Complexities of reducing HIV rates in Russia

Decreasing HIV transmission among Russian HIV-infected drinkers will require creative and innovative approaches, results of a new study conducted in St. Petersburg, Russia, show. While new HIV infections globally have declined, HIV rates remain high in Russia. This is due in large part to injection drug use and spread via heterosexual sex transmission.Results of a new study conducted in St. Petersburg, Russia, show that decreasing HIV transmission among Russian HIV-infected drinkers will require creative and innovative approaches.

While new HIV infections globally have declined, HIV rates remain high in Russia. This is due in large part to injection drug use and spread via heterosexual sex transmission. Alcohol use also has been shown to be related to risky sexual behaviors and sexually transmitted infections (STIs).

The study showed that a behavioral intervention did not lead to a reduction of STIs and HIV risk behaviors in Russian HIV-infected heavy drinkers when compared to the control group. This study was led by researchers from Boston University School of Medicine (BUSM), Boston Medical Center (BMC) and First St. Petersburg Pavlov State Medical University, Russia.

In this study, the researchers adapted a Centers for Disease Control and Prevention-best evidence risk reduction intervention for a Russian clinical setting and assessed its ability to reduce STIs and HIV risk behaviors among 700 HIV-infected heavy drinkers. The intervention stressed disclosure of HIV serostatus and condom use in two individual sessions and three small group sessions. Participants had a laboratory test at a 12-month follow up appointment to determine if they had contracted STIs. They also answered questions about risky behaviors, including unprotected sex, drinking alcohol or injecting drugs.

At the 12-month follow-up assessment, STIs occurred in 20 subjects (8 percent) in the intervention group and 28 subjects (12 percent) in the control group. Both groups, however, reported having decreased their participation in risky behaviors.

"Addressing prevention of HIV transmission from HIV-infected Russian drinkers, a group at particularly high risk for disease transmission, requires creative approaches and aggressive uptake of antiretroviral therapy," said Jeffrey Samet, MD, MA, MPH, professor of medicine at BUSM and chief of the section of general internal medicine at Boston Medical Center. "This study shows that we need to explore other options to help stem the growing epidemic.".

Women living with HIV benefit from 'expressive therapy' intervention

New research from UC San Francisco shows that an "expressive therapy" group intervention conducted by The Medea Project helps women living with HIV disclose their health status and improves their social support, self-efficacy and the safety and quality of their relationships.

"Medication alone is totally insufficient," said the study's first author, Edward L. Machtinger, MD, director of the Women's HIV Program at UCSF. "Over 90 percent of our patients are on effective antiretroviral therapy but far too many are dying from suicide, addiction, and violence. Depression, addiction, and especially trauma are very common and often devastating for women living with HIV but are not being effectively addressed by most clinics. We believe that helping women develop the skills and confidence to tell their stories publicly will reduce their isolation and be the first step towards their becoming genuinely healthy. We partnered with The Medea Project to deliver an effective expressive therapy intervention that starts to address the primary causes of death in our patients."

The Medea Project was founded in 1989 by Rhodessa Jones as a group performance intervention to empower incarcerated women to improve their lives and reduce recidivism. Jones adapted the program to help women living with HIV. The process consists of a series of intensive workshops that culminate in a theatrical performance.

The Medea Project's method focuses on storytelling as a means of healing and empowerment. The storytelling includes talking about and processing other stigmatizing and traumatic experiences in a group setting with the support of other women. In the case of the study, the process included specific prompts given to the women asking how they found out they were HIV-positive and whom they had told about their HIV status. The burden of secrecy was relieved and self-identity could be recast in a more positive light. Then, through public performance, participants felt the power that their stories could have on others and gained both an appreciation for their lives and a desire to unleash their newly found "voices" to change the social conditions that create HIV risk, stigma and trauma.

In the study, eight HIV-positive women and seven HIV-negative women from Medea's core group formed the final performance group that culminated in a professional theatrical run of eight shows seen by more than 1,000 people. None of the HIV-positive participants had publically disclosed their HIV status prior to the study; all disclosed their status during the performances.

"Eddy Machtinger challenged me to take women living with HIV and apply the processes I had used for over two decades with incarcerated women to get them to open up and talk about living with HIV. Sharing is an important process in creating the play and violence is what they talked about the most," said study co-author Rhodessa Jones, director of The Medea Project. "Our data revealed five core themes that described the impact of the intervention on the participants' lives: sisterhood, catharsis, self-acceptance, safer and healthier relationships and gaining a voice.

Importantly, half of the participants reported leaving or avoiding unhealthy or unsafe relationships, a significant impact since we know women living with HIV experience high rates of intimate partner violence," said Machtinger. "Integrating this type of intervention into the primary care of women living with HIV is the first step towards transforming primary care from treatment to actual healing," he said.