Division of Infectious Diseases and Global Public Health, Department of Medicine, University of California San Diego, 9500 Gilman Drive, Mail Code 0507, La Jolla, CA, 92093-0507, USA.
AIDS Foundation-East West in the Kyrgyz Republic, Bishkek, Kyrgyzstan.
Harm Reduct J. 2022 May 25;19(1):53. doi: 10.1186/s12954-022-00633-5.
In Kyrgyzstan and other Eastern European and Central Asian countries, injection drug use and HIV-related intersectional stigma undermines HIV prevention efforts, fueling a rapidly expanding HIV epidemic. The Kyrgyzstan InterSectional Stigma (KISS) Injection Drug Use Cohort is the first study designed to assess the impact of drug use, methadone maintenance treatment (MMT) and HIV stigma experiences among people who inject drugs (PWID) on HIV prevention service utilization.
Adult PWID were recruited from Bishkek city and the surrounding rural Chuy Oblast region in northern Kyrgyzstan via modified time location sampling and snowball sampling. All participants completed a baseline rapid HIV test and interviewer-administered survey. A subsample of participants were prospectively followed for three months and surveyed to establish retention rates for future work in the region. Internal reliability of three parallel stigma measures (drug use, MMT, HIV) was evaluated. Descriptive statistics characterize baseline experiences across these three stigma types and HIV prevention service utilization, and assess differences in these experiences by urbanicity.
The KISS cohort (N = 279, 50.5% Bishkek, 49.5% Chuy Oblast) was mostly male (75.3%), ethnically Russian (53.8%), median age was 40 years old (IQR 35-46). Of the 204 eligible participants, 84.9% were surveyed at month 3. At baseline, 23.6% had a seropositive rapid HIV test. HIV prevention service utilization did not differ by urbanicity. Overall, we found 65.9% ever utilized syringe service programs in the past 6 months, 8.2% were utilizing MMT, and 60.8% met HIV testing guidelines. No participants reported PrEP use, but 18.5% had heard of PrEP. On average participants reported moderate levels of drug use (mean [M] = 3.25; α = 0.80), MMT (M = 3.24; α = 0.80), and HIV stigma (M = 2.94; α = 0.80). Anticipated drug use stigma from healthcare workers and internalized drug use stigma were significantly higher among PWID from Bishkek (p < 0.05), while internalized HIV stigma among PWID living with HIV was significantly greater among PWID from Chuy Oblast (p = 0.03).
The KISS cohort documents moderate levels of HIV-related intersectional stigma and suboptimal engagement in HIV prevention services among PWID in Kyrgyzstan. Future work will aim identify priority stigma reduction intervention targets to optimize HIV prevention efforts in the region.
在吉尔吉斯斯坦和其他东欧和中亚国家，注射吸毒和与艾滋病毒相关的交叉歧视破坏了艾滋病毒预防工作，导致艾滋病毒迅速蔓延。吉尔吉斯斯坦交叉歧视（KISS）注射吸毒者队列是第一项旨在评估吸毒、美沙酮维持治疗（MMT）和艾滋病毒污名经验对注射吸毒者（PWID）艾滋病毒预防服务利用影响的研究。
通过改良的时间地点抽样和滚雪球抽样，从吉尔吉斯斯坦比什凯克市和北部楚河州的周边农村地区招募成年 PWID。所有参与者都完成了基线快速艾滋病毒检测和访谈者管理的调查。一部分参与者进行了为期三个月的前瞻性随访，并进行了调查，以确定该地区未来工作的保留率。评估了三种平行污名测量方法（吸毒、MMT、HIV）的内部可靠性。描述性统计数据描述了这三种污名类型和艾滋病毒预防服务利用的基线经验，并评估了这些经验在城市之间的差异。
KISS 队列（N=279，50.5%比什凯克，49.5%楚河州）主要为男性（75.3%），俄罗斯族（53.8%），平均年龄为 40 岁（IQR 35-46）。在 204 名符合条件的参与者中，84.9%在第 3 个月接受了调查。在基线时，23.6%的人快速艾滋病毒检测呈阳性。城市间的艾滋病毒预防服务利用没有差异。总体而言，我们发现过去 6 个月内有 65.9%的人曾使用过注射器服务项目，8.2%的人正在接受美沙酮维持治疗，60.8%的人符合艾滋病毒检测指南。没有参与者报告使用 PrEP，但 18.5%的人听说过 PrEP。平均而言，参与者报告了中等程度的吸毒（平均[M]=3.25；α=0.80）、美沙酮（M=3.24；α=0.80）和艾滋病毒污名（M=2.94；α=0.80）。来自比什凯克的 PWID 预期的医护人员吸毒污名和内化的吸毒污名明显更高（p<0.05），而与艾滋病毒共存的 PWID 内化的艾滋病毒污名在楚河州的 PWID 中明显更高（p=0.03）。
KISS 队列记录了吉尔吉斯斯坦 PWID 中与艾滋病毒相关的交叉歧视的中等程度和艾滋病毒预防服务参与度不理想。未来的工作将旨在确定优先减少污名的干预目标，以优化该地区的艾滋病毒预防工作。
