showed a considerably high level of knowledge about HIV/AIDS (mean knowledge score of 15.57±1.93 out of 18 points) although there were some misconceptions (N=129). Likert scale responses to 20 attitude statements revealed that respondents generally had moderately positive attitudes toward PLHIV (average score of 69.65±10.08 out of 100 points). Attitudes were inconsistent when it involved direct contact and interaction with PLHIV. Factors significantly associated with level of knowledge and attitudes included age, education and income. There was no difference in mean score for knowledge and attitudes by gender. Further efforts are necessary to improve attitudes of the general staff towards PLHIV, particularly in areas of direct contact with PLHIV.     

暗娼和嫖客艾滋病KAP对比分析

目的 比较暗娼和嫖客的艾滋病相关知识、信念和行为(KAP)的差异,为艾滋病健康教育提供依据。方法 随机选取124名暗娼和155名嫖客,经由培训的调查员采用自填式问卷和询问的方法进行调查。结果 暗娼艾滋病相关知识正确回答率和平均得分高于嫖客,经常使用避孕套的比例也明显较高,对避孕套能够预防艾滋病的信念强于嫖客。另一方面,暗娼有挣脉注射毒品史较高,首次性行为和从事性服务的年龄均偏低,更有以卖淫为职业的倾向。结论 采用有效方法,提高嫖客的避孕套使用意识和使用率,是艾滋病行为干预的重点;暗娼是艾滋病传播的高危对象。     

Knowledge of HIV/AIDS and emotional adjustment in a cohort of men with haemophilia and HIV infection: final report

This study presents the final report of a long-term psychological assessment of men with haemophilia and HIV infection. The knowledge, emotional impact regarding HIV infection and prospective changes over time and the need for psychological support were evaluated. The study group comprised 118 men with haemophilia, 66 HIV seropositive and 52 seronegative, from the Haemophilia Centres in Bari, Florence, Milan and Naples. All subjects performed psychological tests (STAI: state and trait anxiety inventory; SDS: self-rating depression scale) and completed questionnaires to ascertain their knowledge and the emotional impact of AIDS. After enrollment (1992-93) the assessment was repeated twice over a 2-year period. A high percentage of subjects in both groups answered the questionnaire on knowledge correctly and, more specifically, all (100%) admitted knowing that sexual intercourse was a risk factor for HIV infection, adding that sexual partners of haemophiliacs with HIV should be regularly tested. The percentage, however, decreased for seropositives who admitted to always using a condom during sexual intercourse (86%) and for those who declared that partners were periodically tested for HIV (60%). The most important feature of the study is that, contrary to predicted expectations, seropositive and seronegative subjects presented the same degree of emotional involvement: there are no statistically significant differences in average scores between groups either on the anxiety or depression scales. Moreover, for certain aspects, seronegatives revealed greater emotional involvement: at baseline evaluation, they felt more fear and unhappiness with statistically significant differences compared to asymptomatics. Furthermore, seronegatives more than seropositives continue to feel reluctance towards infusion and avoid blood products after learning of AIDS. These results emphasize the importance of paying due attention to the emotional status of seronegatives. Their reluctance towards the use of blood products (despite present safety) is a very important issue for the possible consequences of treatment with the risk of worsening the clinical condition. In conclusion, we believe that counselling on HIV infection/AIDS needs to address every person with haemophilia regardless of HIV status.     

TB and HIV in St Petersburg, Russia: a looming catastrophe?

BACKGROUND: After decades of improved tuberculosis (TB) control in Russia, notification rates started to rise in 1992. Russia also faces a fast growing human immunodeficiency virus (HIV) epidemic. OBJECTIVE: To document the extent and characteristics of HIV co-infection in TB patients in St Petersburg, Russia. DESIGN: A prospective cross-sectional study of HIV coinfected culture-positive TB cases. Between 15 June 2002 and 31 March 2003, TB cases at the St Petersburg City TB hospitals and dispensaries were screened for HIV infection. At the HIV Prevention and Treatment Center, HIV-infected individuals were offered TB screening. RESULTS: Forty-nine HIV-infected culture-positive TB cases were identified, mainly at TB hospitals and dispensaries. Most were new pulmonary TB cases. The majority were young (69% < or = 30 years of age), male (84%), unemployed (94%) individuals with a history of injection drug use (IDU) (92%), and, in 35% of cases a history of incarceration. Active case finding was high among contacts of cases (9%), but was not successful in HIV-infected IDUs. CONCLUSION: Although the HIV seroprevalence rate is rising among TB patients, HIV does not yet appear to be driving the St Petersburg TB epidemic. Aggressive collaborative TB-HIV control efforts may still avert adverse effects of HIV on the TB epidemic.     

北京市农村流动人口的HIV/STD高危性行为和知识分析

目的调查北京市流动人口中存在的感染艾滋病病毒/性传播疾病(HIV/STD)的高危性行为和他们所掌握的艾滋病知识状况。方法在北京市流动人口集中的行业中,用按比例抽样的方法抽取了2222名流动人员,采取问卷调查了解他们拥有的性伙伴数量、参与商业性性行为、安全套使用等高危性行为的情况和艾滋病知识掌握的状况。结果对被调查者中报告有性行为的900人进行了统计分析,结果发现67.4%的人有婚前性行为,31.0%的人有多个性伙伴,9.4%的人参与了商业性性行为,而只有39.0%的人使用过安全套。对全体被调查者的艾滋病知识分析发现,他们的艾滋病知识掌握的相对比较多,熟悉艾滋病传播的三大途径,但对不传播途径没有多大把握。结论加强对流动人口感染HIV/STD的危险和使用安全套的干预。     

社区人群STD/HIV认知水平调查

采用自行设计的KABB问卷,对1139名社区人群的STD／HIV认知水平进行了调查．结果显示,人群对STD／HIV的传播途径认识较模糊;对STD／AIDS仍存有恐惧,对开展性病／艾滋病健康教育普遍持赞同态度,对艾滋病病人的歧视正在减少．本文对这些重要的问题作了初步分析。     

Early stages of HIV treatment cascade in people living with HIV in Saint-Petersburg,Russia

The proportion of people living with HIV (PLWH) in need of antiretroviral therapy (ART) is growing rapidly in Russia. Successful treatment outcomes reduces disease progression and contributes to HIV epidemic control.

We conducted a pilot study following 100 PLWH newly found eligible for ART in St. Petersburg, Russia. We determined the proportion of PLWH who initiated ART, remained in treatment, and achieved an undetectable VL during 6-month follow up. Semi-structured interviews were conducted prior the initiation of ART and progress along the cascade was assessed through medical chart review. Individual characteristics associated with successful ART outcomes were assessed as part of efforts to generate hypotheses.

Almost all (96%) participants initiated ART, full retention was demonstrated by 80%, among whom 71% achieved undetectable VL. Optimal retention was associated with older age and higher education (p?Interventions to improve treatment effectiveness should emphasize that initiation, optimal retention and achieving an undetectable VL are independent of drug abuse status. However, our pilot study highlights the need for the further research in the examining links between individual and structural factors and ART effectiveness.     

Adolescent religiosity and attitudes to HIV and AIDS in Ghana

This study investigated the relationships between adolescent religiosity and attitudes to HIV/AIDS based on two major techniques of analysis, factor and regression analysis towards informing preventive school education strategies. Using cross-sectional data of 448 adolescents in junior high school, the study incorporated survey in a self-administered questionnaire and sought to identify underlying factors that affect pupils' responses, delineate the pattern of relationships between variables and select models which best explain and predict relationships among variables. A seven-factor solution described the ‘attitude’ construct including abstinence and protection, and six for ‘religiosity’. The results showed relatively high levels of religiosity and a preference for private religiosity as opposed to organisational religiosity. The regression analysis produced significant relationships between factors of attitudes to HIV/AIDS and of religiosity. Adolescent with very high private religiosity are more likely to abstain from sex but less likely to use condoms once they initiate: protection is inversely related to religiosity. The findings suggest that religious-based adolescent interventions should focus on intrinsic religiosity. Additionally, increasing HIV prevention information and incorporating culturally relevant and socially acceptable values might lend support to improved adolescent school-based HIV/AIDS prevention programmes.     

1998年艾滋病状况和主要工作

截止1998年底,全国31省、自治区、直辖市共报告艾滋病病毒感染者12639例.其中艾滋病病人417例,死亡224例.经三种传播途径的感染均有发现,但主要经血—注射毒品感染.据估计,我国实际艾滋病病毒感染者可能已逾40万.1998年全国共报告艾滋病病毒感染者3306例.感染途径仍以静脉注射毒品为主,占75.2%;20个省、自治区、直辖市报告在吸毒人群中发现了艾滋病病毒感染者,以新疆和广西的疫情发展最快.新疆1998年报告数首次超过云南,居第一位.1998年,一半以上吸毒人群哨点发现了艾滋病病毒感染者,其感染率明显高于1997年;感染的性乱人群哨点数增加;局部高发地区,已发现孕妇感染,说明艾滋病病毒正从高危人群向一般人群扩散.指出了1998年全国艾滋病疫情报告和监测工作的不足点;总结了国家1998年艾滋病防治的主要工作及制订的艾滋病防治的主要文件、方针和策略.