Effective responses to the HIV epidemic in St. Petersburg and elsewhere in Russia require methods that support both individual and collective traits that increase access to HIV treatment and adherence to ART. Structural elements in the Russian Federation have produced substantial barriers to epidemic control. Supplies of antiretroviral medications are insufficient to meet population needs to the point that treatment has to be at least temporarily halted for many patients . Opioid agonist therapy, which increases ART adherence among PWID, remains illegal in Russia. For many years, active drug use was a disqualification for receiving ART. Although the prohibition has been softened, transitioning along the HIV care continuum that achieve viral suppression remains the exception.
Previous work, including ours demonstrated a strong link between high levels of stigma around both HIV and injection drug use as well as low levels of HIV care engagement for PWID in St. Petersburg. Although <10% of HIV+ PWID were receiving antiretroviral medications, some HIV+ PWID do successfully negotiate an HIV care system that has not encouraged their participation ). Efforts to increase the proportion of HIV+ PWID who achieve viral suppression is key to epidemic control. Successful programs to achieve this must overcome the multiple stigmas experienced by HIV+ PWID. Eliminating societal stigmas is not practical in the short term, since these are culturally embedded and long-standing. Instead, we focus on increasing a range of coping skills that build resilience in the face of stigma – increasingly termed "stigma resilience". Identifying malleable elements of stigma resilience would serve as the basis for interventions to improve HIV treatment outcomes.
We are proposing to build on past collaborations with researchers at SPbSU who have been working with the affected population, including HIV+ PWID, for nearly twenty years. Their connections with harm reduction organization, HIV patient groups, and both HIV/AIDS and substance use treatment providers makes them ideal partners for this project. Their past efforts at interventions demonstrate their ability to undertake studies to reduce the impact of HIV. With the added expertise from the Yale School of Nursing, we will explore elements of the HIV care delivery system to identify elements of stigma resilience that can influence the ways in which HIV+ PWID interact with staff at HIV treatment clinics in St. Petersburg.
The research we are currently proposing – the development and validation of a culturally appropriate stigma resilience scale – is an essential step in a larger research program. We seek funds through the Hecht grant to undertake preliminary research leading to the submission an R01 to implement and test an intervention directed at enhancing stigma resilience among PWID in several Russian cities. The goal is. We anticipate an intervention project in several Russian cities. The goal is to expand HIV treatment access for PWID, since transmission of HIV from PWID remains the force of HIV infection throughout Russia.
Although there have been quite a few studies exploring stigma affecting PWID and HIV+ individuals in Russia and elsewhere in the countries of the former Soviet Union, the issue of stigma resilience remains unexplored. No attempts to increase resilience as a way to improve HIV treatment outcome has been explored in populations of HIV+ PWID in countries where the HIV epidemic is driven by transmission among PWID. In fact, we know of only one study to date looking at stigma resilience in PWID populations and there is nothing on this topic from Eastern Europe.
Stigma has been shown to act together with PTSD to produce negative outcomes in many different stressor-exposed population and for many different health conditions including HIV and drug use disorders. However, these relationships have yet to be explored in populations in Eastern Europe.