HIV incidence and factors associated with HIV acquisition among injection drug users in St Petersburg, Russia.
BACKGROUND
The Russian HIV-1 epidemic has been driven by injection drug use.


OBJECTIVE
To determine HIV incidence and identify demographic and behavioral correlates of infection to facilitate the development of longitudinal HIV prevention programs.


METHODS
In 2002, a cohort of 520 injection drug users (IDU) in St Petersburg, Russia were recruited and tested and counseled for HIV-1. HIV-seronegative IDU were enrolled and reevaluated at 6 and 12 months. HIV testing was performed and sociodemographic and behavioral data were collected during each study visit. The relationship of sociodemographic and behavioral factors to HIV-1 incidence was assessed.


RESULTS
Most enrolled subjects were young, male, living at home, educated, heroin users, and frequently shared needles and other injection paraphernalia. The retention rate at the 12 month follow-up was 80%. The HIV-1 incidence rate was 4.5/100 person-years. In univariate analysis, psychostimulant use, especially frequent use, three or more sex partners in the past 6 months, and females selling sex were associated with HIV seroconversion. In the multivariate analysis, psychostimulant use three or more times per week was the only factor still associated with HIV seroconversion.


CONCLUSIONS
The high incidence of HIV infection places St Petersburg among the worst IDU-concentrated epidemics in Europe. Interventions targeting psychostimulant and heroin users and their accompanying behaviors such as frequent injections and increased sexual activity are needed immediately.
Kozlov
Andrei P
AP
Biomedical Center and St Petersburg State University, St Petersburg, Russia. biomed@mailbox.alkor.ru
Shaboltas
Alla V
AV
Toussova
Olga V
OV
Verevochkin
Sergei V
SV
Masse
Benoit R
BR
Perdue
Tom
T
Beauchamp
Geetha
G
Sheldon
Wayne
W
Miller
William C
WC
Heimer
Rober
R
Ryder
Robert W
RW
Hoffman
Irving F
IF
D000293:Adolescent; D000328:Adult; D000697:Central Nervous System Stimulants; D015331:Cohort Studies; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission; D015497:HIV-1; D006556:Heroin Dependence / Q000150:complications; D006801:Humans; D015994:Incidence; D008297:Male; D016485:Needle Sharing / Q000009:adverse effects; D012307:Risk Factors; D012309:Risk-Taking; D012426:Russia / Q000453:epidemiology; D011477:Sex Work / Q000706:statistics & numerical data; D012725:Sexual Behavior / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000150:complications*
D000697:Central Nervous System Stimulants