Yelena Rozental

Couple-Based HIV Prevention for Injecting Drug Users in Kazakhstan: A Pilot Intervention Study

This pilot randomized controlled trial in Kazakhstan aimed to adapt and test the feasibility of a couple-based HIV/STI risk-reduction intervention (CHSR) for couples who are injecting drug users (IDUs). The study examined the preliminary effects of the intervention versus an attentional control wellness promotion (WP) condition on HIV risk behavioral outcomes among 40 couples who are IDUs (n = 80 participants). Compared with WP participants, CHSR participants were significantly more likely to increase condom use and decrease unsafe injection acts at the 3-month follow-up. This pilot trial demonstrates the feasibility and preliminary effects of the CHSR in reducing drug-related and sexual HIV risks.

Effects of a couple-based intervention to reduce risks for HIV HCV and STIs among drug-involved heterosexual couples in Kazakhstan: a randomized controlled trial.

Objective:Project Renaissance is a randomized controlled trial of an HIV/hepatitis C virus (HCV)/sexually transmitted infection (STI) prevention intervention conducted in Almaty, Kazakhstan. We hypothesized that couples assigned to the intervention of interest will have lower incidence of HIV, HCV, STIs, rates of unprotected sex, and unsafe injection over the 12-month follow-up period compared with those assigned to an attention control arm. Design:A total of 300 couples (600 participants) where one or both partners reported injecting drugs in the past 90 days were randomized to 1 of 2 arms: (1) a 5-session HIV/HCV/STI prevention intervention (risk reduction: RR) or (2) a 5-session Wellness Promotion (WP) intervention. Results:Over the 12-month follow-up period, assignment to RR compared with WP significantly lowered the incidence of HCV infection by 69% [incidence rate ratios (IRR) = 0.31, 95% (CI) confidence interval: 0.10 to 0.90, P = 0.031]. Although differences were not statistically significant, RR participants had a lower incidence of HIV infection by 51% (IRR = 0.49, 95% CI: 0.16 to 1.48, P = 0.204) and any STI by 37% (IRR = 0.63, 95% CI: 0.21 to 1.93, P = 0.418) than WP participants. RR participants reported significantly fewer numbers of unprotected vaginal sex acts with their study partners (IRR = 0.58, 95% CI: 0.36 to 0.93, P = 0.024) and more consistent condom use (odds ratios = 2.30, 95% CI: 1.33 to 4.00, P = 0.003) over the entire follow-up period compared with WP participants. Conclusions:Project Renaissance demonstrated a significant effect for biological and behavioral endpoints. Findings draw attention to an HIV/HCV/STI prevention intervention strategy that can be scaled up for drug-involved couples in harm reduction programs, drug treatment, and criminal justice settings.

HIV risks among injecting and non-injecting female partners of men who inject drugs in Almaty, Kazakhstan: Implications for HIV prevention, research, and policy

BACKGROUND Kazakhstan and other countries in Central Asia are experiencing a rapidly growing HIV epidemic, which has historically been driven by injection drug use, but is more recently being fueled by heterosexual transmission. METHODS This paper examines HIV and HCV infection, as well as sexual and drug-related risks among female partners of men who inject drugs (MWID), comparing females who inject drugs (FWID) to non-injecting female partners on socio-demographic, relationship context, and structural characteristics. RESULTS The prevalence rate of HIV was 30.1% among FWID and 10.4% among non-IDU female partners of MWID. The prevalence rate of HCV was 89.8% among FWID and 14.8% among female non-IDUs. Less than one-fifth of all female participants had access to HIV education and services or harm reduction programs. Although high rates of non-injection drug use and sexual risk behaviors were found among both FWID and non-injecting female partners of MWID, we found that FWID were more likely to be HIV seropositive (aRR=3.03; 95% CI=1.78, 5.18) and HCV seropositive than non-IDU females (aRR=6.05; 95% CI=4.05, 9.04), were more likely to have used alcohol or drugs before sex (aRR=1.67; 95% CI=1.40, 2.00), and were more likely to have used sedatives, barbiturates, tranquilizers, sleeping pills, or painkillers that were not prescribed by a physician (aRR=17.45; 95% CI=8.01, 38.01). CONCLUSION Given the spread of the HIV epidemic to heterosexual partners in Kazakhstan, more attention is needed in research, prevention, and policies regarding female partners of male injection drug users.

Depression Among People Who Inject Drugs and Their Intimate Partners in Kazakhstan.

This paper examines individual, social, and structural factors associated with depression among 728 people who inject drugs (PWID) and their intimate partners in Kazakhstan, with separate multivariate models by gender. Depression scores were higher on average among participants of both genders who recently experienced sexual intimate partner violence, food insecurity, and who had lower levels of self-rated health. Among females, higher depression scores were associated with experiencing childhood sexual abuse, lower levels of social support, and not having children. Findings highlight a need to incorporate gender differences and factors associated with depression in designing mental health services for PWID in Kazakhstan.

Factors associated with self-rated health among migrant workers: results from a population-based cross-sectional study in Almaty, Kazakhstan

ObjectivesTo determine factors associated with SRH among migrant workers in Almaty, Kazakhstan.MethodsIn 2007, 805 vendors were screened. Approximately half were eligible (n =450), defined as at least 18 years old, a worker/owner in a randomly selected stall, having traveled 2 + hours outside of Almaty within the past year, and being an internal/external migrant. 28 non-migrants were excluded, leaving 422 participants. Logistic regression was used to examine the relationship between SRH, mental health, and psychosocial problems.ResultsApproximately 46% reported having poor or fair SRH. Clinical depression (OR 0.859, 95% CI 0.342–2.154), alcohol problems (OR 1.169, 95% CI 0.527–2.593), and legal status (OR 0.995, 95% CI 0.806–1.229) were not significantly associated with SRH, nor was exposure to interpersonal violence among women (OR 1.554, 95% CI 0.703–3.435). After adjusting for key variables, only ethnicity and social support were found to be significantly protective against poor or fair SRH.ConclusionsSRH was not a comprehensive health measure for these Central Asian migrant workers. More specific questions are needed to identify mental illness and interpersonal violence.

Partner notification among HCV-positive couples who inject drugs

Abstract Background: This study examines predictors of partner notification (PN) confirmed by a test counselor among people who inject drugs (PWID) and their sexual partners in Kazakhstan. Methods: We used baseline data from an HIV couple-based intervention study, restricting the sample to couples where both partners knew they were hepatitis C virus (HCV)-positive prior to participation in the study (N = 136 individuals). Cross-tabulation and logistic regression were used to examine predictors of PN, including socio-demographic characteristics, sexual and drug risk behaviors, and access to health services. Results: Of the sample, 68 (50%) participants notified their partners of their HCV status. PN was associated with participation in a needle/syringe exchange program and sexually transmitted infection counseling or education in the past 6 months. In the adjusted model, concurrent HIV infection (OR = 2.4, p < 0.05), having more than one sexual partner (OR = 2.5, p < 0.05), and participation in a needle exchange program (OR = 4.3, p < 0.01) were positively associated with notifying ones partner. Conclusions: The findings from this study emphasize the importance of service access among PWID and point to the need for additional research on HCV counseling and notification strategies as a component of health services for injection drug users.

HIV testing and access to HIV medical care among people who inject drugs and their intimate partners in Kazakhstan

Abstract Background: Growing rates of HIV and high rates of injection drug use in Kazakhstan call for examining access to testing and treatment among people who inject drugs and their intimate partners. Objectives: We examine how access to health and drug treatment services as well as risk environment factors are associated with ever being tested for HIV and ever receiving any general HIV medical care among 728 male and female intimate partners, where at least one partner injects drugs. Methods: Multivariate random effects logistic regression with random effects for couple were conducted to examine associations between access to health and drug treatment services, risk environment factors, and HIV testing and HIV medical care outcomes. Results: Analyses indicate that accessing needle exchange services and having a regular physician were associated with access to both HIV testing and HIV medical care. Receiving drug treatment was associated with accessing HIV testing but not HIV medical care. Being arrested and charged with a criminal offense was also associated with accessing HIV testing but not HIV medical care. Conclusions/Importance: Study findings highlight the need for increased scale-up of HIV testing efforts, as well as integrated HIV treatment and care in Kazakhstan.

HCV among Male Injection Drug Users and their Female Partners in Almaty, Kazakhstan: Implications for HCV Treatment and Prevention

HCV infection is a serious concern among people who inject drugs. Despite imposing a major disease burden in countries with high rates of injection drug use such as Kazakhstan, other Central Asian and East Asian countries, Eastern Europe, and Russia, HCV remains an understudied issue. This study includes 728 individuals (364 couples) from Almaty, Kazakhstan, where at least one member of the dyad reported recent injection drug use. Participants were recruited to participate in a couple-based HIV prevention study. We examine the prevalence of HCV and co-infections between HCV and HIV, correlates of HCV, and the association between HCV prevalence and sexual behaviors after adjusting for non-injection illicit drug use, unsafe injection behaviors, and socio-demographic characteristics. Of the total sample, 90.2% of people who had ever injected drugs were diagnosed HCV positive and 15.5% of those who did not report injecting drugs were HCV positive. The prevalence of HIV and HCV co-infection among the total sample was 20.7%. In the multivariate analysis, having sex while high on alcohol and/or drugs was associated with HCV after adjusting for unsafe injection practices, non-injection drug use, and socio-demographic characteristics (PR=1.20; 95% CI=1.04, 1.39). The high rates of HCV and co-infection of HIV and HCV found in the study underscore the need for attention to HCV testing and treatment among people who inject drugs in Kazakhstan and their sex partners. Keywords: HCV, Injection drug use, Central Asia, HIV, Kazakhstan.