MED Grant Tackles AIDS in Russia

Russia’s HIV epidemic is growing with alarming speed, fueled largely by the country’s rising drug use and traditionally high rate of alcohol consumption, according to Jeffrey Samet, a professor of medicine and public health at the Boston University School of Medicine and chief of general internal medicine at Boston Medical Center.

To reduce risky sex- and drug-related behaviors among HIV patients with alcohol problems, the National Institutes of Health (NIH) has awarded Samet a grant of more than $3.1 million. Working with Russian researchers, Samet and BMC colleagues will study the effectiveness of an HIV-prevention intervention in St. Petersburg.

“The amounts they drink in Russia are greater than here in the States,” says Samet. “That’s pretty clear. And what we call risky drinking here is not necessarily perceived as excessive drinking or putting anybody at risk.”

The scope of the problem can seem daunting when put in perspective — the World Bank estimates that more than one million Russians suffer from HIV, among a population of 144 million. By comparison, according to the Centers for Disease Control and Prevention, about a million Americans have HIV — out of a population of 300 million.

“AIDS/HIV is about to hit Russia’s population in a big way,” says Walter Connor, a College of Arts and Sciences professor of political science, sociology, and international relations. “While demographic estimates vary, the most pessimistic projections make room for declines on the order of 30 million or so over the next four decades. These are losses of an order that generally require a war to produce.”

With the NIH grant, BU investigators and researchers from Pavlov State Medical University in St. Petersburg will implement and assess strategies that have been successful in the United States, but are not typical in Russia, such as educating patients about the dangers and counseling them to reduce their alcohol consumption and other risky behaviors.

The study also may have broader, global implications. “The World Health Organization looks at countries around the world for per capita alcohol consumption, and South Africa and Russia are at the top of the heap,” Samet says. “The fact that South Africa has a lot of HIV as well makes this alcohol-HIV issue of interest internationally.”

The scale of alcohol consumption in Russia is hard for Westerners to imagine.

“Alcohol-related problems are as serious –– or more so –– in Russia today as in the Soviet years,” says Connor. “From long-term pathologies which are a big factor in making male life expectancy disgracefully low for an industrialized country, at around 59 years, to rates of death from acute alcohol poisoning and drunkenness-related accidents, Russia is a world leader.”

Additionally, a sharp increase in heroin use over the past decade has contributed to the increase in HIV cases because of shared needles. “In 1997,” says Samet, “there was no HIV among this whole population. Essentially, it wasn’t there.” According to a previous study conducted by Samet and Russian collaborators, the percent of drug- and alcohol-dependent people with the disease that year was zero. By 2001, 33.4 percent of the drug-dependent were infected (1.2 percent of the drinkers who didn’t also use heroin were infected).

And the infection may spread to the rest of the population. “The few [drug users] that may be men having sex with men have a hard time ever admitting it,” says Samet. “There’s a huge stigma around that in Russia.”
 
Samet is excited about the grant, called HIV’s Evolution in Russia — Mitigating Infection Transmission and Alcoholism in a Growing Epidemic, and “grateful for the opportunity to work with outstanding Russian colleagues,” he says. The two groups will meet twice a year and conduct business via teleconferencing and e-mail. “They are much better than we are — they speak English quite well. We have really crappy Russian,” he says with a laugh.

The other researchers on the study are Anita Raj, an associate professor of social and behavioral sciences in the School of Public Health, Debbie Cheng, an associate professor of biostatistics in SPH, and Tibor Palfai, an associate professor of psychology in the College of Arts and Sciences.

Patrick Kennedy can be reached at plk@bu.edu.