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HIV in the Russian Federation 

HIV in Russia

Knowledge for Action in STDs / HIV /AIDS in the Russian Federation

Start Date:  1998     End Date:  2006      Status: Completed

Background: 

Over the past 2 decades the Russian Federation experienced major epidemics of infectious diseases associated with transmission through sex or drug use. From the low point in 1988, more than 80 fold rises in annual syphilis notifications had been observed by 1998, with incidence rates among younger women reaching more than 3% in some regions. These syphilis epidemics point to more widespread epidemics of STIs in the population. Although these now appear to have stabilised, incidence remains high.

After the first case of HIV was registered in the Russian Federation in 1987 incidence remained low and stable until the mid 1990s with a cumulative total of 726 cases registered  to  the end of 1993. From 1995 onwards the number of new cases began to increase sharply from 1,086 in 1995, to 6,959 in 1997, to 178, 857 in 2001. By 2006 305,805 people were  registered as living with HIV in the Russian Federation, and the majority of cases were associated with injecting drug use (IDU). Thus HIV is concentrated among injecting drug  users although Russian Health Authorities argue that heterosexual spread has been  increasing in recent years.

There is a substantial overlap between sex worker and IDU populations (6), giving rise to the possibility of large epidemics of sexually transmitted HIV infections; especially against the  background of high prevalence of HIV transmission enhancing STI infections. Russia has the  second largest prison population in the world and a very high turnover (9). A large proportion  of the prison population are IDUs and this, coupled with the high turnover of the population  and severe overcrowding, leads to a high potential for HIV transmission within prisons.

Between 1998 and 2007 Prof Adrian Renton led a collaborative research programme, funded by the UK Department for International Development (DFID) as part of its wider programme to support Russian Authorities and civil society in responding to the epidemic of HIV/AIDS.

The programme was implemented through genuine partnerships between the UK and Russia based teams and between multiple governmental and non-governmental stakeholders. The key focus of the programme was on building local capacities for research and on developing sustainable links between policy-makers, clinicians, sociologists, epidemiologists and community workers.

Aims:

  • estimating prevalence of HIV, Hepatitis C and syphilis among community-recruited samples of injecting drug-users;
  • estimating the prevalence of drug use using a capture-recapture method;
  • characterisation of injecting risk environments and factors that increase risks of contracting HIV and hepatitis C by injecting drug- users;
  • identification of barriers for implementing effective HIV control programmes including drug treatment; harm reduction for IDUs; sex education in schools; and antiretroviral treatment programmes;
  • development of a mathematical model, which is being used by Russian policy-makers and practitioners to forecast the development of the HIV epidemic;
  • characterisation of socio-economic characteristics of injecting drug-users and sex workers as compared to the general population;
  • delivery of population-based studies, which explored the spread of injecting and sexual risks in the general population;
  • characterisation of attitudes towards HIV/AIDS and people living with HIV/AIDS among policy-makers and the general public;
  • estimation of the impact of AIDS on firms and private sector enterprises;
  • estimation of costs and evaluation of cost-effectiveness of HIV/AIDS interventions in the Russian context

Methods:

Initial studies on syphilis epidemics and drug injecting were followed between 2002 and 2006 by a programme including fifteen primary studies, which focused on behavioural, epidemiological, economic and political aspects of HIV/AIDS in Russia.
The research for the first time systematically linked data on risk behaviour, HIV epidemiology, economics and policy environment and allowed a more coherent and comprehensive understanding of both the Russian HIV epidemic and response.

Main Findings:

  • Please see Peer Reviewed Publications below

Impact:

Objective evidence was produced through a comprehensive research programme which

  • Provided evidence of the scale of Russian syphilis and HIV epidemics leading to major international investment is supporting Russian response.
  • Provided evidence of the very poor performance of Russian STI diagnostics which directly led to abandonment of use of these tests, introduction of better tests and probably the prevention of millions of cases of tubal infertility in young women.
  • Challenged stereotypes and preconceptions about HIV  epidemics and the people who are affected by them, and assumptions about the views and perceptions of different constituencies including policy makers and the general public. Overcoming these stereotypes and abandoning misconceptions helped to make delivery of needed interventions more politically feasible.
  • Provided information on possible trajectories of HIV epidemics based on models grounded in locally estimated behavioural patterns clarified planning and intervention  prioritization.allowing Russian partners to develop commensurate response.
  • Provided knowledge of health system barriers to implementation of effective interventions allowed the development of strategies to overcome these.
  • Delivered detailed characterization of patterns of behaviour which drive HIV epidemics informed  the design and fine tuning of preventive interventions
  • Knowledge of the source quantity and disposition of resources available, and currently being brought to bear on the problem of HIIV/AIDS supported Russian partners reallocating them in a more cost effective way.

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Report:

The final report outlining the key findings was produced in Russian and English at the end of October 2006. In the same year the UK DFID commissioned IHHD an additional project to develop eight policy briefs advocating the key recommendations and targeting national and international policy-makers. These policy briefs were produced in Russian only.

Peer Reviewed Publications

  1. Tichanova L, Borisenko K, Ward H, Meheus A, Gromyko A, Renton A. "Epidemics of syphilis in the Russian Federation: trends, origins and  priorities  for control". Lancet 350, (1997), 210-213.
  2. Renton AM, Borisenko KK, Meheus A, Gromyko A. " Epidemics of syphilis in the newly independent states of the former Soviet Union ". Sex. Transm. Infect. 74, (1998), 165-6.
  3. Renton AM, Riedner G, Gromyko A. " Epidemics of Syphilis in the Newly Independent States". Eurohealth. 3, (1997), 15-17.
  4. Renton AM, Borisenko KK. "Epidemic syphilis  in Russia". Curr. Opin. Inf Dis. 11, (1998), 53-56.
  5. Тэйлор Д Робинсон, Рентон А. "Какие Тесты для диагностики инфекций передаваемых половым путем, cледует использовать в индустриально развитых странах". ЗППП. 5, (1998), 23-26.
  6. Renton AM Borisenko KK, Tichonova LI, Akovbian VA. "Control of sexually transmitted disease: a comparison of the UK and the Russian Federation". Int J STD and AIDS. 10, (1999), 659-664.
  7. Borisenko KK, Tichonova, LI, Renton AM. "Syphilis and other sexually transmitted Diseases in the Russian Federation". International Journal of STD and AIDS. 10, (1999), 665-668.
  8. Rhodes T, Ball A, Stimson GV, Kobushka Y, Fitch C, Pokrovsky V, Bezruchenko-Novachuk M, Burrows D, Andrushchak A, Renton A. "HIV infection associated with drug injecting in the Newly Independent States, eastern Europe: the social and economic context of epidemics". Addiction.  94, (1999), 1323-1336
  9. Рентон АМ, Борисенко КК, Тихонова ЛИ, Аковбян ВА. "Контроль и лечение заболеваний передаваемых половым путем, в Великобритании и в Российской Федерации - сходство и различие ".  ЗППП. 5, (1999), 27-34
  10. A. Renton, A .A. Kubanova, V. A. Akovbian, L. I. Tikhonova, E. N. Filatova. Public health approaches to the control of sexually transmitted diseases. Инфекции Передаваемые Половым Путем (Sexually Transmitted Infections) 2000;5:30-34
  11. I.G. Shakurov, E.N. Filatova, A .A. Bykov, J.S. Pevzner, A. Renton, F. Hutchinson, L. I. Tikhonova, M. V. Tuz. STI/HIV prevention activities in the Samara region. Proposals developed within the framework of the joint project of Russia and the Great Britain. Инфекции Передаваемые Половым Путем (Sexually Transmitted Infections) 2000;5:50-56.
  12. Filatova EN, Akovbian VG, Dmitriev G, Tichonova LI, Renton AM. Cultural methods for the diagnosis of gonorrhoea in women of reproductive age. Sexually transmitted infections Инфекции Передаваемые Половым Путем (Sexually Transmitted Infections) 2002;4:64-72
  13. Tim Rhodes, Catherine Lowndes, Ali Judd, Larissa A. Mikhailova, Anya Sarang, Andrey Rylkov, Mikhail Tichonov, Kim Lewis, Nina Ulyanova, Tatiana Alpatova, Victor Karavashkin, Mikhail Khutorskoy, Matthew Hickman, John V. Parry, and Adrian Renton Explosive spread and high prevalence of HIV infection among injecting drug users in Togliatti City, Russian Federation: Implications for HIV prevention. AIDS 2002: 16 F25-F31
  14. Grassly, N. C., Lowndes, C., Rhodes, T., Judd, A., Renton, A., Garnett, G. (2003) Modelling emerging HIV epidemics: the role of injecting drug use and sexual transmission in the Russian Federation, China and India, International Journal of Drug Policy, 14: 25-34
  15. Lowndes, C., Renton, A., Alary, M., Rhodes, T., Stimson, G. V. (2003) Conditions for widespread heterosexual spread of HIV in the Russian Federation: implications for research, monitoring and prevention, International Journal of Drug Policy, 14: 45-62.
  16. Rhodes, T., Mikhailova, L., Sarang, A., Lowndes, C., Rylkov, A., Khutorskoy, M., Renton, A. (2003) Situational factors associated with drug injecting, risk reduction and syringe exchange practices in Togliatti City, Russian Federation: a qualitative study of micro risk environment, Social Science and Medicine 2004;57:39-54.
  17. Rhodes, T., Judd, A., Mikhailova, L., Sarang, A., Khutorskoy, M., Platt, L. et al (2004) Injecting equipment sharing among injecting drug users in Togliatti City, Russia: Maximising the protective effects of syringe distribution, Journal of Acquired Immune Deficiency Syndromes;  35:293-300.
  18. Filatova EN, Dmitriev GA, Akovbian VA, Ison K, Renton A, Vakhina TE, Kolikova TG. Role of Biological Provocation in laboratory diagnostics of gonorrhoea. (RCT). Clinical Dermatology and Venereology (2004);1;95-99.
  19. Rhodes, T., Sarang, A., Bobrik, A., Bobkov, E., Platt, L. HIV transmission and HIV prevention associated with injecting drug use in the Russian Federation, International Journal of Drug Policy, 2004;15: 1-16.
  20. Platt, L., Hickman, M., Rhodes, T., Mikhailova, L., Karavashkin, V. et al (2004) The prevalence of injecting drug use in a Russian city: implications for harm reduction and coverage, Addiction 2004;99:1430-1438.
  21. Joana Godinho, Nedim Jaganjac, Dorothee Eckertz, Adrian Renton, Thomas Novotny, and Lisa Garbus.  HIV/AIDS in the Western Balkans: Priorities for Early Prevention in a  High-Risk Environment. World Bank Working Paper. Washington: World Bank 2005.
  22. Joana Godinho, Adrian Renton, Viatcheslav Vonogradov, Thomas Novotny, Mary-Jane Rivers. Working Paper 54: Reversing the Tide: Priorities for HI/AIDS Prevention in Central Asia.  World Bank Working Paper. Washington: World Bank 2005.
  23. Tim Rhodes Lucy Platt, Svetlana Maximova, Evgeniya Koshkina, Natalia Latshevskaya,  Matthew Hickman, Adrian Renton,  Natalia Bobrova,  Tamara McDonald,  John V Parry Prevalence of HIV, hepatitis C and syphilis among injecting drug users in Russia: Multi-city study. Addiction 2006;101:252-266.
  24. Adrian Renton; David Gzirishvilli; George Gotsadze; Joana Godinho. Epidemics of HIV and sexually transmitted infections in Central Asia. Trends, drivers and priorities for control.  Int J Drug Pol 2006;17:493-503.
  25. Platt L, Wall M, Rhodes T, Judd A, Hickman M, Johnston LG, Renton A, Bobrova N, Sarang A. Methods to recruit hard-to-reach groups: comparing two chain referral sampling methods of recruiting injecting drug users across nine studies in Russia and Estonia. J Urban Health. 2006 Nov;83(6 Suppl):i39-53.
  26. Wall M, Tkatchenko-Schmidt E, Renton A.  Sexual behaviour in Russia: who exhibits a higher risk? Evidence from longitudinal data. Int J STD AIDS. 2006 Nov;17(11):759-63
  27. Lucy Platt, Tim Rhodes, Ali Judd, Evgeniya Koshkina, Svetlana Maksimova, Natalia Latishevskaya, Tamara McDonald,  John V Parry, Adrian Renton. Effects of Sex Work on the Prevalence of Syphilis Among Injection Drug Users in 3 Russian Cities. Am J Pub Hlth 2007;97: 478-485.
  28. Tkatchenko-Schmidt E, Renton A, Gevorgyan R, Davydenko L, Atun R. Prevention of HIV/AIDS among injecting drug users in Russia: opportunities and barriers to scaling-up of harm reduction programmes. Health Policy. 2008 Feb;85(2):162-71. Epub 2007 Sep 4.
  29. Adrian Renton, Ekaterina Filatova, Catherine Ison, Andre Meheus, George Dmitriev, Vagan Akovbian Performance of  direct fluorescent antibody tests for routine diagnosis of Chlamydia trachomatis in Russian Sexually Transmitted Disease clinics. Int J STD AIDS 2008;19:851-855.
  30. Adrian Renton, Ekaterina Filatova, Catherine Ison, Andre Meheus, George Dmitriev, Vagan Akovbian. A trial of the validity of genital smears and cultures with gonococcal vaccine provocation in diagnosing genital gonorrhoea in women. Int J STD AIDS 2009;20:24-29.
  31. Taylor-Robinson, D, Renton, A, Jensen, J S, Ison, C A, Filatova, E, Dmitriev, G, Akovbian, V (2009). Association of Mycoplasma genitalium with acute non-gonococcal urethritis in Russian men: a comparison with gonococcal and chlamydial urethritis. Int J STD AIDS 20: 234-237.
  32. Elena Tkatchenko-Schmidt, Rifat Atun, Martin Wall, Patrick Tobi, Jürgen Schmidt, Adrian Renton. "Why do health systems matter? Exploring links between health systems and HIV response: a case study from Russia". Health Policy Plan, 2010;25:283-291.
  33. Wall M, Schmidt E, Sarang A, et al, Sex, drugs and economic behaviour in Russia: A study of socio-economic characteristics of high risk populations., Int J Drug Policy, 2010 17(5):1023-9, ISSN:1873-4758(doi).
  34. Ruzanna Gevorgyan, Elena Schmidt, Martin Wall, Geoffrey Garnett, Rifat Atun, Svetlana Maksimova,Ludmila Davidenko & Adrian Renton. Does Russia need sex education? The views of stakeholders in three Russian regions. Sex Education 2011;11:213-226.

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Project Lead: 


Professor Adrian Renton

Project Team: Adrian Renton, Rifat Atun, Tim Rhodes Geoff Garnett, Patrick Tobi, Elena Tkatcheno-Schmidt, Martin Wall, Ruzanna Geogavan

Funder: UK Department for International Development.

Project Partners: Federal AIDS Centre, Russian Federation, National Institute of Sexually Transmitted Disease Research and Ministry of Health, Russian Federation.

For more information, contact: Adrian Renton a.renton@uel.ac.uk

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