Program discourages HIV transmission in Russia

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Researchers from Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) found that sexual behavior counseling during drug addiction treatment should be considered an important component among Russian substance-dependent individuals, in order to decrease risky sexual behavior in the HIV at-risk population. This study appears in the journal Addiction.

Russia has one of the fastest-growing acquired immune deficiency syndrome (AIDS) epidemics in the world. Mainly prevalent among injection drug users, HIV now is expanding into the general population via sexual transmission. According to research, alcohol use is highly pervasive in Russia, and has been associated with sexual HIV risk-taking behavior. According to lead author Jeffrey Samet, MD, chief of the Section of General Internal Medicine at BMC and BUSM, "a behavioral intervention to reduce unsafe sex is an essential component to HIV prevention, and is critical in the absence of a cure or vaccine."

Researchers compared the current method used to decrease unsafe sexual behavior with the Russian Partnership to Reduce the Epidemic Via Engagement in Narcology Treatment (PREVENT) intervention program. Participants were HIV-positive and negative, and were assigned to either the PREVENT program or the standard addiction treatment.

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PREVENT sessions occurred at the hospital and involved obtaining HIV test results, discussion of personal risk and creation of a behavioral change plan. Interventionists provided test results and explained the risk reduction plan to promote safe sex that included using condoms, building sexual-negotiation skills, developing positive attitudes regarding safe sex and emphasizing alcohol and drugs role in impairing judgment. After patients were discharged from the hospital, telephone updates took place for three months. Interventionists checked in and updated participants' personal long-term risk reduction goals and plans.

Participants assigned to the standard addiction treatment program received the usual addiction treatment at the hospital, including HIV testing, but no sexual behavior counseling. Those known to be HIV-infected or who tested positive received a 20-minute HIV post-test counseling session with the study interventionists. This session included creating risk reduction goals and a referral to an HIV care program. Subjects were contacted for study check ups, but not counseled. Both participants of the standard addiction treatment and PREVENT program received condoms upon leaving the hospital.

The researchers found that when comparing the two forms of intervention, participants of the PREVENT program had a higher percentage of safe sex than did the standard addiction participants at the six month follow-up visits. "Both control and intervention groups had improvements in the percentage of safe sex occurrences, restraining from unprotected sex and increasing condom use between baseline and the three month follow-up. While the intervention group maintained or improved their safe sex behaviors at the six month follow-up, the standard addiction treatment group worsened," said Samet.

The Russian PREVENT trial demonstrates that an HIV intervention program targeting the sexual behaviors of alcohol and drug users is feasible in inpatient substance abuse treatment settings, and is effective in increasing safe sex.

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