Correlates of Lifetime History of Purchasing Sex Services by Men in Saint Petersburg and Leningrad Oblast, Russia.

P Girchenko,R Kulchynska,D Bikmukhametov,S Dugin,L Gensburg,D C Ompad

doi:10.1007/s11524-015-9990-z

Abstract

Commercial sex workers (CSWs) in the Russian Federation are at high risk of HIV infection and transmission as a result of unsafe sexual and injecting behaviors. Their clients might be at increased risk of acquiring HIV; however, little is known about the population of men purchasing sex services. This study aims to investigate factors associated with a history of purchasing sex services by men in Saint Petersburg and Leningrad Oblast, Russian Federation. Data were collected as part of a cross-sectional study offering free anonymous rapid HIV testing in Saint Petersburg and Leningrad Oblast in 2014; in total, 3565 men aged 18 years and older provided information about their behaviors associated with risk of acquiring HIV during face-to-face interviews. Prevalence of CSW use in our study was 23.9 %. Multivariable analyses using log-binomial regression were stratified by self-reported HIV testing during the 12 months preceding the study interview. In both strata, older age, multiple sex partners, and a history of sex with an injection drug user (IDU) were associated with an elevated prevalence ratio (PR) for history of purchasing sex services, although the strength of the association differed by strata. Among men who reported recent HIV testing, condom use (PR = 1.22, 90 % confidence interval (CI) 1.0, 1.48) was associated with a history of purchasing sex services, and among men who did not report recent HIV testing, having a consistent sex partner was associated with purchasing sex services (PR = 1.23, 90 % CI 1.1, 1.37). The high prevalence of CSW service use and associations found in this study raise serious concerns about potential for sexual HIV transmission and should be investigated more closely.

Highlights

IntroductionThe HIV epidemic in the Russian Federation is one of the fastest-growing HIV epidemics worldwide.[1,2,3] Injection drug use has been a major driver since the Girchenko, Kulchynska, and Gensburg are with the Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Room 131, Rensselaer, NY 12144-3456, USA; Girchenko and Kulchynska are with the New York State International Training and Research Program, New York, NY, USA; Ompad is with the Global Institute of Public Health, New York University, New York, NY, USA; Ompad is with the Center for Drug Use and HIV Research, New York University, New York, NY, USA; Ompad is with the Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA; Bikmukhametov is with the Department of Internal Medicine #1, Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Neubrandenburg, Germany; Dugin is with the Fund for Social and Medical Programs Humanitarian Action, Saint Petersburg, Russian Federation
As previous studies found sex work in Russia to be associated with injection drug use,[11,13,37] self-reported injection drug use and history of having sex with an injection drug user (IDU) categorized as yes/no were included in the list of potential covariates
The high prevalence of lifetime commercial sex workers (CSWs) services use among the men in our study, though not necessarily reflecting the prevalence of paying for sex among the general population of men in Saint Petersburg and Leningrad oblast, is concerning

Summary

Introduction

The HIV epidemic in the Russian Federation is one of the fastest-growing HIV epidemics worldwide.[1,2,3] Injection drug use has been a major driver since the Girchenko, Kulchynska, and Gensburg are with the Department of Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York, One University Place, Room 131, Rensselaer, NY 12144-3456, USA; Girchenko and Kulchynska are with the New York State International Training and Research Program, New York, NY, USA; Ompad is with the Global Institute of Public Health, New York University, New York, NY, USA; Ompad is with the Center for Drug Use and HIV Research, New York University, New York, NY, USA; Ompad is with the Center for Health, Identity, Behavior, and Prevention Studies, New York University, New York, NY, USA; Bikmukhametov is with the Department of Internal Medicine #1, Dietrich-Bonhoeffer-Klinikum Neubrandenburg, Neubrandenburg, Germany; Dugin is with the Fund for Social and Medical Programs Humanitarian Action, Saint Petersburg, Russian Federation. With regard to sexual HIV transmission, commercial sex workers (CSWs) represent a population highly vulnerable to HIV infection.[9,10] In addition, sex workers in the Russian Federation are at elevated risk of injection drug use,[11] which places them at higher risk for HIV because of multiple possible routes for HIV acquisition and transmission.[12,13,14] men who use CSW services are at increased risk of HIV infection and represent potential Bbridges^ for HIV transmission from the vulnerable population of sex workers to the general population.[15,16,17]

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