Abstract
In Russia, up to half of premature deaths are attributed to hazardous drinking. The respective roles of alcohol and drug use in premature death among people with HIV in Russia have not been described. Criminalization and stigmatization of substance use in Russia may also contribute to mortality. We explored whether alcohol, drug use and risk environment factors are associated with short-term mortality in HIV-infected Russians who use substances. Secondary analyses were conducted using prospective data collected at baseline, 6 and 12-months from HIV-infected people who use substances recruited between 2007–2010 from addiction and HIV care settings in a single urban setting of St. Petersburg, Russia. We used Cox proportional hazards models to explore associations between 30-day alcohol hazardous drinking, injection drug use, polysubstance use and environmental risk exposures (i.e. past incarceration, police involvement, selling sex, and HIV stigma) with mortality. Among 700 participants, 59% were male and the mean age was 30 years. There were 40 deaths after a median follow-up of 12 months (crude mortality rate 5.9 per 100 person-years). In adjusted analyses, 30-day NIAAA hazardous drinking was significantly associated with mortality compared to no drinking [adjusted Hazard Ratio (aHR) 2.60, 95% Confidence Interval (CI): 1.24–5.44] but moderate drinking was not (aHR 0.95, 95% CI: 0.35–2.59). No other factors were significantly associated with mortality. The high rates of short-term mortality and the strong association with hazardous drinking suggest a need to integrate evidence-based alcohol interventions into treatment strategies for HIV-infected Russians.
Highlights
Russia has one of the largest HIV epidemics in the world, with almost 1 million people infected among a population of 144 million [1]
We focused on drug and alcohol use behaviors that are potentially modifiable through treatment and prevention, as well as factors that shape the risk environment, interactions with police and experiences of incarceration, stigma, and sex trade involvement
The mean age was 30 years, 59% were male, 15% were on antiretroviral therapy, the median time since HIV diagnosis was 4 years (IQR = 1–8 years), 42% reported recent use of injection drugs, and 60% fulfilled National Institute on Alcohol Abuse and Alcoholism (NIAAA) criteria for hazardous drinking in the prior 30 days (Table 2)
Summary
Russia has one of the largest HIV epidemics in the world, with almost 1 million people infected among a population of 144 million [1]. Reduced access to antiretroviral therapy and evidence-based interventions for people who inject drugs, needle syringe access programs and opioid agonist therapies with methadone and buprenorphine, perpetuate the transmission and ongoing high mortality in HIV-infected people in Russia [4,5,6]. In other settings, including North America, heavy drug use and homelessness, but not alcohol use, have been shown to be major predictors of all-cause mortality in HIV-infected people who use substances [10,11,12,13]. The respective roles of alcohol and drug use in premature death among people with HIV in Russia have not been described
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