Double jeopardy--drug and sex risks among Russian women who inject drugs: initial feasibility and efficacy results of a small randomized controlled trial

Women (N = 100) were randomized into one of two one-hour long intervention conditions--the Woman-Focused intervention (n = 51) or a time and attention-matched Nutrition control condition (n = 49).The results showed that 57% of the participants had been told that they were HIV-positive. At 3-month follow-up, both groups showed reduced levels of injecting frequency. However, participants in the Woman-Focused intervention reported, on average, a lower frequency of partner impairment at last sex act and a lower average number of unprotected vaginal sex acts with their main sex partner than the Nutrition condition.The findings suggest that improvements in sexual risk reduction are possible for these at-risk women and that more comprehensive treatment is needed to address HIV and drug risks in this vulnerable population.Russia is an emerging epicenter of the global HIV epidemic [1], accounting for 66% of all newly registered HIV cases in Eastern Europe and Eurasia [2]. The geographical nexus of Russia's HIV epidemic is St. Petersburg, with an HIV prevalence rate of 30-47% among injecting drug users (IDUs) [3]. Additionally, 80-90% of the HIV cases in St. Petersburg are associated with IDUs, many of whom are unaware of their HIV status [4-6]. Further, HIV morbidity is reported to be highest among IDUs in St. Petersburg [7].In earlier studies, Russian women in general and female IDUs in particular appeared to be at high risk of HIV, but HIV prevalence among them was relatively low [8,9]. However, between 1996 and 2006, the number of HIV-infected women increased rapidly from 29% to 44% [2,9]. In St. Petersburg, HIV prevalence among female IDUs was estimated to be 20% [10]. Consequently, there is a critical need to address the HIV risks of female IDUs [11-13].Because of the multifaceted risks women face, they are at high risk for contracting and spreading HIV. For example, sharing contaminated injecting equipment and sexual transmission are the main causes of HIV infection fo