The HIV epidemic in Russia has occurred within the past 10 years and now includes an estimated 1 million people. Russia also has one of the highest levels of per capita alcohol consumption. Thus far, the HIV epidemic in Russia has been primarily propelled by injection drug users (IDUs). However, the risk for viral transmission beyond drug users, as previously observed in other countries when this epidemic progresses, looms large. Many HIV-infected persons with alcohol problems take part in risky sex and drug related behaviors. Thus alcohol use may accelerate HIV transmission to the general population in Russia. The objective of this proposal, HERMITAGE, HIV's Evolution in Russia - Mitigating Infection Transmission and Alcoholism in a Growing Epidemic, is to test in a randomized controlled trial the effectiveness of a USHIV secondary prevention program, Healthy Relationships Intervention, among HIV-infected patients with risky drinking in a Russian infectious disease hospital. The intervention will be culturally adapted and modified to address substance use and associated risk behaviors. The study will randomize 300 HIV-infected patients with risky alcohol consumption to an adapted Healthy Relationships Intervention (HRI) or attention-control support groups. Subjects participating in the HRI will attend 5, 2-hour structured group sessions in addition to 2, 1-hour individualized sessions. Subjects participating in the attention-control group will be exposed to support groups during the same timeframe. All patients will be assessed at baseline, 6, and 12-months post- randomization. Primary outcomes are HIV sex- and drug risk behaviors, sexually transmitted diseases, and alcohol consumption. Additionally, subjects will be assessedregarding secondary outcomes including addiction severity and disclosure of HIV serostatus. We hypothesize that relative to controls, participants receiving the Healthy Relationships Intervention will reduce HIV sex- and drug risk behaviors, STDs and alcohol consumption. If the intervention is effective among HIV-infected hospitalized patients, it could be used to address other HIV infected persons in a variety of Russian settings potentially reducing the transmission of HIV by decreasing risky sex- and drug-usebehaviors.
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