Stemming Russia’s HIV Epidemic

Clean Syringes Often Unavailable in St. Petersburg, YSPH Research Finds

Russia’s HIV epidemic is among the fastest growing in the world and injection drug users who often share needles and other supplies are hardest hit. This occurs even though pharmacies are a legal source for clean syringes and can sell them without restriction.

A recent study led by the Yale School of Public Health and St. Petersburg State University mapped the city’s 965 pharmacies and compared their locations and density to HIV prevalence at the district level.

While an association between pharmacy location and HIV rates was not identified, the researchers discovered that many pharmacies did not offer syringes for sale, have them in stock, or outright refused to sell them. The researchers visited all of the pharmacies in two of the city’s districts. The study results were published recently in BMC Public Health.

Robert Heimer PhD, MSc. Professor of Epidemiology (Microbial Diseases) and of Pharmacology; Director, Emerging Infections Program. Image credit: Yale University

Robert Heimer PhD, MSc. Professor of Epidemiology (Microbial Diseases) and of Pharmacology; Director, Emerging Infections Program. Image credit: Yale University

“The HIV epidemic, especially among people who inject drugs, is as much a disease of social structures as it is a disease transmitted by individual behaviors.  When syringes are unavailable because of prejudice against drug users, the users are likely to resort to risky practices such as sharing syringes, which can result in the transmission of HIV and other blood-borne pathogens.  As a first step in HIV prevention, interventions directed toward reducing syringe-borne transmission, we sought to understand the extent of the problem of lack of syringe access through pharmacies,” said Robert Heimer, a professor in the Department of Epidemiology of Microbial Diseases who has been involved in AIDS-related research since the 1980s. “Our next step is to use data we collected from pharmacists and from people who inject drugs to develop and implement effective interventions that build on pharmacists’ desire to be seen as actor in the public health sector.” 

Heimer and several colleagues from the School of Public Health are part of an international team seeking to understand how political and cultural factors may be blocking syringe access in foreign and domestic locations and how these obstacles might be overcome in order to address a rapidly growing public health crisis. 

The study found that about one-third of the pharmacies canvassed in St. Petersburg refused to sell syringes. The finding suggests that policy changes are in needed that encourage pharmacies to stock syringes for sale. Interventions may also be needed to reduce the stigma of drug use and to make pharmacists more aware of the public health implications of clean syringes. Pharmacies are primary source of syringes for injection drug users because there are few needle exchange programs in St Petersburg, and those that do exist are small and underfunded, Heimer said. 

The HIV epidemic in St. Petersburg and many other parts of Russia is severe. The epidemic arrived in the late 1990s and is concentrated among people who inject drugs such as heroin. Within St. Petersburg alone, a city of some five million people, there are an estimated 80,000 people who inject drugs, half of whom are HIV-positive and who can pass the virus onto other drug users and to their sex partners.

St. Petersburg is not unique; throughout Russia there are an estimated 1.2 million people infected with HIV, the vast majority of whom inject drugs.  Unsafe injection practices, primarily due to the lack of clean syringes, are a major factor in the transmission of the virus. 

“Our Russian colleagues know that working with pharmacists and St. Petersburg city officials to promote the use of pharmacies for expanded syringe access is clearly needed,” Heimer said. “But intervention development also needs to be undertaken carefully to overcome the stigma experienced by people who inject drugs and to convince pharmacists and officials that the health benefits will outweigh the social costs.” 

– By Michael Greenwood

*Source: Yale University

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