title: People with HIV in HAART-era Russia: transmission risk behavior prevalence, antiretroviral medication-taking, and psychosocial distress.
abstract: Russia has seen one of the world's fastest-growing HIV epidemics. Transmission risk behavior, HAART-taking, and psychosocial distress of the growing population of Russian people living with HIV (PLH) in the HAART era are understudied. Participants of a systematically-recruited cross-sectional sample of 492 PLH in St. Petersburg completed measures of sexual and drug injection practices, adherence, perceived discrimination, and psychosocial distress. Since learning of their status, 58% of participants had partners of HIV-negative or unknown serostatus (mean = 5.8). About 52% reported unprotected intercourse with such partners, with 30% of acts unprotected. Greater perceived discrimination predicted lower condom use. A 47% of IDU PLH still shared needles, predicted by having no primary partner, lower education, and more frequently-encountered discrimination. Twenty-five percentage of PLH had been refused general health care, 11% refused employment, 7% fired, and 6% forced from family homes. Thirty-nine percentage of participants had probable clinical depression, 37% had anxiety levels comparable to psychiatric inpatients, and social support was low. Of the 54% of PLH who were offered HAART, 16% refused HAART regimens, and 5% of those on the therapy took less than 90% of their doses. Comprehensive community services for Russian PLH are needed to reduce AIDS-related psychosocial distress and continued HIV transmission risk behaviors. Social programs should reduce stigma and discrimination, and promote social integration of affected persons and their families.
authors.affiliation: Department of Psychiatry and Behavioral Medicine, Center for AIDS Intervention Research, Medical College of Wisconsin, Milwaukee, Wisconsin 53202, USA. yuri@mcw.edu
authors.forename: Yuri A
authors.initials: YA
authors.lastname: Amirkhanian
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Kelly
authors.forename: Anna V
authors.initials: AV
authors.lastname: Kuznetsova
authors.forename: Wayne J
authors.initials: WJ
authors.lastname: DiFranceisco
authors.forename: Vladimir B
authors.initials: VB
authors.lastname: Musatov
authors.forename: Dmitry G
authors.initials: DG
authors.lastname: Pirogov
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000523:psychology* / Q000635:transmission*; D006801:Humans; D008297:Male; D055118:Medication Adherence / Q000523:psychology*; D008603:Mental Health; D016485:Needle Sharing; D015995:Prevalence; D012307:Risk Factors; D012309:Risk-Taking; D012426:Russia / Q000453:epidemiology; D012725:Sexual Behavior / Q000523:psychology*; D012747:Sexual Partners; D012944:Social Support; D013315:Stress, Psychological; D015819:Substance Abuse, Intravenous / Q000150:complications; D055815:Young Adult
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