HIV Risks, Testing, and Treatment in the Former Soviet Union: Challenges and Future Directions in Research and Methodology

Abstract

BackgroundThe dissolution of the USSR resulted in independence for constituent republics but left them battling an unstable economic environment and healthcare. Increases in injection drug use, prostitution, and migration were all widespread responses to this transition and have contributed to the emergence of an HIV epidemic in the countries of former Soviet Union. Researchers have begun to identify the risks of HIV infection as well as the barriers to HIV testing and treatment in the former Soviet Union. Significant methodological challenges have arisen and need to be addressed. The objective of this review is to determine common threads in HIV research in the former Soviet Union and provide useful recommendations for future research studies.MethodsIn this systematic review of the literature, Pubmed was searched for English-language studies using the key search terms “HIV”, “AIDS”, “human immunodeficiency virus”, “acquired immune deficiency syndrome”, “Central Asia”, “Kazakhstan”, “Kyrgyzstan”, “Uzbekistan”, “Tajikistan”, “Turkmenistan”, “Russia”, “Ukraine”, “Armenia”, “Azerbaijan”, and “Georgia”. Studies were evaluated against eligibility criteria for inclusion.ResultsThirty-nine studies were identified across the two main topic areas of HIV risk and barriers to testing and treatment, themes subsequently referred to as “risk” and “barriers”. Study design was predominantly cross-sectional. The most frequently used sampling methods were peer-to-peer and non-probabilistic sampling. The most frequently reported risks were condom misuse, risky intercourse, and unsafe practices among injection drug users. Common barriers to testing included that testing was inconvenient, and that results would not remain confidential. Frequent barriers to treatment were based on a distrust in the treatment system.ConclusionThe findings of this review reveal methodological limitations that span the existing studies. Small sample size, cross-sectional design, and non-probabilistic sampling methods were frequently reported limitations. Future work is needed to examine barriers to testing and treatment as well as longitudinal studies on HIV risk over time in most-at-risk populations.

Uptake of HIV testing among women of reproductive age in Tajikistan: An assessment of individual determinants

“…Evidence suggests that HIV testing services are underutilized in the country and limited research explored this problem. 6,7 Considering that Tajikistan has been experiencing one of the fastest growing HIV epidemics in the world, there is an urgent need to study the factors that govern individual choice to seek HIV testing services. Therefore, the goal of this study was to address this need by examining individual determinants associated with HIV testing among women in Tajikistan.…”

Implementation of antiretroviral therapy (ART) in former Soviet Union countries

“…One of the major struggles to improving the coverage of these services in the FSU countries would be the predominance of a punitive approach towards people living with HIV and those who inject drugs [6]. A meta-analysis conducted by Saadat identified that the main challenges of HIV testing are HIV stigma, legal status of migrants, low access to testing locations, confidentiality issues, careless attitude towards own health, self-perception of HIV risk and lack of experience in sex work [7]. Overall, ART resistance in FSU countries has been recorded to range from 3.4% in Latvia to 8.3% in Georgia (Table 1).…”

Injection drug use, depression, and HIV screening in rural primary care settings: A retrospective cross-sectional study

“…5,6 HIV screening among PWID is critical for early initiation of ART, and regular engagement in HIV medical care is necessary to achieve viral suppression which is strongly associated with reduced HIV transmission. 11 Several barriers to HIV screening among PWID in several countries have been identified including poor access, 12 fear of disclosure of results, 12 distrust in the treatment system, 12 fear of positive results, 13 and fear of stigma and/or discrimination. 13 Given stigma has been associated with the development and exacerbation of mental illness, and mental illness has been linked to drug use, 14 it is essential to examine the associations between mental illness, injection use, and HIV screening.…”