title: "It is easier for me to shoot up": stigma, abandonment, and why HIV-positive drug users in Russia fail to link to HIV care.
abstract: Many HIV-positive people who inject drugs (PWID) globally are not receiving HIV care. This represents a major challenge among key populations to end the global HIV epidemic. This qualitative study explored the process and associated barriers of linking HIV-positive PWID who are in addiction treatment to HIV care in St. Petersburg, Russia. We conducted three focus groups and seven semi-structured interviews with participants in the LINC ("Linking Infectious and Narcology Care") project at addiction and HIV hospitals in St. Petersburg. The sample consisted of 25 HIV-infected patients with opioid dependence and seven health-care providers, including addiction and infectious disease physicians and case managers. A variety of intertwining factors influence effective engagement of PWID with HIV treatment. Stigma, problematic patient-provider relationships, and fragmented health care were the main challenges for HIV care initiation by PWID, which were further exacerbated by injection drug use. Effective linkage of PWID to HIV care requires acknowledging and addressing stigma's role and different perspectives of patients and providers.
authors.affiliation: a Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit , Boston University School of Medicine/Boston Medical Center , Boston , MA , USA.|b Ukrainian Institute on Public Health Policy , Kyiv , Ukraine.
authors.forename: Tetiana
authors.initials: T
authors.lastname: Kiriazova
authors.affiliation: a Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit , Boston University School of Medicine/Boston Medical Center , Boston , MA , USA.
authors.forename: Karsten
authors.initials: K
authors.lastname: Lunze
authors.affiliation: c Department of Medicine, Division of Global Public Health , University of California-San Diego School of Medicine , La Jolla , CA , USA.
authors.forename: Anita
authors.initials: A
authors.lastname: Raj
authors.affiliation: d First St. Petersburg Pavlov State Medical University , St. Petersburg , Russian Federation.
authors.forename: Natalia
authors.initials: N
authors.lastname: Bushara
authors.affiliation: d First St. Petersburg Pavlov State Medical University , St. Petersburg , Russian Federation.
authors.forename: Elena
authors.initials: E
authors.lastname: Blokhina
authors.affiliation: d First St. Petersburg Pavlov State Medical University , St. Petersburg , Russian Federation.|e St. Petersburg Bekhterev Research Psychoneurological Institute , St. Petersburg , Russian Federation.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Krupitsky
authors.affiliation: a Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit , Boston University School of Medicine/Boston Medical Center , Boston , MA , USA.
authors.forename: Carly
authors.initials: C
authors.lastname: Bridden
authors.affiliation: d First St. Petersburg Pavlov State Medical University , St. Petersburg , Russian Federation.
authors.forename: Dmitry
authors.initials: D
authors.lastname: Lioznov
authors.affiliation: a Department of Medicine, Section of General Internal Medicine, Clinical Addiction Research and Education Unit , Boston University School of Medicine/Boston Medical Center , Boston , MA , USA.|f Department of Community Health Sciences , Boston University School of Public Health , Boston , MA , USA.
authors.forename: Jeffrey H
authors.initials: JH
authors.lastname: Samet
authors.affiliation: g Department of Health Law, Policy, and Management , Boston University School of Public Health , Boston , MA , USA.|h Boston University School of Medicine, Section of General Internal Medicine , Boston , MA , USA.|i Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital , Bedford , MA , USA.
authors.forename: Allen L
authors.initials: AL
authors.lastname: Gifford
mesh_terms: D000328:Adult; D000071959:Case Managers; D003266:Continuity of Patient Care; D055030:Drug Users / Q000523:psychology*; D005260:Female; D017144:Focus Groups; D006679:HIV Seropositivity / Q000188:drug therapy / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D009293:Opioid-Related Disorders / Q000523:psychology*; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D010817:Physician-Patient Relations; D010820:Physicians; D036301:Qualitative Research; D012426:Russia; D057545:Social Stigma; D015819:Substance Abuse, Intravenous / Q000523:psychology
keywords: HIV care; Russia; addiction treatment; barriers; linkage to care