risk factors impacting on the spread of hiv among pregnant women ...

RISK FACTORS IMPACTING ON THE SPREAD OF HIV AMONG PREGNANT WOMEN IN THE RUSSIAN FEDERATION
SUMMARY
Key concepts: human immunodeficiency virus (HIV), epidemic, <strong>risk</strong> groups, <strong>risk</strong>s, behavioural studies,
sentinel surveillance, injecting drug users, sex workers (SW), pregnant women.
This work focuses on HIV epidemics among women in five HIV high prevalence areas of the Russian
Federation (RF) (St Petersburg, Kaliningrad, Yekaterinburg, Irkutsk, and Tver).
The survey’s target group consisted of HIV-positive pregnant women first registered as HIV-positive in
July 2004 – July 2006. The total sample size was 758 persons. Participation in the survey was voluntary
and anonymous. The completed questionnaires were statistically processed. The basic survey was a
specially developed standardized questionnaire aimed at investigating behavioural <strong>risk</strong>s among women
before and after HIV diagnosis. A total of 111 questions formed the survey’s indicators.
The investigation of socio-demographic and behavioural characteristics showed that the surveyed
sample can be classed in terms of HIV infection as a high-<strong>risk</strong> (IDUs, SWs, IDUs selling sexual services,
sexual partners of HIV-positive persons) or low-<strong>risk</strong> group (IDUs’ sexual partners, persons
engaging in sexual contacts with non-regular partners, SW’s sexual partners). It was found that
female vulnerability to HIV varied geographically: while in Saint Petersburg, Yekaterinburg and
Kaliningrad HIV <strong>risk</strong>s were largely present in the behaviour of women at the moment of the diagnosis,
in Irkutsk and Tver, a much lower number of women reported practicing <strong>risk</strong> behaviours. In all
the cities, many of the respondents’ partners represented high and low-<strong>risk</strong> groups.
Women tended to suggest that they had been infected sexually. In addition, women that were on
remission at the time of the diagnosis often did not think it necessary to report past drug use experience.
This may have had an impact on the objectiveness of HIV transmission route assessment at primary
epidemiological history collection. Some correlation between the subjective assessment of
transmission route and behavioural <strong>risk</strong> <strong>factors</strong> was only present in the Saint Petersburg cohort (every
fourth respondent regarded drug use as the cause of her infection). There is a link between generative
behaviour and behavioural HIV <strong>risk</strong>s. Thus the proportion of planned pregnancies as well as the number
of patients forgoing antenatal care was reliably low in Kaliningrad and Saint Petersburg. In Saint
Petersburg, up to one half of the HIV cases in women were not diagnosed till delivery.
After HIV diagnosis, the total number of respondent’s sexual partners droped, while condom use
could either increase or decrease. Much smaller number of women reported practicing drug injection:
by two times in Irkutsk and Kaliningrad, by three times in Saint Petersburg and Tver and by
seven times in Yekaterinburg. However, no significant changes in injecting equipment use could be
identified.
The analysis showed that the involvement of the social environment of high-<strong>risk</strong> groups in the epidemic
occurs at different paces. As the epidemiological assessment of the stages of the HIV epidemic
is based on the evaluation of behaviours both in <strong>risk</strong> groups and within the general population, it is
advisable to monitor the behaviours of the general population in the cities studied.
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