We quantified treatment challenges faced by people living with HIV (PLHIV) in Russia. Crosssectional data of 150 PLHIV in Russia were from the 2019 Positive Perspectives Survey. Mean age was 38.3 y. Two-thirds (68.0%[102/150]) had ever disguised their HIV pills, and 43.3%[65/ 150] said they would be stressed if someone saw their HIV pills. Overall, 14.7%[22/150] reported being ever diagnosed with substance use disorder (SUD). Self-rated optimal health was significantly lower among those with vs without a report of SUD on multiple health domains: sexual (40.9%[9/22] vs. 70.3%[90/128], p = 0.007), physical (22.7%[5/22] vs. 68.0%[87/128], p < 0.001), and overall health (27.3%[6/22] vs. 68.8%[88/128], p < 0.001). Those reporting SUD were more likely to miss HIV medication ≥ 1 time in the past month because they used recreational drugs (age and gender-adjusted prevalence ratio [APR] = 8.23, 95%CI = 6.99-9.68), could not afford their medication (APR = 3.28, 95%CI = 2.90-3.72), had to work (APR = 3.27, 95%CI = 2.97-3.60), or to avoid side effects (APR = 2.62, 95%CI = 2.37-2.89). Furthermore, self-reported SUD was strongly associated with numerous poor health conditions, including self-reported diagnosis of cancer (APR = 6.67, 95%CI = 5.24-8.48), mental illness (APR = 5.01, 95%CI = 4.53-5.55), and liver disease (APR = 4.29, 95%CI = 3.98-4.61). The distinct patterns of poorer healthrelated outcomes among PLHIV with SUD underscore the need to address behavioral and psychosocial challenges as part of holistic HIV care.

No abstract

No abstract

Introduction. Social determinants of health are often a major topic for syndemic research. This is consistent with the fundamental idea of syndemic conditions that share common social factors and bio-social interactions. One of the earliest syndemies was the reported abuse of psychoactive substances in the United States, the experience of victimization from interpersonal violence and HIV infection (SAVA).The objective of this study was to assess the prevalence of SAVA syndrome and its relationship with risk factors for HIV infection in key groups — female sex workers (SW). Materials and methods. The analysis is based on data from a biobehavioral study carried out in 4 cities of the Russian Federation and involving 817 SWs (time-place sampling). The study included a questionnaire survey and determination of HIV status.Results and discussion. The prevalence of SAVA syndemics in the groups of SWs and MSM was relatively low because of relatively low (in comparison with IDUs) prevalence of HIV infection. Full syndemics occurred in 1.27%, [95% CI=0.30–2.24%] female sex workers. Incomplete syndemics (excluding HIV infection from definition) was detected in 7.31%, [95% CI=4.59–10.02%] of SW.SWs who were physically and sexually abused had HIV infection in 16.7% of cases, only physically abused — in 10% of cases, while among those who denied violence against them — only 6.5%.

Study of the peculiarity of HIV spread, first of all in the cities led to the formulation of syndemic concept — mutually enhancing set of social, behavioral and biological characteristics of which most frequently mentioned is a combination of substance abuse, victimization (experience of violence) and presence of HIV-infection or AIDS (SAVA syndrome). The prevalence of this syndemic is not studied in detail in Russian Federation.The goal of the present study was to evaluate the prevalence of this syndrome and its components among injecting drug users in six cities in the Russian Federation.Results and discussion. The summary prevalence of the full SAVA was 12,3% (95% CI=10,0–14,.6%), but there were significant differences between cities especially between St. Petersburg and Krasnoyarsk (18,9% vs 6,7%, р=0,031). Prevalence of incomplete SAVA syndrome (without the mandatory presence of HIV/AIDS) was 66,0% (95% CI=62,4–69,6%) the and majority of respondents (96,8%) had up to 4 SAVA components. There were no statistically significant differences in SAVA prevalence depending on gender. SAVA is relatively highly prevalent among IDU in participating cities and does not relate to respondents’ gender.