Estimates of HIV incidence among drug users in St. Petersburg, Russia: continued growth of a rapidly expanding epidemic

Abstract

Background: Russia has one of the world’s fastest growing HIV epidemics and it has been largely concentrated among injection drug users (IDU). St Petersburg, Russia’s second largest city, is one of the country’s regions that has been most affected by the HIV epidemic. To monitor the current epidemic situation, we sought to estimate recent HIV incidence among IDU in St Petersburg. Methods: In a cross-sectional study of 691 IDU recruited during 2005–08, HIV incidence was estimated by two methods: a retrospective cohort analysis and BED capture enzyme immunoassay (EIA) results. Socio-demographic and behavioural correlates of incident infections and spatial patterns were examined. Results: In the retrospective cohort analysis, the incidence rate was estimated to be 14.1/100 person-years [95% confidence interval (CI) 10.7–17.6]. Using results of BED EIA and two correction formulas for known misclassification, incidence estimates were 23.9 (95% CI 17.8–30.1) and 25.5 (95% CI 18.9–32.0) per 100 person-years. Independent correlates of being recently infected included current unemployment (P = 0.004) and not having injected drugs in the past 30 days (P = 0.03). HIV incident cases were detected in all but one district in the city, with focal areas of transmission observed to be expanding. Conclusions: High HIV incidence among IDU in St Petersburg attests to continued growth of the epidemic. The need for expansion of HIV prevention interventions targeted to vulnerable populations throughout the city is urgent. These results also suggest that the BED EIA may over-estimate incidence even after correction for low specificity.

HIV infection among persons who inject drugs

“…There have been many examples of very rapid spread of the virus in PWID populations. HIV incidence rates greater than 10/100 person-years (PY) have been reported in New York [10], Bangkok [11], Manipur India [12], Vancouver Canada [13] and areas in China [14, 15], Estonia [16] and Russia [17]. A number of factors have been associated with very rapid transmission of HIV among PWID (see Table 1).…”

Estimating hidden population size using Respondent-Driven Sampling data

“…Because they are based on multiple captures, to date, all methods that use RDS data require additional data collected by mechanisms other than RDS (Bernard et al, 2010; Johnston et al, 2011; Niccolai et al, 2010; Salganik et al, 2011). …”

Internalized HIV and Drug Stigmas: Interacting Forces Threatening Health Status and Health Service Utilization Among People with HIV Who Inject Drugs in St. Petersburg, Russia

“…HIV has been a rapidly growing epidemic in the St. Petersburg community of people who inject drugs throughout the first part of this century [3–6], with prevalence plateauing at approximately 60 % only in the past three to 4 years [7]. Understanding factors that contribute to declines in health status and combating barriers to health service utilization among people with HIV who inject drugs are important for maximizing the wellbeing of this group and potentially stemming transmission to others.…”