Background: The Russian HIV-1 epidemic has been driven by injection drug use. Objective: To determine HIV incidence and identify demographic and behavioral correlates of infection to facilitate the development of longitudinal HIV prevention programs. Methods: In 2002, a cohort of 520 injection drug users (IDU) in St Petersburg, Russia were recruited and tested and counseled for HIV-1. HIV-seronegative IDU were enrolled and reevaluated at 6 and 12 months. HIV testing was performed and sociodemographic and behavioral data were collected during each study visit. The relationship of sociodemographic and behavioral factors to HIV-1 incidence was assessed. Results: Most enrolled subjects were young, male, living at home, educated, heroin users, and frequently shared needles and other injection paraphernalia. The retention rate at the 12 month follow-up was 80%. The HIV-1 incidence rate was 4.5/100 person-years. In univariate analysis, psychostimulant use, especially frequent use, three or more sex partners in the past 6 months, and females selling sex were associated with HIV seroconversion. In the multivariate analysis, psychostimulant use three or more times per week was the only factor still associated with HIV seroconversion. Conclusions: The high incidence of HIV infection places St Petersburg among the worst IDU-concentrated epidemics in Europe. Interventions targeting psychostimulant and heroin users and their accompanying behaviors such as frequent injections and increased sexual activity are needed immediately.

We examined how the presence of an interpreter during an interview affects eliciting information and cues to deceit, while using a method that encourages interviewees to provide more detail (model statement, MS). A total of 199 Hispanic, Korean and Russian participants were interviewed either in their own native language without an interpreter, or through an interpreter. Interviewees either lied or told the truth about a trip they made during the last twelve months. Half of the participants listened to a MS at the beginning of the interview. The dependent variables were 'detail', 'complications', 'common knowledge details', 'self-handicapping strategies' and 'ratio of complications'. In the MS-absent condition, the interviews resulted in less detail when an interpreter was present than when an interpreter was absent. In the MS-present condition, the interviews resulted in a similar amount of detail in the interpreter present and absent conditions. Truthful statements included more complications and fewer common knowledge details and self-handicapping strategies than deceptive statements, and the ratio of complications was higher for truth tellers than liars. The MS strengthened these results, whereas an interpreter had no effect on these results.

Introduction: The HIV/AIDS epidemic in St Petersburg, as in much of Russia, is concentrated among injection drug users (IDU) in whom prevalence reached 30% in 2003. Understanding the dynamics of the epidemic is important in developing appropriate responses in the resource-constrained context of Russian cities such as St Petersburg. Methods: IDU were contacted and screened to create a seronegative cohort for prevention and vaccine studies. At screening, individuals provided sociodemographic, drug use, and injection and sex-related risk behavior data. Seronegative individuals who enrolled in the cohort were followed for one year and tested for HIV semiannually. Residential addresses were entered into a geographical information system programme and analysed for spatial clustering using Moran's I and nearest-neighbor analysis. Results: We mapped 788 of the 900 study participants to discrete locations within St Petersburg; 236 (29.9%) were HIV seropositive at baseline. Although there was no clustering of the study population as a whole, HIV-infected individuals were tightly clustered and prevalence co-clustered with high frequency of heroin injection, receptive syringe sharing, being younger than 24 years, and living with parents. These clusters were restricted to 5% of populated areas of the city. We mapped 18 of 20 incident cases detected among the cohort, and more than half were located within or adjacent to the clusters. Interpretation: Spatial analysis identified linkages between disease prevalence and risky injection behaviors that were not evident using traditional epidemiological analysis. The analysis also identified where resources might be allocated geographically for maximum impact in slowing the HIV epidemic among IDU.