Abstract
Introduction. Described at the beginning of HIV epidemics in the USA syndrome (or syndemia) of substance abuse, violence and AIDS (SAVA) still continue to be an important risk factor for HIV-infection acquisition. The goal of this study was to analyze association between SAVA and STI and also new cases of HIV infection among IDU in six cities in Russian Federation. Materials and methods. Analysis is based on the data from bio-behavioral survey conducted in six Russian cities with help of respondent-driven sampling. Results. It was found no statistically significant association between SAVA and STI after correction for sampling, but without correction STI prevalence in group without SAVA was 4.1% and in group with SAVA and binge drinking – 9,2% (р=0.04). Stratified analysis showed that it is impossible to combine data from males and females and in case of separate analysis statistically significant association between SAVA and STI exists in females (р=0,027). Analysis with adjustment for interview site, gender and age SAVA with binge drinking significantly elevates STI risk (OR=2.69 [95%CI=1.21... 5.99], р=0.016). Study of association between SAVA components and new cases of HIV found that experience of physical and/or sexual violence combined with binge drinking increase risk of HIV acquisition (adjusted for interview site, gender, age, needle/syringe sharing, education and sex work OR=4.03 [95%CI=1.19...13.69], р=0.026). Experience of physical and/or sexual violence combined with binge drinking was significantly associated with such HIV risk factors as needle and syringe sharing (OR=3.07 [95%CI=1.02...9.24], p=0.046) and sex work (OR=17.29 [95%CI=3.83...77.96], p<0.001). Conclusion. SAVA existence should be taken into account when planning preventive measures in Russian Federation and existing programs of comprehensive prevention should have components designed to decrease consequences of syndemia.
Highlights
Described at the beginning of HIV epidemics in the USA syndrome of substance abuse, violence and AIDS (SAVA) still continue to be an important risk factor for HIV-infection acquisition
Stratified analysis showed that it is impossible to combine data from males and females and in case of separate analysis statistically significant association between SAVA and STI exists in females (р=0,027)
Study of association between SAVA components and new cases of HIV found that experience of physical and/or sexual violence combined with binge drinking increase risk of HIV acquisition
Summary
Методология формирования выборки и особенности исследования детально описаны ранее [6,7]. Существуют данные о том, что в рамках синдрома SAVA с риском насилия больше связано употребление кокаина и алкоголя [9], поэтому дополнительно был рассчитан и учтен в анализе влияния на распространенность ИППП показатель SAVA, который в определение включал частое (еженедельное или ежедневное) ударное употребление алкоголя (более 6 алкогольных доз или 80 мл чистого спирта за раз). При анализе влияния на частоту новых случаев синдрома SAVA использовать информацию о результатах тестирования на ВИЧ-инфекцию было нельзя, поэтому использовались компоненты полного синдрома SAVA без информации о наличии ВИЧ-инфекции, неполный SAVA и компоненты полного SAVA в сочетании с информацией о частом ударном потреблении алкоголя. Соответственно, популяционные оценки рассчитывались при помощи процедур, предназначенных для анализа сложных выборочных планов (PROC SURVEYFREQ, SURVEYLOGISTIC) системы SAS с указанием в качестве весового коэффициента величины, обратной размеру сети знакомых и кластерной переменной в виде цепочки респондентов, связанных с респондентами первой волны. Результаты унивариантного анализа всех показателей синдрома SAVA представлены в таблице 1
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