Stigma, serostatus disclosure, coping strategies, and the role of social capital resources among HIV care-nonadherent MSM in Russia: a qualitative analysis.

The HIV epidemic continues to expand in Russia, with suboptimal levels of care uptake. This qualitative study aimed to characterize social capital resources and lived stigma experiences, coping, and disclosure among care-nonadherent men who have sex with men (MSM) living with HIV in Russia. Twenty-five HIV-positive MSM - recruited online - completed in-depth interviews over Zoom, with data analyzed using MAXQDA software. Stigma was more likely to be encountered in interactions with persons with whom social ties were weaker such as medical providers and relatives, particularly males. Close friends - often other HIV-positive MSM and female relatives - were the most supportive and least stigmatizing. Similar persons were most often considered for HIV serostatus disclosure. Coping strategies to reduce the impact of stigma included ignoring stigmatizing experiences, seeking support from members of one's social circle, minimizing contact with stigmatizing persons, seeking new relationships with persons who are also HIV-positive, proactively reducing stigma through involvement in advocacy roles, and correcting myths and educating others about HIV infection. These findings underscore the need for interventions to assist HIV-positive MSM in building accepting social capital resources to reduce the impact of stigma and to build support within their social networks, often with other HIV-positive MSM.

HIV Testing Patterns Among Recently Self-Tested Russian Men Who Have Sex With Men: A Qualitative Study.

ABSTRACT: Most qualitative research to date on HIV self-testing (HIVST) has been devoted to questions related to perceptions of HIVST among various groups of men who have sex with men (MSM) in different countries. However, little is known about HIV testing patterns of HIVST testers. Thrity-two Russian MSM, 10 with HIV and 22 without, from five cities were interviewed about their HIV testing and risk behaviors. Five types of testers "maintenance testers," "risk-based testers," "convenience testers," "test avoiders," and "HIVST-only testers" were identified in the study. Three dimensions of HIV testing patterns-testing motive, frequency, and mode-were proposed to improve existing typifications. Almost all informants practiced condomless sex with their primary partners; HIV testing or condom negotiation in primary partnerships before proceeding to condomless sex was rare. Increase in HIVST availability at no cost for MSM and targeted prevention efforts for MSM on both individual and dyadic level are urgently needed.

A New Generation of Drug Users in St. Petersburg, Russia? HIV, HCV, and Overdose Risks in a Mixed-Methods Pilot Study of Young Hard Drug Users.

Russia has a widespread injection drug use epidemic with high prevalence of HIV and HCV among people who inject drugs (PWID). We conducted a mixed methods study of young (age 18-26) hard drug users in St. Petersburg. Thirty-nine structured and 10 semi-structured interviews were conducted. No HIV cases and two HCV cases were detected among the PWID subsample (n = 29). Amphetamine and other stimulants were common (70%), opioid use was rare and episodic. Consistent condom use was 10%. No PWID reported syringe-sharing, 51% reported other drug paraphernalia sharing. Most (89%) never or rarely communicated with older (30 +) opiate users. A new cohort of drug users in St. Petersburg may have emerged, which is much safer in its injection practices compared to previous cohorts. However, risky sexual practices among this new cohort may expose them to the possibility of sexual transmission of HIV and widespread drug paraphernalia sharing to the HCV epidemic.

Barriers and Facilitators of HIV Care Engagement: Results of a Qualitative Study in St. Petersburg, Russia.

Russia has a large HIV epidemic, but medical care engagement is low. Eighty HIV-positive persons in St. Petersburg completed in-depth interviews to identify barriers and facilitators of medical HIV care engagement. The most commonly-reported barriers involved difficulties accessing care providers, dissatisfaction with the quality of services, and negative attitudes of provider staff. Other barriers included not having illness symptoms, life stresses, low value placed on health, internalized stigma and wanting to hide one's HIV status, fears of learning about one's true health status, and substance abuse. Care facilitators were feeling responsible for one's health and one's family, care-related support from other HIV-positive persons, and the onset of health decline and fear of death. Substance use remission facilitated care engagement, as did good communication from providers and trust in one's doctor. Interventions are needed in Russia to address HIV care infrastructural barriers and integrate HIV, substance abuse, care, and psychosocial services.

Effects of a social network HIV/STD prevention intervention for MSM in Russia and Hungary: a randomized controlled trial.

OBJECTIVE: To test a novel social network HIV risk-reduction intervention for MSM in Russia and Hungary, where same-sex behavior is stigmatized and men may best be reached through their social network connections. DESIGN: A two-arm trial with 18 sociocentric networks of MSM randomized to the social network intervention or standard HIV/STD testing/counseling. SETTING: St. Petersburg, Russia and Budapest, Hungary. PARTICIPANTS: Eighteen 'seeds' from community venues invited the participation of their MSM friends who, in turn, invited their own MSM friends into the study, a process that continued outward until eighteen three-ring sociocentric networks (mean size = 35 members, n = 626) were recruited. INTERVENTION: Empirically identified network leaders were trained and guided to convey HIV prevention advice to other network members. MAIN OUTCOME AND MEASURES: Changes in sexual behavior from baseline to 3-month and 12-month follow-up, with composite HIV/STD incidence, measured at 12 months to corroborate behavior changes. RESULTS: There were significant reductions between baseline, first follow-up, and second follow-up in the intervention versus comparison arm for proportion of men engaging in any unprotected anal intercourse (UAI) (P = 0.04); UAI with a nonmain partner (P = 0.04); and UAI with multiple partners (P = 0.002). The mean percentage of unprotected anal intercourse acts significantly declined (P = 0.001), as well as the mean number of UAI acts among men who initially had multiple partners (P = 0.05). Biological HIV/STD incidence was 15% in comparison condition networks and 9% in intervention condition networks. CONCLUSION: Even where same-sex behavior is stigmatized, it is possible to reach MSM and deliver HIV prevention through their social networks.

Using social network methods to reach out-of-care or ART-nonadherent HIV+ injection drug users in Russia: addressing a gap in the treatment cascade.

INTRODUCTION: HIV treatment to reduce downstream HIV incidence and to decrease disease mortality and morbidity at a population level both require that hidden, out-of-care people living with HIV (PLH) in the community be reached and engaged to enter care. This research evaluated the feasibility of reaching out-of-care or non-adherent PLH through members of their social networks in St Petersburg, Russia. MATERIALS AND METHODS: To recruit a social network sample of HIV-positive injection drug users, 16 HIV+ seeds were enrolled into the study through PLH-oriented websites and online forums using recruitment ads or approached in needle exchange sites. Interested persons called the study phone number and completed a brief eligibility interview. Seed inclusion criteria were HIV+ status, being 18 years or older, having ever injected drugs, and having not visited an HIV doctor in the past 6 months. Seeds provided blood specimens tested for HIV to confirm their self-reported status. Eligible seeds were enrolled, completed brief network elicitation interview, and were asked to invite their own HIV+ friends into the study. Incentives were provided as compensation for participants' time and additional smaller incentives were provided for inviting each HIV+ network member to also participate. The seed's PLH friends established the first ring of participants who, in turn were asked to invite their own PLH friends (second ring). All study participants completed assessment of psychosocial wellbeing and sexual and injection-related HIV risk behaviour. Blood samples were collected from all participants to confirm their HIV+ status. RESULTS: Through this chain referral process, the initial 16 seeds led to the enrolment of a total of 66 PLH from the community (mean=4 per initial seed), most of whom - like the seed - were not presently in HIV care or were ART non-adherent. CONCLUSIONS: Implementation of treatment cascade goals requires complementing conventional paths of identifying PLH with feasible and effective community-based approaches such as described in this study. This research establishes that PLH are connected in their day-to-day social networks with other HIV+ persons and shows that social network methods can be employed to reach infected persons through their connections with other PLH. This method has the potential to expand the reach of medical care efforts and ART uptake.

Stigma reduces and social support increases engagement in medical care among persons with HIV infection in St. Petersburg, Russia.

INTRODUCTION: The proportion of people living with HIV (PLH) in care and on antiretroviral therapy (ART) in Russia is lower than in Sub-Saharan Africa (1). This is undoubtedly due to a variety of systems and structural issues related to poor treatment access, linkage and care delivery models. However, little research has explored the reasons that PLH are not in care from their own perspectives. This information can help to guide the development of approaches for improving HIV care engagement in the country. MATERIALS AND METHODS: In-depth interviews were undertaken with 80 PLH in St. Petersburg who had never been in HIV medical care, had previously been out of care, or had always been in care. Participants were recruited through online PLH forums and Websites, outreach needle exchange and non-government organisation (NGO) programs, and chain referral. The interviews elicited detailed information about participants' experiences and circumstances responsible for being out of care, and factors contributing to nonretention in HIV treatment. Verbatim transcriptions of the interviews were coded and analyzed using MAXQDA software to identify emerging themes. RESULTS: Two types of care engagement barriers most often emerged. Some related to medical services, and others to the family and social environment. The most frequent medical service barriers were poor treatment infrastructure conditions and access; dissatisfaction with quality of services and medical staff; and concerns over confidentiality and HIV status disclosure. Social barriers were fears of potential harm to family relationships, negative consequences if status became known at work, and public stigmatization and myths associated having an HIV+ status. Social support from the PLH community and from family and close friends facilitated care engagement, as did motivation to take care of oneself and one's family. Most participants also described circumstances in which engaging into HIV care was brought about by an urgent issue (opportunistic infections) or was enforced through hospitalization or imprisonment. Trust in one's doctor and simply not wanting to die were also common motives. CONCLUSIONS: Stigma was a major barrier to care engagement, including fear that others would learn of one's HIV+ status, whether at work, in one's family, or in the general community. By contrast, support from family, friends and the PLH community contributed to care engagement.